6 Tips for Preventing Patellofemoral Pain Syndrome: AKA Runner’s Knee

It often starts as a dull ache or a “stiff” feeling in your knee. Occasionally, you may feel a strain or ache along the back of the knee or under the kneecap as well. This phenomenon is known as patellofemoral pain syndrome, or simply “runner’s knee.”

Don’t let the name fool you, though; patellofemoral pain syndrome affects many exercisers (and non-exercisers alike). That said, it is most prevalent among new runners who haven’t built up the thigh strength or have overdone it with their training when they begin.

So, how do you prevent this common complaint amongst new runners? First, it’s important to understand exactly what patellofemoral pain syndrome is and why it happens.


The pain from runner’s knee occurs for several reasons. In fact, the name “patellofemoral pain syndrome” simply means “pain under the kneecap.” Not all knee pain is indicative of runner’s knee, and other joint conditions and injuries also result in knee pain.

Patellofemoral pain syndrome isn’t typically accompanied by swelling. Often, runners report it doesn’t hurt as much during their exercise. The pain from runner’s knee is often worse after you finish running, when you go up and downstairs, or if you sit or lay with your legs folded in one position for a while.

Long periods of running may also lead to this type of pain, due to fatigue in the quad muscles. Once your quads tire, the patella (kneecap) must absorb the stress of the activity, leading to poor form and your patella moving “off-track.”

Your kneecap is a small triangular bone between the femur (thigh) and tibia (shin). The patella slides along a groove in the femur. Articular cartilage cushions the femur ends, the underside of the patella, and top of the tibia. Tendons hold and stabilize the kneecap.

Patellofemoral pain syndrome may result from an injury to the articular cartilage beneath the kneecap. Weak and poorly conditioned muscles and poor form lead to pelvic instability, which causes stress and strain on the knees. As the kneecap rubs against the femoral groove, pain occurs. Runner’s knee is often seen in runners who overpronate, meaning their foot rolls inward as they strike.

The good news about patellofemoral pain syndrome is it’s preventable and treatable. It typically doesn’t mean an end to running (although you may need to take time off to recover). It’s essential to consult with a doctor or physical therapist if you suspect runner’s knee. This will help you rule out any chronic knee conditions and ensure you’re engaging in the right therapeutic exercises to rehabilitate your knee.

If you’re suffering from knee pain, the Orthopaedic Hospital of Wisconsin has a team of highly trained physical therapists to help you determine the root cause of your discomfort. Give us a call to schedule a consultation, and we’ll get you back on the road to recovery.

In the meantime, do your best to prevent patellofemoral pain syndrome with the following precautions.


Supportive shoes make a huge difference in the impact of foot strike on your body and joints. As a beginning runner, you may not think it necessary to splurge on running shoes, but it’s well worth the investment.

Many running shoe stores will assess your gait and help you find shoes to fit your feet comfortably. Look for supportive, high-quality shoes (newbies may want to avoid “minimalist” type running shoes) and watch for wear and tear. If your shoes start to show signs of tread loss or lose their shape, it’s time to update. Most running shoes last about six months, depending on your mileage.

Crystal Toll, Physical Therapist at the Orthopaedic Hospital of Wisconsin agrees, explaining that “when dealing with knee pain, it is essential to evaluate footwear. I make sure the shoe is appropriate for the foot’s structure and double check that the shoe is not overly worn. Correcting any faults here is a must to get people on the path to running or jogging with comfort.”


Thigh muscle weakness is a significant cause of patellofemoral pain. Weakness in the thighs and glutes leads to pelvic instability, which causes extra strain and misalignment in your knees.

If you’re a cardio king or queen, you may need to supplement your workouts with strength training and resistance activities. Using a resistance band to do simple leg lifts will help you build muscle strength in your outer thighs and combat knee pain. One word of caution, however—add new activities to your workout regimen slowly. Overdoing it with sudden changes may exacerbate your soreness.

Toll adds, “Many times the cause of patellofemoral pain is due to weakness in the hip region. Stability exercises for this area is one that all runners should incorporate into their general strength routine.”


Your knees are greatly affected by your weight, absorbing much of the impact when you run. In studies, as little as a 10-15 pound weight loss in young adults proved to reduce osteoarthritis issues down the road.

Exercise is a literal step in the right direction, but you may need to adjust your diet as well if you’re looking to lose weight. New runners often report increased appetite, but overeating to compensate can derail your progress. Keep in mind a two-mile jog burns about 200 calories, or the equivalent to half an avocado, a 16 oz Coke, or about four Oreo cookies.


If you’re experiencing pain of any sort, it’s important to pay attention to the level, intensity, and possible cause. Listen to your body and the signals it sends your way. For example, some exercisers find that hard surfaces, like pavement, may exacerbate knee pain and discomfort. If this is the case, use lower impact surfaces and activities like the treadmill, water jogging, or even biking.

“Contact your physical therapist as soon as any troubles arise. Early on, there is typically less tissue involvement which helps with getting the body back on track sooner,” recommends Toll. She adds, “Working with a physical therapist that specializes in the treatment of runners is key. Such specialists are adept at identifying errors in form and training, and more importantly, will work with you to help you reach your goals.”

Similarly, your body needs rest and recovery, especially if you’re beginning a new exercise regime. Don’t push yourself to run every day or hit the gym each night after work. Start slow—every other day, or three days per week—and build up to more frequent workouts. Keep your mileage in check as well.


Warmups, cooldowns, and regular hydration are essential for each workout. When you warm up, you’ll experience a more comfortable workout, allowing your body to adjust to your pace. Stretching before and after your workout also helps you feel good after you run.

Some runners find that foam rolling feels good, especially for tight muscles. You may want to roll, stretch, or even do yoga positions to recover from your run gently. No matter what you do to warm up and cool down, be sure to drink plenty of fluids to fight dehydration from heat and sweating.

“I recommend my athletes stretch after their workouts when muscles are warm and most receptive to the benefits of stretching,” says Toll.


If your knee pain isn’t going away in a few days, or if you suspect a more severe injury, it’s time to consult with a doctor or physical therapist. Your practitioner will guide you on the next steps to combat Patellofemoral Pain Syndrome.

Your practitioner may suggest wearing a knee strap or brace when you work out, or they may show you exercises to build up your thigh and glute strength to fend off knee discomfort in the future. Follow their advice so you can continue your training.

If you’re experiencing knee pain or suspect patellofemoral pain syndrome, our team of expert physical therapists is ready to help you. Request an appointment online or call 414-961-6800 to set up a consultation with a member of our physical therapy team.

Crystal Toll, PT, CMTPT, CSCS, is a physical therapist at The Orthopaedic Hospital of Wisconsin. A marathon runner and Ironman triathlete, Crystal enjoys working with endurance athletes of all abilities and helping them reach their goals.