The Best Way to Recover from Runner’s Knee
Runner’s Knee, which physical therapists refer to as Patellofemoral Pain Syndrome, is an injury that a lot of runners have battled through and experienced in their careers.
It’s that dull, achy pain in the front of the knee and around that kneecap that only gets worse the more you bend the knee (or hello, after sitting for a long period of time).
This is a common injury that we see in a variety of athletes, not just runners. Any athlete in a sport that involves repetitive running, jumping, or deep knee bending can experience Runner’s Knee - that means soccer players, cyclists, softball players, basketball players, and dancers alike.
As a sports physical therapist, I see this injury all the time in the clinic and have helped a lot of athletes get back to 100%.
I created this ultimate guide to give you all the best tips and tricks for and the best way to recover from Runner’s Knee, so that you can get better faster and focus more on the miles in your training plan (and less on your knee pain).
If you just ignore the pain, spoiler alert it won’t actually go away. It’s going to take a little extra care, introducing some physical therapy exercises, a brief modification to your current training plan, and a lot of patience. Ready for the good news? This injury responds well to treatment and there’s so many things you can do to get things headed the right direction.
So let's dive into runner's knee and the best way to recover from runner's knee.
What is Runner’s Knee?
Runner’s Knee (or Patellofemoral Pain Syndrome in the physical therapy world) is characterized by pain that is:
Mostly in the front of the knee and/or around the kneecap (more widespread)
Feels dull and achy
Typically increases with increased knee flexion (bending)
Present during or after activity or repetitive movements
Repetitive running
Jumping
Squatting
Kicking
Present while sitting for a long period of time with the knee bent like in a car, at your desk, or on the sofa
Usually on one side, but can be present in both knees
Pain in the patellofemoral joint, where the kneecap rests on the femur, is caused from increased compression at this joint, resulting in more widespread pain across the front of the knee.
What actually causes the compression experienced with Runner's Knee in the first place?
Muscle strength imbalances in the hips, legs, and core, that put excess strain on the patellofemoral joint during movement.
Muscle tightness in the quadriceps
Trauma or injury to the knee
Overuse of the knee and muscles around it
Should you use ice for Runners knee? — Ice, Ice, Baby
Ice can be beneficial to reduce pain and inflammation of the knee during those flare-ups.
Ice helps to reduce swelling and pain because it helps stimulate vasoconstriction in the area where it’s applied, which prevents the buildup of excess fluid around the knee. You’ll want to apply ice with the leg elevated above the level of your heart for best results. I tell my patients to lay down on the floor with their foot resting up on the couch, apply an ice pack (wrapped in a pillowcase) to the front of the knee, and keep it there for 20 minutes.
Do this at least once per day following exercise or activity.
The Right Way to Rest When You Have Runner's Knee
This next part is important - you don’t have to completely rest, but you also need to be strategic in your recovery. You will have to modify your routine for a short time so that we can prevent further injury, keep your healing on track, and ultimately get you back in the game sooner.
Best Exercises for Runner’s Knee
Quad sets - This is more of a muscle-retraining exercise and less of a strengthening exercise.
Start with the leg straight out in front of you
Activate the quad by completely straightening your leg. You want to feel the quadriceps muscle on the front of your thigh working here!
Hold for 5 full seconds, remember to breathe!
Then relax the leg completely and repeat.
Do 20-30 reps per day.
*Progression: Advance to straight leg raises once this feels too easy. Again, working on muscle retraining instead of pure strengthening. )
Start with doing a quad set
Keep it straight as you lift the leg about 6 inches off the ground
Lower back to the start with a slow, controlled movement.
Then relax the leg completely and repeat.
Do 2-3 sets of 8-12 reps on each side.
2. Heel slides - Another one to retrain the movement for better joint mobility, less muscle tension, better hamstring activation, and help the knee glide better as you bend it.
Start laying with legs straight
Gently press your heel into the ground as you slide the foot up toward your buttocks.
Only slide the foot up as high as you can without increased pain in the front of the knee.
Repeat 20-30 times on each leg.
3. Squats to elevated surface - Check ego at the door!
We want a pain-free squat here - so that means only squatting as deep as you can WITHOUT increasing pain or discomfort in the knees. I have my clients squat to a specific target that’s slightly elevated than a regular chair, either their bed, a chair with pillows stacked in the seat, or an elevated plyometric box.
Start with stance just wider than hip width apart
Keep weight throughout the whole foot - feel contact with the ground through your heel, midfoot, balls of the foot, and toes during the entire movement
As you lower down toward the target think about pushing your glutes back and down (instead of bending your knees to lower down)
Only lower as far as you can without pain in the knees
After hitting the target, think about pushing down through the feet to stand back up.
Repeat for 8-12 reps. Do 2-3 sets.
