If you have been diagnosed with patellofemoral stress syndrome (PFSS), also known as runner's knee, you may be referred to a physical therapist (PT) for treatment.Exercise is one of the main treatments for PFSS.
With PFSS, the kneecap rubs against the lower part of the femur (thighbone), causing pain. Many cases of PFSS are caused by tight muscles around the knees and hips or weakness in muscles that help keep your kneecap in its correct position. The prescribed exercises focus on improving the flexibility and strength of the muscles that support your knee and help keep excessive stress off your kneecap.
Before starting this, or any other, exercise program, check with your healthcare provider to ensure that exercise is safe for you to do.
Anatomy of the Knee
1
Quadriceps Strengthening
Research indicates that weakness in your quadriceps muscle, specifically an area of the quad called the vastus medialis obliquus (VMO), may lead to patellar misalignment and PFSS. Working to strengthen your quad may be an important part of your exercise program for PFSS.
One simple way to strengthen your quads is with the quad set exercise.
To do the exercise:
- Lie down with your knee straight and place a small towel underneath your knee.
- Press your knee down into the towel while tightening your quadriceps muscle on the top of your thigh.
- Hold your muscle tight for 5 seconds, and then release.
The short arc quad is another exercise that can help improve the way your quadriceps muscle supports your kneecap.
To do this:
- Lie down and place a soccer ball or paper towel roll underneath your knee.
- Straighten your knee fully while keeping the back of your leg against the ball.
- Hold your knee straight for 5 seconds, and then slowly release.
Repeat each exercise 10 to 15 repetitions, twice a day.
2
Straight Leg Raises
Straight leg raises are a great way to strengthen your quadriceps and hips while maintaining your knee in a safe, pain-free position. During the straight leg raise, your knee joint should remain locked, decreasing stress and strain (and pain) around your kneecap.
To perform a straight leg raise:
- Lie on your back with one knee straight and one knee bent.
- Tighten the muscle on the top of the thigh of your straight leg, and then lift your leg about 15 inches off the ground.
- Hold your leg straight up for a few seconds, and then slowly lower it down.
- Repeat the leg raise 10 to 15 repetitions.
You can work different muscle groups around your hips by performing the straight leg raise on your back, on your side, or while lying on your stomach. Each method will alter the exercise enough to keep it fresh and to work the various muscles that support your leg and knee.
You can make this exercise more challenging by adding a small cuff weight around your ankle. Usually, two to three pounds is sufficient. Another way to add resistance is to place a resistance band around your ankles for the straight leg raises.
Straight Leg Raise Exercise Progression
3
Clam Shell
The clamshell is a great exercise to do to improve the strength of your hip muscles, specifically the gluteus medius. Your glutes help to control the position of your knee, and weakness of these muscles can lead to PFSS.
To perform the clamshell:
- Lie on your side with both knees bent.
- Tighten your abdominals, and slowly lift your top knee up while keeping your feet together.
- Hold your knee up for a few seconds, and then slowly lower.
- Repeat the exercise 15 to 25 times.
You can make the clamshell exercise more challenging by placing a resistance band around your knees for the exercise. Your PT can help you get a suitable band for your condition.
4
Isometric Gluteal Strengthening
Isometric gluteus medius strengthening can help to keep your legs and kneecaps in proper alignment.
To perform the exercise:
- Lie on one side with your knees straight and with a belt wrapped around your ankles.
- Be sure it isn't too tight; you should be able to lift up your top leg.
- Slowly lift your top leg while keeping it straight, and press it into the belt.
- You should feel your hip muscle working to lift up your leg further, but the belt should be resisting your movement.
- Press up into the belt for five seconds, and then slowly relax.
- Perform the exercise for 10 repetitions, and then repeat it on the other side.
Isometric Gluteus Medius Training
5
Advanced Hip Strengthening
Once you become a pro at performing the clamshell and isometric gluteus medius strengthening exercises, it is time to move on to more advanced hip strengthening exercises.
Bridges are a great way to strengthen your hips and core while working to keep your knees in proper alignment. You can modify your bridging routine by adding a Swiss ball to the bridge or by performing the exercise with your feet on a pillow or another unsteady surface.
