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3 ways to Improve Knee Pain with Running

What kind of knee pain do I have?

Knee pain may originate from a variety of structures, including the ligaments stabilizing the knee; the tendons connecting the knee musculature to the femur, kneecap (patella), and shin bone (tibia); or the cartilage and other “cushioning” structures around the knee. The most common type of knee pain occurring in runners is generalized pain on the front of the knee. This kind of pain is called patellofemoral knee pain, referring to the patella as it interacts with the femur.

What are common signs of patellofemoral knee pain?

  • Generalized pain around or beneath the kneecap
  • Pain with stairs, especially going down
  • Pain worsens as activity progresses
  • Downhill walking and running are worse than uphill

Importantly, joint cracking and popping is not indicative of a worsened condition. If you have noisy knees, don’t sweat it.

3 tips to manage patellofemoral knee pain with running

  • Strengthen your outer hips to improve single leg stability. Strong outer hips help keep the knee aligned when jumping onto a single leg (as in running). If the outer hip isn’t working to keep the pelvis level, the knee collapses toward the midline, resulting in sub-optimal loading of the patellofemoral joint. Try single-leg banded hip abduction (kicking out to the side), 4 sets to fatigue, 3-4 times per week.
  • Strengthen the quads to support the knee, especially for the phase of running when and just after you initially land on one leg. During this phase, the knee stops the body from falling all the way to the ground and softens the ground reaction force. Stand on one foot on a slightly elevated surface (a stair, a book–whatever height isn’t uncomfortable to complete the exercise). Bend the knee until the free foot reaches the ground, then straighten to return to the starting position. Keep the hips level and the knee tracking straight (rather than inward) as you complete the exercise. Do 3-4 sets of 10-15 reps, 3-4 times per week.
  • Increase your forward trunk lean when you run. Leaning slightly forward shifts the work to your hip and reduces stress on the knee. As an added bonus, a slight forward lean (shoulders should be in front of your hips) also makes for more efficient running. To practice this, stand on one leg (as if you’re running) about a foot away from a wall. Practice leaning forward until you feel the point where you just start to lose your balance, then catch yourself on the wall. This point simulates your optimal trunk position when running. Repeat finding that position 10 times on each leg. Then repeat the drill 10 times on each leg again but with eyes closed to help solidify where that point is.


  • The most common knee pain with running is pain around or beneath the kneecap, called patellofemoral pain.
  • Noisy knees do not mean further damage.
  • Hip strength, quad strength, and altering gait mechanics help improve knee pain in runners.
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Here at Peak Endurance Performance & Physical Therapy we help active adults in the Madison Area get back to the activities they love without pain or limitations. We see people of all ages, ability levels, and individuals trying to get back to a multitude of movements including: getting back into running, women postpartum, CrossFit athletes, climbers, gymnasts, wrestlers, overhead athletes, and your recreational weekend warrior. If you’re looking to get back to the activities that give you meaning, relieve stress, and make you feel like you again, feel free to reach out below and we’ll see if we’re the right fit for you.