*Progression: work towards squatting to a slightly lower surface each time as tolerated until you can perform a full squat to a regular chair height without pain. If you find that a surface is too low and recreates your pain in the knees, increase the height of your target surface.
4. Single leg standing balance - working on balance will help improve muscle stability and activation for decreased pain in the knee with activity.
Start with standing on one leg
Feel full contact of your foot on the floor (from heel to midfoot and toes to the ball of the foot) and keep standing leg slightly bent (so it isn’t locked straight)
Think of standing tall through the trunk and looking straight ahead to activate your core.
Try to balance on one leg for 30-60 seconds before switching sides.
Repeat for 2-3 sets on each side.
*Progress to standing on an uneven surface such as a foam pad, cushion, or grass.
5. Heel raises on step - this exercise targets the strength and mobility of the calf muscles, which impact how the knee moves. By strengthening and adding range of motion to the ankle joint and calf muscles, it reduces the strain of the knees and allows for less restriction while running.
Start in a standing position with feet hip width apart
Raise up onto the ball of the foot by lifting your heels
Slowly lower to starting position and repeat 8-15 times.
Do 2-3 sets.
*Progression: Advance to this step when regular heel raises feel too easy. Perform the same movement, but start with the ball of the foot on a step or stair and lower the heel down below the height of the stair. You’ll feel a little stretch in the back of the heel, Achilles, or calf muscle during this movement. This can be slightly aggravating for pain if you aren’t ready for this step.
Strengthening Recommendations for Prevention of Runner’s Knee
Proper strengthening is absolutely essential for athletes wanting to prevent Runner’s Knee and other injuries. Often times athletes are working on some form of strengthening, but missing a few key exercises in their routine. It’s important to target strengthening muscles around the knee.
You don’t need fancy machines, a ton of weight, or a full blown gym set-up to complete most of these movements, but it does require some intentional programming. You can make these exercises work using body weight and resistance bands, but can also be utilized for free weights or cable machines.
Hip strengthening and stability exercises
Clamshells (great warm up movement)
Single leg glute bridges (another great warm up movement)
Single leg deadlift
Paloff side step
Single leg squats
Bulgarian squats
Anti-rotation lunges (sometimes called paloff lunges)
Single leg standing and stability
Bosu ball
Foam pad
With opposite leg kick in various directions
With weight held in opposite hand to work core strength with uneven load
While performing straight leg deadlift
Cross-training to reduce overuse injuries, promote muscle balance, and maintain muscle conditioning in various planes of motion (lateral movements, forward and backward movement)
Strength training - weight lifting, high intensity interval training (HIIT) classes
Yoga - incorporates strength, mobility, core activation, breathwork and flexibility training
Swimming - low impact, total body workout
Cycling - low impact cardiovascular exercise
Pro tip: Consult with a rehab pro or coach who specializes in working with athletes to get a customized routine that addresses all of your concerns.
How to Improve Mobility and Flexibility
The secret here is that it takes consistency and intentional work on your mobility to actually improve it. You can’t expect to increase your flexibility if you aren’t working on it regularly. My best advice is to find a mode of mobility that you enjoy and do it. One person might absolutely love yoga and another can’t stand it. Someone else might love foam rolling and another person might have access to a massage gun.
Let’s go over a few of my best ideas for increasing mobility:
Foam rolling (see my checklist below)
Massage gun (see my favorite upper and lower body routines below)
Stretching - helps to increase available motion in the joints and muscles/tendons
Yoga routines - find a local class in your area, try out different styles of yoga (hatha, vinyasa, yin, etc), and use online resources (lululemon and Alo yoga have excellent free classes on youtube)
Compression boots - helps to reduce swelling, promote lymphatic drainage, and improve circulation
Deep breathing - helps to downregulate the nervous system and decrease muscle tension
Schedule regular massages with a local therapist who specializes in sports massage
My Favorite Foam Rolling Routine
This 10-minute routine targets total body mobility and decreases muscle tightness. Just foam roll over each of the designated areas for 30 seconds on each side at a tolerable intensity and move onto the next one. I recommend setting a timer for 30 seconds because time flies faster than you think.
Quadriceps
Shins (just lateral to the shin bone on the meaty part of the muscle)
Calves (rotate foot pointing in and out while rolling)
Hamstrings (rotate knee/leg pointing in and out while rolling)
Glutes
Mid back (keep hips on the ground)
Lats (can use tennis ball instead)
Pecs (can use tennis ball instead)
Foot (can use tennis ball instead)
How to Get the Most Out of Your Massage Gun Routine
So many of my athletes have massage guns available to use at home, but few rarely know the best way to use them. Some brands, like Theragun and Hyperice, have Bluetooth routines available on your mobile device that sync with your massage gun and lead you through available protocols on the app. This can be super helpful, but for those of you who don’t have a massage gun that does this or those who want something new, I’m sharing my favorite upper and lower body massage gun sequences.
