How to Banish Patellofemoral Pain Syndrome for Good

In 2012, just months before that year’s Olympics, 800-meter runner Nick Symmonds felt a sharp pain under his kneecap. There had been no traumatic event. It just flared up one day during a regular training run. With a little trial and error, he quickly found that his pain abated when he ran at faster speeds. So he cut back on his mileage, and did all his easy runs at a quicker pace. Within a few weeks, he was pain free and on his way to racing the 800-meter final in London. 

“I didn’t see a doctor—I could just kind of tell that it didn’t hurt running fast, so I picked up my speed,” Symmonds says. “I’m old-school like that.” He had self-diagnosed his condition as runner’s knee—or patellofemoral pain syndrome—a common injury in runners across all different levels.  

Although Symmond’s treatment plan is far from the norm, all runner’s knee cases aren’t created equal. There’s no definitive cause for the pain, making its rehab complicated. Nor is there any one way it presents, so it has essentially become a catch-all term for when the kneecap or the surrounding area twinge and bark during your run. Sometimes the pain can be strong enough to stop you in your tracks; in other instances, it's just enough to nag you for months on end. 
 
Variation aside, there are some measures you can take to treat and ultimately prevent runner’s knee. We talked to Michael Conlon, owner of Finish Line Physical Therapy in New York City, to mine the best advice on getting you back to 100 percent for good.  

What It Is

Normally, your kneecap moves smoothly along a groove in your femur bone every time you bend your knee. If it gets off track, your kneecap will twist and torque the tendons underneath it. That’s what causes pain under or around the knee, Conlon says. 

Even at its worst, the pain outweighs the structural damage being done. Simply inflaming the tendons likely won’t cause long-term or permanent harm, says Conlon. But even if you can run through the pain, it’s best to get treated rather than continually toughing it out. You could be changing your stride to overcompensate for the discomfort, a surefire way to injure another part of your body. 

The Cause 

Usually the root problem is a combination of inflexibility, weak muscles, or imbalances that are totally separate from the knee itself.  “It’s not really an issue at the knee in terms of biomechanics,” says Conlon. “Typically your knee is structurally sound, but a mobility or strength discrepancy anywhere from your spine to your foot throws it off track during movement.” 

Overuse can exacerbate these imbalances. Ramping up your miles quickly or suddenly, running at the same pace all the time, wearing the same shoes, or running on the same surfaces can all trigger patellofemoral pain, because your body isn’t equipped to take on the increased load. 

The Signs 

If you feel localized pain underneath or even around the kneecap while running, chances are you’ve joined the ranks of runner’s knee sufferers. But you could feel it during your workday, too—usually when you walk downhill or down stairs or sit too long at a desk with your knees bent. “It’s hard to isolate,” Conlon says. “People often say it feels like their kneecap is floating. That’s inflammation of the tissues around the kneecap.”

The Cure

Good news: it’s almost always treatable. But Symmonds’s experts-only method of running faster isn’t the recommended solution for most.

Consider taking a hiatus from running for a couple days, or at least backing off your mileage or pace. If you don’t give the inflamed tissue a break, you’ll likely just make the pain worse. “If your pain is moderate to severe at the beginning of a run, then don’t even start,” Conlon says. “You’re better off doing something that’s pain free, like the elliptical or the bike.”

Use the rest days to see a doctor of physical therapist. They can prescribe a therapy program specific to your case to expedite recovery. If you can’t get an appointment right away, Conlon recommends the following broad tips.  

Heat: If you don’t have severe acute pain, steer clear of icing. Cold restricts blood flow, which you need for tissue to repair itself. Heat, such as warm baths or heating pads, are a better idea.  

Rolling: Myofascial release with a foam roller improves flexibility, as it unlocks your hips and releases tightness in muscles. That increased mobility allows the rest of your body to move as it should to help get the knee tracking properly.

Sports massage: Similar to rolling, deep-tissue release through massage or Active Release Therapy lets an expert identify specific spots—or adhesions—where your muscle isn’t moving efficiently and could be compromising your stride. 

Prevention

First, sit less. It keeps the hips tight, which can prevent the patella from tracking in the joint properly. 

Second, add some variety to your footwear and runs. Rotate between several different pairs of shoes, change your speeds and distances, and run on varied surfaces. “Speed work is a great way to alter your biomechanics. As you run faster or slower, your gait changes so you maintain fluidity and openness in all your joints. You get more flex in the knees and bigger range of motion in your hip,” says Conlon. 

Third, learn to love your floor. Foam roll regularly and incorporate exercises, like the ones below, that focus on smaller muscles and change your range of motion to address imbalances and weakness. 

Exercises

For lasting biomechanical change (and improved injury protection), add these exercises to your regular workout routine a few times per week. 

Forward lunge and overhead press: Lunge forward with right leg bent to 90 degrees. Hold the position and raise your right hand (dumbbell optional) over your head. Push right hip out towards your right side slightly and tilt torso inward. Then alternate sides. Do ten reps on each leg. 

Single-leg stance and rotational reach: Put your right hand on your right hip and move your left foot a half-step back. Squat halfway down, bearing most of your weight on right leg, while bringing your left hand across your body, rotating hips and trunk. Three times on each side counts as one rep. Do one set of ten reps per side.

Single-leg stance and lateral reach: Put your right hand on your right hip and move your left foot a half-step back. Squat halfway down, bearing most of your weight on right leg, while holding your left arm sideways and parallel to the ground. Three times on each side counts as one rep. Do one set of ten reps per side. 

Pivot lunge and reach: Start with feet shoulder-width apart and your hands above your head. Lunge with your left foot back and rotate both arms across your body to the left. In one continuous motion, step into a backward lunge with your right foot leading, and pass both arms to your right as you do so. Four steps counts as one rep. Do one set of ten reps. 

Lunge matrix: Lunge forward with your right leg, then twist arms and torso to the right. Step back to the starting position, then lunge laterally to your right, again twisting both arms and torso to right. Return to starting position, then lunge backward while twisting both arms and hips to right. Then return starting position. Perform this matrix for one minute, doing three minutes on each side.