Stop trying to convince yourself knee pain is a normal part of running! That aching pain just means I am working hard, right? Everyone’s knees hurt after sitting for long periods of time, I think? Knee pain when running hills or squatting is normal?

That deep ache you feel deep inside of your knee could be caused by a condition called Patellofemoral Pain Syndrome (PFPS). Pain is caused by abnormal tracking of the kneecap (patella) in the front of the knee leading to abnormal friction between the kneecap and the thigh bone (femur). While there is some argument among doctors and researchers on what leads to the abnormal tracking, the friction between these bones in PFPS is most frequently attributed to the following three problems.

Knock Knees (Genu Valgum):

For those of us who have knees that point slightly inward, this allows the quadriceps muscle to pull the patella towards the outside of the knee leading to rubbing in the joint. 

Flat Feet (Pes Planus):

When people have flat feet this leads to rotation of the leg bone (tibia) below the thigh bone (femur). This results in abnormal tracking of the kneecap.   

Weakness of Quadriceps Muscle:

The quadriceps is composed of 4 muscles. Weakness of one or more of these muscles can lead to poor tracking of patella.


What do you do if you think you have this problem?

  • First of all, take it easy. Pain is not a normal part of any training program. Relative rest is important. Pain is usually pretty predictable with this condition the pain usually begins after overuse, so rest before it becomes painful. 
  • Try another form of cardio like swimming, biking or the elliptical.
  • Run on soft, more forgiving surfaces like a rubber track. 
  • Keep your affected knee(s) extended when at rest. Knee flexion can cause pain when at rest. Get up and walk around every once and a while.
  • See a professional. Some knee pain can be caused by more serious conditions within the knee that can be diagnosed by a physician.
  • Icing knee for 20 minutes after exercise and taking anti-inflammatories can reduce swelling and pain but does not treat cause of condition.
  • Orthotics! Orthotics can be helpful to support those with fallen arches when placed in appropriate running shoes.
  • For those with week quadriceps muscles or knock knees, strengthening of muscles can often help reduce rubbing in knee and improve tracking.   
  • Strengthening and stretching. General quadriceps strengthening can be performed by extending the knee and holding muscle contraction for 10-20 seconds and repeat 10 times each leg. It is very difficult to isolate one muscle of the quadriceps. Hamstring stretches can also be helpful for those with tight hamstrings which can lead to abnormal pressure to the patella during exercise.
  • Weightlifting can be helpful if it isolates the quadriceps muscle. Avoid exercises like squats which can aggravate condition.
  • Support. Knee supports designed to alter abnormal patellar movement are available, however, their effectiveness is controversial. Physical therapists and trainers can also tape the knee to reduce friction.

If you are suffering knee pain don’t wait until it is too late to see a professional. Untreated PFPS can lead to more serious conditions that can lead to permanent cartilage damage. 

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