Using a resistance band in standing is a functional way to improve hip strength and control while keeping your knees in proper alignment. This can help to teach your body where your kneecaps should be during activities like walking and running.
Advanced Hip Strengthening Exercises
6
Plyometrics
Running involves flying through the air and landing on one foot. That foot and leg is then required to propel you forward to fly through the air once again. Repeat over and over again, and you are running.
Plyometric exercises may be helpful for treating runner's knee. Your PT can help you progress from double-leg to single-leg exercises.
Some exercises that you may do might include:
- Double leg hop
- Single leg hopping
- Diagonal hopping
These exercises may be challenging, and if you experience pain in your knee, you must stop. Your PT can guide you in the correct way to progress plyometrics for running.
7
Advanced Balance Exercises
Many people with PFSS have impaired balance and proprioception (position sense), so working on your balance may be an important part of your PFSS rehab exercise program.
You can start with simple balance activities like the single-leg stance, and progress further with more dynamic balance activities like the T-stance or by working with a BOSU ball.
Your physical therapist can assess your balance and prescribe the best exercises for you to do to work on maintaining your knees in proper alignment to treat your PFSS.
A Word From Verywell
If you have runner's knee or PFSS, you should check in with your PT and get started on an exercise program to get back on track to running with no pain.
8 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
Peters JS, Tyson NL. Proximal exercises are effective in treating patellofemoral pain syndrome: a systematic review. Int J Sports Phys Ther. 2013;8(5):689-700.
Kaya D, Doral MN, Callaghan M. How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?. Muscles Ligaments Tendons J. 2012;2(1):25-32.
Chan MK, Chow KW, Lai AY, Mak NK, Sze JC, Tsang SM. The effects of therapeutic hip exercise with abdominal core activation on recruitment of the hip muscles. BMC Musculoskelet Disord. 2017;18(1):313. doi:10.1186/s12891-017-1674-2
Burnet EN, Pidcoe PE. Isometric gluteus medius muscle torque and frontal plane pelvic motion during running.J Sports Sci Med. 2009;8(2):284–288.
Gong W. The effects of the continuous bridge exercise on the thickness of abdominal muscles in normal adults. J Phys Ther Sci. 2018;30(7):921-925. doi:10.1589/jpts.30.921
Keller JL, Fritz N, Chiang CC, et al. Adapted Resistance Training Improves Strength in Eight Weeks in Individuals with Multiple Sclerosis. J Vis Exp. 2016;(107):e53449. doi:10.3791/53449
Davies G, Riemann BL, Manske R. Current concepts of plyometric exercise. Int J Sports Phys Ther. 2015;10(6):760-86.
Janssens L, Brumagne S, Mcconnell AK, et al. Proprioceptive changes impair balance control in individuals with chronic obstructive pulmonary disease. PLoS ONE. 2013;8(3):e57949. doi:10.1371/journal.pone.0057949
(Video) Runner's Knee Pain Exercises & Stretches - Ask Doctor Jo
By Brett Sears, PT
Brett Sears, PT, MDT, is a physical therapist with over 20 years of experience in orthopedic and hospital-based therapy.
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FAQs
What is the fastest way to fix runner's knee? ›
- Rest your knee. ...
- Ice your knee to ease pain and swelling. ...
- Wrap your knee. ...
- Elevate your leg on a pillow when you sit or lie down.
- Take NSAIDs, if needed, like ibuprofen or naproxen. ...
- Do stretching and strengthening exercises, especially for your quadriceps muscles.
Physical therapy is the most common, and the most efficient form of treatment in runner's knee. Physical therapy in Cary will help improve your posture and joint mobility, relieve pain, and help you partake in your everyday activities with less pain.
What are 3 exercises to strengthen your knee? ›- Exercise 1: Knee Extension.
- Exercise 2: Knee Flexion (Standing)
- Exercise 3: Heel and Calf Raises.
- Exercise 4: Wall Squats.
- Exercise 5: Swimming.
- Straight Leg Raises. If your knee's not at its best, start with a simple strengthening exercise for your quadriceps, the muscles in the front of the thigh. ...
- Hamstring Curls. These are the muscles along the back of your thigh. ...
- Prone Straight Leg Raises. ...
