How to prevent runner’s knee, and four exercises to treat it

It’s a common complaint among triathletes – our resident physio has the expert advice and exercises you need


Runners’ knee is a term many of you may be familiar with. It’s a common condition among runners, but can occur in any athlete who does activities that require putting load through the knee. It’s no wonder then that it’s a common complaint within the triathlete community.


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The technical term for runners’ knee is patellofemoral pain syndrome (PFPS). This term is used to describe numerous conditions that result in anterior knee pain and is the irritation of the cartilage on the underside of the patella (kneecap). Around 40% of running injuries are knee injuries, so how would you know if you have runners’ knee?

Who’s at risk?

Pinpointing a single cause of runners’ knee is difficult. Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, so assessment by a physiotherapist might be needed for specific treatment.

Risk factors include: poor foot biomechanics (reduced control of inward foot rolling); the kneecap sitting too high in the femoral groove; and any wear in the cartilage of the knee joint or patella reducing the knees’ shock absorbing capacity.

There are also muscular causes: weak quads, hips or glutes can cause the kneecap to track out of alignment, while tightness in the hamstrings and calf muscles can put pressure on the knee. Women are thought to be at higher risk as the pelvis tends to be wider, resulting in a greater angling of the thigh to the knee.

Signs and symptoms

– Pain behind/around the kneecap, this is varied and can be sharp and sudden or dull and chronic.

– Pain when you flex the knee, when walking, squatting, kneeling, running and cycling.

– The pain may be worse when walking downstairs/downhill.

– Swelling around or underneath the kneecap.

– Popping or grinding sensations in the knee, occasionally you may feel the knee gives way.


– See a podiatrist to analysis foot mechanics and think about using orthotics if you have hypermobile feet or other foot problems that may lead to runners’ knee.

– Make sure you regularly change your training shoes.

– Try to vary the surface you run on.

– Never abruptly increase the intensity of your training. Make changes slowly, gradually increasing volume or speed.

Expert tips

PRICE is a common acronym when dealing with acute injury before rehabilitation, but what does it stand for?

Protection: Protect the injured area with a splint, crutches, strapping, so it can be offloaded and no weight is put through it.

Rest: All injuries need time to recover (different injuries require different recovery times). With acute injuries often a rest period of 72 hours is necessary to allow the initial inflammation to reduce.

Ice: Ice packs are used immediately on acute injuries; not only to reduce swelling, but also to reduce pain levels. It’s always advisable to wrap any ice pack in a cloth to reduce the risk of ice burns.

Compression: Compression of the area using a stretchy bandage or taping is advised. This will limited the amount of swelling and bleeding/bruising to the injured area, therefore reducing the chances of any secondary soft tissue injury.

Elevation: Keeping the injured area elevated, again helps with immediate reduction in swelling. Once the swelling has resolved rehab can begin.


It’s possible to train through runners’ knee – you may just need to reduce running volume or just run every other day while you concentrate on the rehab exercises. To reduce symptoms of runners’ knee, alignment is key.

Concentrate on exercises that strengthen quads (and control movement of the kneecap) and the lateral hip muscle (to prevent the knee dropping inwards).

These four exercises not only help to reduce symptoms, but can also help to prevent a relapse. Some coaches also recommend shortening your stride length and landing with a slightly bent knee, as this could reduce the load transmitted through the knee:

(Main image: Romilly Lockyer)

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For lots more injury advice head to our Training section