Upper body routine for athletes x 30-60 sec each area
Neck/upper traps
Pecs
Biceps
Triceps
Forearm front
Forearm back
Hands
Lower body routine for athletes x 30-60 sec each area
Quads
Hamstrings
Calves
Shins
Glutes
Sole of Foot
Side of low back
Stretching Checklist: Make sure to target each area 1-2 times per week. Hold a stretch at mild discomfort for 30-60 seconds on each side.
Quadriceps
Hamstrings
Hip flexors
Glutes
Adductors (inner thigh)
Abductors (outer hip and deep glutes)
Calf muscles
Feet (stretch the bottom of the foot by sitting on your heels) and toes extended out
Guidelines for Easing Back Into Running
I’ve helped a lot of runners return to their usual running routines after injury and I have a few recommendations to make sure that the transition is successful. It takes a lot of diligence and patience to do it right. But here’s some of my best advice when it comes to easing back into running:
How to Start Running Again After Dealing with Runner's Knee
Aim to under-do It each time you run
Don’t just pick up where you left off in your training
Start low with your daily and weekly mileage (then build up slowly)
Make sure to take at least one day off between running days
Start with low intensity walk/run intervals and adjust as you go
Leave a little in the tank by the end of the workout (you want to be able to look back at your effort and say “I think I could have pushed it harder”)
Make sure you have the right gear - proper footwear is key (go to your local running shoe store for the right fit)
Tips for Before and During Your First Run:
Perform a running specific warm-up routine prior to each time you run
Keep cadence of 90 steps per minute on each leg to reduce strain on the knee
Run on a relatively flat course (skip the hills for now)
Start with walking and running intervals before continuous running
Check in with yourself after set intervals - every 5-10 minutes, take note of how you are feeling and if symptoms are increasing, take a break
Realize that not every run will feel great
Aim to under-do it with intensity, distance, and duration
What’s the most important thing to remember when you’re on the path of returning to running?
Listen to your body and avoid overexertion! Easier said than done, but taking the time to check in with yourself and actually note how you’re physically feeling. If your pain keeps coming back or increasing in intensity then take it as a sign that you need to do something differently. The mistake I see a lot of runners and athletes make is increasing too many variables at once, jumping into their usual mileage, or stopping their recovery practices because they “just don’t have time.” It’s important to track your progress, how you feel, and adjust intensity as needed. Feeling good? Keep it there or continue to progress intensity. Having more pain? Decrease intensity slightly and observe how you feel afterwards.
When Should I Get Help for my Runner's Knee?
The short answer if you’re currently dealing with Runner’s Knee is: Now! You don’t have to suffer through the pain. There’s so much that you can do. But the best way to get truly personalized solutions and treatment is to see a specialist in movement and rehab. Schedule a visit with your trusted healthcare professional if you’re concerned or feeling frustrated with knee pain.
Seeing a sports physical therapist is a great place to start. We are the movement experts and rehabilitation professionals and we help athletes recover from Runner’s Knee all the time. Rehab for this injury typically isn’t too complicated, but responds well to a customized exercise program and manual therapy interventions (dry needling, massage, scraping) to the area. We can also direct you to the orthopedic surgeon for a second opinion if pain becomes more severe and isn’t responding to physical therapy treatment.
If you’re in the Kennewick, WA area or surrounding region, I’d be happy to help you in your recovery. Book a free discovery call using this link and let’s get started.
Runner’s Knee Isn’t Something You Have to “Just Get Through” Anymore
Many runners and athletes have dealt with Runner’s Knee, or patellofemoral pain, over the years. It’s one of those injuries that doesn’t just go away if you take a couple weeks off and it can persist for years. But it doesn’t have to be that way - patellofemoral pain responds really well to physical therapy treatment.
We’ve already discussed several key recovery strategies to get rid of Runner’s Knee for good, which include:
Listen to your body and adjust accordingly
Get help! Personalized sports rehab makes all the difference
Prioritize recovery practices (foam rolling, massage gun, massage therapy, yoga, etc.)
Start slow and ease back into running
Aim to under-do it with intensity and mileage
Stay consistent with strength training for hips, core, and legs
Focus on the long game (being able to run for years in the future)
This ultimate guide shared a lot of my top tips and tricks for athlete rehabilitation and recovery from Runner’s Knee. Hopefully you found it helpful in answering some of your questions.
Get treatment for your runner’s knee
At Game Changer Physical Therapy, we offer physical therapy treatment in Kennewick, WA and would love to help you get back to running pain free.
Get started by booking a discovery call below.