- Wall Squats. ...
- Calf Raises. ...
- Step-Ups. ...
- Side Leg Raises. ...
- Leg Presses.
Unfortunately, runner's knee doesn't usually go away on its own. A period of rest or reduced running distance is typically needed to get your pain under control. You can use this time to increase your endurance and build muscle strength.
How long does it take to cure runner's knee? ›How long will my Runner's knee last? Patellofemoral syndrome will often require 4-6 weeks to fully recover given proper treatment and rest.
Is runner's knee reversible? ›If you must run, wear a brace for runner's knee to help support your knee joint and ramp up physical therapy. Don't ignore knee pain, as it could be runner's knee, which can be cured by focusing on a strength training routine and taking care of your body.
Are squats good for runners knee? ›If we could pick one exercise to recommend to all runners, it would be squats. Squats can help improve knee stability, leg power, and body awareness, as well as prevent common running injuries.
How do you strengthen your knees if you have aches and pains from running? ›How to do it: Stand with feet hip-width apart with a towel or slider under right foot. Slide right foot back as you bend left knee, allowing left hip to flex, and lowering left knee to floor. Press left heel into the floor, then drive upwards to return to standing. Do 1 to 2 sets of 8 to 10 reps on each side.
Should you ice or heat runner's knee? ›Ice: Reduce pain and swelling by applying an ice pack or a pack of frozen peas on your knee for up to 30 minutes at a time. Avoid heat to your knee. Compression: Wrap your knee with an elastic bandage or sleeve to restrict swelling, but make sure not to wrap your bandage too tightly as to cause swelling below the knee.
Does compression help runners knee? ›
To further boost the healing process, you should wear a knee brace or support that provides medical-grade compression. A good compression support can relieve your knee pain, which is particularly important at the beginning of your recovery when the pain is most severe.
Is heat or ice better for runner's knee? ›Knee pain is one of the most common issues that doctors attend to. It can be caused by a sprain, cartilage tears, tendonitis, runner's knee, or many other issues. If there is swelling in your knee, you should ice for at least 72 hours until the swelling goes down. After that, heat can be used to help regain mobility.
How can I rehab my knee at home? ›- Lie on the floor with both legs bent.
- Lift one leg off of the floor and bring the knee toward your chest. ...
- Straighten your leg and then pull it gently toward your head, until you feel a stretch. ...
- Hold this position for 30 to 60 seconds.
- Repeat with the opposite leg.
Strengthening the knee is one way to prevent knee trouble and deal with a knee condition you already have. One exercise that's simple to do is stair climbing.
What exercises should I avoid with knee pain? ›High-impact exercises can further injure painful knees. Avoid jarring exercises such as running, jumping, and kickboxing. Also avoid doing exercises such as lunges and deep squats that put a lot of stress on your knees. These can worsen pain and, if not done correctly, cause injury.
What helps knee pain at night? ›People may find relief from their knee pain by using ice packs, heat packs, or heating pads. Before falling asleep or going to bed, a person can try to ice or heat their knees. They should aim to heat or ice their knees right before bed for about 20 minutes.
How do you stretch your knees in your bed? ›5 Knee Pain Relief Stretches & Exercises You Can Do In Bed
Should I exercise if my knee hurts? ›If you've got sore knees, exercise might seem like the hardest thing you can do — but it's also one of the best. "Exercise is one of the most important things you can do for knee pain," says Dr. Lauren Elson, an instructor in physical medicine and rehabilitation at Harvard Medical School.
Does walking help runners knee? ›Walking on the treadmill or outside at a comfortable pace will provide some cardio advantages with a low impact. Runner's knees often become stiff with long periods of inactivity, so some exercise is beneficial. Elliptical machines provide resistance without impact and work in a gliding effect.
What happens if you don't treat runner's knee? ›Can runner's knee cause permanent damage? Yes, some evidence suggests that if you neglect runner's knee, it may predispose you to develop osteoarthritis in your patellofemoral joints.
Why does my runner's knee keep coming back? ›
It's often caused by overtraining, running too much on hard surfaces, or having tightness or weakness in the hips and glutes. Listed below is my five-step “quick fix” for runner's knee that should get you back to running normally within one to several weeks.
