Knee pain is a common complaint that affects people of all ages and activity levels and is especially common in runners.

Patella-femoral pain syndrome (PFPS) commonly referred to as runner’s knee, can be quite debilitating.

What you may not realize is that your knee pain isn’t directly related to damage to the knee itself. More often than not, symptoms of runner’s knee are coming from higher up. The hips and low back are more likely the issue than then knee itself.

Symptoms of runner’s knee

Typically, a person with PFPS will have pain under or slightly above or below the knee cap. Pain can increase with going up and down stairs or running up and down hills. Squatting and kneeling may also be painful. There may be occasional “popping” in the knee as well as mild swelling.

Although runner’s knee is the common name for this condition, you don’t necessarily have to be a runner to have symptoms. People who sit at a desk for several hours may experience similar symptoms from having the knee bent in one position for most of the day. Prolonged sitting will cause tightness in the hips, knees, ankles and low back, which may result in symptoms occurring in the knee during the activities mentioned above.

What causes runner’s knee?

PFPS is usually due to repetitive stress and overuse. For that reason, distance runners are usually more susceptible to symptoms. Surprising as it may sound, the knee itself is not usually the direct cause of pain.

As mentioned previously, runner’s knee is usually related to issues at the hip and low back. Limited hip mobility and tightness of the surrounding muscles will cause compensations with walking or running that will manifest in the knee. Core muscle weakness and weakness of the glute muscles can cause instability that can lead to PFPS as well.

Anyone can have weakness and tightness in their hips and core which leads to knee pain even if they don’t run. In fact, most knee issues are a result of these imbalances. However, those that do run and have deficits in the hip and low back are much more susceptible to having knee pain. The more mileage that goes on without correction, the worse these symptoms can become.

What can be done about runner’s knee?

Listen to your body  

The most important thing is to listen to your body. If you feel pain in your knee, back off on how much you are doing. Feeling soreness in muscles from exercise is okay, but you should not be increasing your symptoms. Pain is a signal that your brain gives you to let you know something is wrong. Don’t just try to push through pain or your symptoms can become much worse and harder to treat.

Proper warm-up

A proper warm-up is essential for all exercise. Most people don’t do a warm up or they don’t warm up properly. Many runners believe that because they are “just running”, they don’t need to warm-up. This is simply not true. Whether you are an avid runner or a weekend warrior out for a jog, warming up is critical. Actually, for any activity, recreation, or sport, warm-up is very important to help prevent injury.

What type of warm-up is best?

Active stretching and sport specific activities. Active stretching is the best type of stretching because it prepares your muscles for exercises by actively engaging them.

For example, kicking your leg forward as high as you can is an active stretch for the hamstrings. This differs from static (traditional) stretches that many of us know and do.

This involves bending forward until a “strain” is felt on the muscle and held for 20-30 seconds. Stretching this way may be more harmful to muscles.  Studies reveal that a statically  stretched muscle becomes 3-5% weaker afterwards. Static stretching is best to be avoided as part of your warm-up as it may leave you more susceptible to injury.

Strengthen the essential muscles

 A lot of people fall into a similar pattern of muscle imbalances. This is a result of more sedentary work schedules that have us sitting for hours at a time. Generally speaking, people have tight hamstrings, weak glutes, weak abdominals/core muscles and tight hip flexors. These imbalances are what leads to having pain with activity.

With runner’s knee, hip and glute weakness is often an issue. Runners commonly have weakness in their glutes and tightness in the hip flexors because their running style.

There are a lot of ways to build up your core and hip muscles through functional movements that will allow you to develop strength and stability quickly so you can get back to activities that you love. It is best to consult with a physical therapist to find our what specific imbalances you have and what you can do to fix them.

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Improve your footwear 

Footwear is important to all physical activity. From walking to running to hiking, you need to have the right shoes for the activity. Make sure to get shoes that are appropriate. Foot and ankle stability can play an important role in knee pain and PFPS. For instance, those who over-pronate (flat footed) may began to experience knee pain with activity due to instability of the foot. Properly fitting footwear will help to give support and help to prevent or reduce pain in the knee.

Summary

Runner’s knee and PFPS is a common condition that many people suffer with. It is often chalked up to aging or when we’re told to just stop doing the activity that causes pain. While rest and listening to your body is recommended, you shouldn’t be stopping an activity because of pain. Pain is a signal our brain gives us to let us know that something is wrong. Once that wrong is corrected, the pain will go away.

It is important to not ignore knee pain or to just think it will go away on its own. If left untreated, you can develop more extensive issues such as early onset of arthritis and damage to other structures. You can develop other pains such as hip and low back pain as well, which can be very debilitating.

With proper evaluation and treatment, knee pain can be resolved and allow you to return to activity. In a lot of cases you’ll feel even better than before. It’s amazing how proper exercise and movement can help to alleviate pain. Don’t delay your healing and definitely don’t accept knee pain as something you just have to live with.