What can I do about my kneecap hurting when I run?

Tamar Amitay
Physical Therapy

Runner’s knee or patellofemoral pain syndrome is a common overuse among runners. Runner’s knee is pain typically around and under the kneecap. Often it occurs as runner’s mileage increases (around 30+ miles per week) and the pain often feels worst when walking down the stairs or running downhill. Patella femoral pain can often make the knee stiff and sore after sitting for long periods (a cinema sign) and painful grinding and popping may occur when the knee is flexed and extended.

Patellofemoral pain occurs when your kneecap or patella maltracks causing irritation of the femoral groove in which the kneecap rests on the thigh and irritation of the cartilage around the kneecap. Runner’s knee may be due to running too much too soon, without adequate flexibility and quadriceps strength, it can also occur when the quadriceps or stronger than the hamstrings or when the hamstrings are tight and inflexible.

Runner’s knee can also be due to variety of biomechanical or alignment issues, examples include a kneecap that sits too high or too lateral in the groove, due to a poor base of support in which the runner excessively pronates and causes the leg to roll inward.

To prevent knee pain while running, run on softer surfaces and keep your mileage increases to less than 10 % per week. Gradually increase hill work into your training program. Strengthen your quadriceps to improve patellar tracking, stretch your hamstrings and calves. Go to a sports store that specializes in running to make sure that you are wearing the proper shoes for your foot type and gait.

If you are having pain at first try rest, use ice and take anti-inflammatories. Cut back on your mileage, and avoid canted surfaces and hills until the pain subsides. However, if you are having knee pain that persists despite conservative treatment, and does not get better with rest, it is prudent to see a sports medicine physician or a physical therapist to properly evaluate the factors contributing to your knee pain. They are best equipped to determine the causative factors that led to your knee pain and guide you in an effective rehabilitation and training program so that you can return to running as quickly and safely as possible.

Dr. Mike Clark, DPT
Kneecap pain while running is often caused by tightness in the rectus femoris, which is the main thigh muscle, and your biceps femoris, which is the outside back of your thigh muscle (the outer hamstring). Tightness of these two muscles, increases the pressure on the kneecap (patella). There is usually also weakness in the inside thigh muscle (called your vastus medialis obliquus), and the upper outer hip muscle (gluteus medius). Weakness in these two muscles allow the thigh to move inward when the foot hits the ground. The combination of the thigh moving in (caused by muscle weakness), and the kneecap being compressed (muscle tightness), causes kneecap pain. To deal with this, here are the 4 main things that you can do:
1. Foam roll the outside of your thigh.
2. Stretch the thigh muscle (rectus femoris).  Try the kneeling hip flexor stretch and hold the stretch 30 seconds.
3. Stretch the outside thigh muscle (biceps femoris). Perform the 90-90 outer hamstring stretch and hold the stretched position for 30 seconds.
4. Activate the inside thigh muscle and the outside hip muscle (gluteus medius). Perform side lunges to balance, side to side tube walking and stability ball squats.
In addition, make sure you ice the knee when you are done running. If the pain persists, please contact your physician.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.