Runner's Knee Causes and Treatment

Man with runner's knee applying ice gel pack to his knee
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Runner's knee (also known as patellofemoral pain syndrome or anterior knee syndrome) is one of the most common complaints among runners. It also affects other athletes—such as hikers and bicyclists—and even people who are sedentary, because their knees are so often in the flexed position. The good news is that runner's knee is fairly easy to treat and prevent.

Runner's Knee Symptoms

Runner's knee feels like soreness around the front and sometimes behind the kneecap. It's usually aggravated by running downhill, squatting, or going up or down stairs. Your knee may feel stiff (like it needs to be stretched) and sore after sitting down for long periods. You might even hear a clicking sound when you bend or extend your knee.

Causes of Stiff Knee After Running

Runner's knee is usually caused by weakness and/or a lack of flexibility in the muscles that support the knee. Your quadriceps and hip flexors should hold your kneecap in place, so it tracks up and down. But if they're weak, your kneecap moves left and right and ends up scraping your cartilage, causing painful friction and irritation.

Stiffness in the hamstrings and IT bands can also lead to kneecap pain. The iliotibial (IT) band connects the hip to the knee and lower leg; it runs along the outside of the thigh.

You may also be at risk of runner's knee if you have flat feet and you overpronate (your feet roll inward) when you run. Running on uneven running surfaces or running in incorrect or worn-out running shoes may also a contributing factor.

Treatment and Prevention

Try these strategies to manage runner's knee. But if pain persists, be sure to see your doctor for advice and rule out other conditions. Stretching and strengthening can help prevent runner's knee.

Other things that may help include:

  • Avoiding compression: Don't use a knee sleeve or elastic bandage (such as an Ace bandage) to help with the pain. Doing so may compress your kneecap so that's still rubbing and grinding your cartilage. It's better to keep it loose and free and work on strengthening your muscles.
  • Icing it: Reduce pain and inflammation by icing your knees immediately after running.
  • Resting: Don't run through pain. Take a couple of days off from running. Or cross-train, as long as you can do so without pain.
  • Strengthening exercises: Work on strengthening your quad muscles, which will help support and stabilize your kneecap. Simple exercises, such as forward lunges or straight leg raises, can help work the quads.
  • Stretching out: Loosen up tight hamstrings and IT bands with stretches.

If you only have runner's knee on one side, don't neglect the other leg. Some runners rehab one leg, only to develop the same pain on the other side. Make sure you do the same exercises and stretches on both legs.

How to Return to Running Safely

You can start running again after runner's knee when you're able to run without changing your form due to pain. Stick to running on flat surfaces when you first return and only increase time and distance 5% to 10% a week.

Shortening your stride and striking the ground directly underneath your center of gravity may also help alleviate the problem. Make sure you have the right kind of running shoes for your foot type. Also, make sure you're not running in worn-out shoes. You should replace your shoes every 300 to 400 miles. You may also want to consider buying over-the-counter arch supports.

A Word From Verywell

Although some runners can treat and prevent future runner's knee by following the above steps, others may need further treatment. You may need to visit a physical therapist who can give you the proper stretches and exercises.

If your runner's knee is caused by overpronation (foot rolling inward when you run), you may need to see a podiatrist about custom-fitted orthotics. Severe cases of runner's knee may require a cortisone injection under the kneecap.

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