Where is runner's knee pain located? ›Runner's knee is dull pain around the front of the knee. It may be caused by a structural defect, or a certain way of walking or running. Symptoms include pain, and rubbing, grinding, or clicking sound of the kneecap. Treatment includes not running until the pain goes away.
Can runner's knee lead to arthritis? ›Many people mistakenly believe that running causes knee osteoarthritis — however, doctors now know this is not true.
Should I keep running with knee pain? ›If the pain's severe or the knee's swollen, see a GP straight away. If your knee pain is not severe, stop running and get it checked by a GP or physiotherapist if the pain does not go away after a week. They can also recommend stretches or exercises to help you recover.
How do you tape runners knee? ›KT Tape: Runner's Knee - YouTube
Is runner's knee degenerative? ›Chondromalacia Patellae (also known as CMP, Patello-femoral Pain Syndrome, or Runner's Knee) is a degenerative condition of the cartilage surface of the back of the knee cap, or patella.
What cardio can I do with runner's knee? ›- Walking. Since running or jogging may not be the best option, walking (including speed walking) is a good low-impact cardio workout if you keep a brisk pace. ...
- Swimming/Pool Exercises. ...
- Elliptical Machine and Bicycle. ...
- Low-Resistance Circuit Training. ...
- Other Exercises.
As you work to rehab the injury, stay fit with vigorous upper-body work, plus pool running and/or biking if you can do so without knee pain. Meanwhile … Strengthen your knees, quads and hips.
How do I keep my runner's knees healthy? ›- Stretch the Muscles around Your Knees. Before running, make sure to do a light warm-up followed by some stretching. ...
- Strengthen Your Leg Muscles and Core. ...
- Use Cold Therapy on Sore Knees. ...
- Give your Knees a Break. ...
- Stay Hydrated.
Runner's knee may be caused by a structural defect, or a certain way of walking or running. Other causes may include: Malalignment of the kneecap. Excessive training or overuse.
Which food is good for knee ligament? ›
- Manganese – nuts, legumes, seeds, whole grains, leafy green veggies.
- Omega-3 – as listed above, salmon, mackerel, etc.
- Vitamin A – liver, carrots, sweet potato, kale, spinach, apricots, broccoli, winter squash.
Ultrasound heat therapy to improve blood circulation, which may aid the healing process. Deep massage to boost flexibility and circulation and prevent further injuries. Endurance activities, such as riding a stationary bike. Coordination or agility training.
Can knee cartilage regenerate? ›“Cartilage has practically zero regenerative potential in adulthood, so once it's injured or gone, what we can do for patients has been very limited,” said assistant professor of surgery Charles K.F. Chan, PhD.
How do you strengthen weak knees? ›- Wall or Chair Squats. If your knees are weak, stand in front of a chair or against a wall while you do squats so that you don't lose your balance. ...
- Full Chair Sits-to-Stands. ...
- Lunges. ...
- Straight Leg Lifts. ...
- Side Leg Raises. ...
- Short-Arcs. ...
- Step-ups or Knee Marching. ...
- Calf and Abductor Raises.
If you are not experiencing swelling, then heat is the correct temperature treatment. Hot baths, hot compresses, or a hot water bottle on the knee can work wonders, especially if the pain is caused by strained soft tissue. The heat relaxes muscles and tendons and promotes blood flow which accelerates healing.
What happens if you ice for more than 20 minutes? ›Greater than 20 minutes of icing can cause reactive vasodilation, or widening, of the vessels as the body tries to make sure the tissues get the blood supply they need. Studies have also shown 30 to 40 minutes in between icing sessions are needed to counter this reaction.
Is Deep heat good for knee pain? ›Soaking in warm water or applying a heated compress is one of the oldest, cheapest, and safest forms of complementary therapy. Research has shown that heat treatments can loosen stiff joints and relieve achy muscles.
How tight should a knee brace be? ›It's important that the brace is snug, but not too snug. If the brace is too tightly strapped to your leg, it can cut off circulation. Having the right length for your height and your injury is also important. This brace comes in different lengths ranging from 12 to 24 inches.
How tight should a knee sleeve be for running? ›Compression knee sleeves should not be loose or baggy, in fact, a snug fit is exactly what you're looking for so that you can get the right support. The knee sleeve should not be so tight that it cuts off flow or feel like it's pinching your knee/skin.
Should I wrap my knees for running? ›Wrapping your knee may be useful for providing additional support and stability to your knee to prevent injury, especially with repetitive high-impact or joint-loading activities, such as running, jumping, and heavy squatting.
How do you wrap a runner's knee with an ace bandage? ›
How to Apply an ACE Wrap to Your Knee - YouTube
Does Runner's knee ever go away? ›Unfortunately, runner's knee doesn't usually go away on its own. A period of rest or reduced running distance is typically needed to get your pain under control. You can use this time to increase your endurance and build muscle strength.
How long does Runner knee take to heal? ›How long will my Runner's knee last? Patellofemoral syndrome will often require 4-6 weeks to fully recover given proper treatment and rest.
Can you still run with runner's knee? ›Avoid doing any intense running, such as long runs, intervals or speed work, as these may cause further damage to your knee and increase inflammation. If your level of pain is above a 3 out of 10, you may want to stop running entirely. However, you should continue training your cardio with low-impact cross training.
Are squats good for runners knee? ›If we could pick one exercise to recommend to all runners, it would be squats. Squats can help improve knee stability, leg power, and body awareness, as well as prevent common running injuries.
Does walking help runners knee? ›Walking on the treadmill or outside at a comfortable pace will provide some cardio advantages with a low impact. Runner's knees often become stiff with long periods of inactivity, so some exercise is beneficial. Elliptical machines provide resistance without impact and work in a gliding effect.
What happens if you don't treat runner's knee? ›Can runner's knee cause permanent damage? Yes, some evidence suggests that if you neglect runner's knee, it may predispose you to develop osteoarthritis in your patellofemoral joints.
What happens if runner's knee goes untreated? ›Left untreated, patellofemoral pain syndrome generally gets worse over time. If you continue using the affected knee without treatment, you may cause further injury.
How can I heal my knees naturally? ›- Rest. Take a break from your normal activities to reduce repetitive strain on your knee, give the injury time to heal and help prevent further damage. ...
- Ice. Ice reduces both pain and inflammation. ...
- Heat. ...
- Compression. ...
- Elevation.
Runner's knee is dull pain around the front of the knee. It may be caused by a structural defect, or a certain way of walking or running. Symptoms include pain, and rubbing, grinding, or clicking sound of the kneecap. Treatment includes not running until the pain goes away.
Does KT Tape help runner's knee? ›
Athletic taping such as KT Tape helps provide relief from runner's knee by aligning the knee cap and supporting the patella tendons. KT Tape is very comfortable to wear and sticks in place even after showering or during sweating.
How do you tape runners knee? ›KT Tape: Runner's Knee - YouTube
How do you prevent runner's knee from coming back? ›- Stretch the Muscles around Your Knees. Before running, make sure to do a light warm-up followed by some stretching. ...
- Strengthen Your Leg Muscles and Core. ...
- Use Cold Therapy on Sore Knees. ...
- Give your Knees a Break. ...
- Stay Hydrated.
- Walking. Since running or jogging may not be the best option, walking (including speed walking) is a good low-impact cardio workout if you keep a brisk pace. ...
- Swimming/Pool Exercises. ...
- Elliptical Machine and Bicycle. ...
- Low-Resistance Circuit Training. ...
- Other Exercises.
Tendons and ligaments attach your kneecap to your shinbone and thigh muscle. When any of these components fails to move properly, it can cause your kneecap to rub up against your thigh bone. This abnormal rubbing can lead to deterioration in the patella, resulting in chondromalacia patellae, or runner's knee.
Why do I have runner's knee? ›Runner's knee may be caused by a structural defect, or a certain way of walking or running. Other causes may include: Malalignment of the kneecap. Excessive training or overuse.
How do you build leg endurance for running? ›- Squat. These are excellent for strengthening and activating glutes, especially for those who sit down a lot. ...
- Single-leg squat. ...
- Split squat. ...
- Wall squat. ...
- Forward lunge. ...
- Reverse lunge. ...
- Arabesque. ...
- Step-up.