Whether you are preparing for your first 5K, returning to running after a break or increasing your weekly mileage, knee pain can quickly interrupt your progress.
One of the most common problems runners experience is runner’s knee, a term often used to describe pain around or behind the kneecap. In many cases, this is known clinically as patellofemoral pain.
The good news is that there are several practical steps you can take to reduce your risk of developing runner’s knee, including managing your training load, strengthening the muscles around your hips and knees, allowing enough recovery and responding early to warning signs.
However, no single exercise, running shoe or training rule can guarantee that runner’s knee will never occur. Current research suggests that prevention is more complex than following one universal formula.
This guide explains what runners can realistically do to keep their knees healthy and when physiotherapy may help.
What Is Runner’s Knee?
Runner’s knee usually refers to pain at the front of the knee, particularly around or behind the kneecap.
The medical term commonly associated with it is patellofemoral pain syndrome (PFPS) or simply patellofemoral pain.
Typical symptoms may include:
- A dull ache around or behind the kneecap
- Pain during or after running
- Discomfort when climbing or descending stairs
- Pain during squats or lunges
- Aching after sitting with the knee bent for a long time
- Occasional clicking or cracking around the kneecap
Patellofemoral pain is particularly associated with activities that repeatedly load the knee while it is bent, including running, jumping, squatting and using stairs.
Importantly, not every case of knee pain in a runner is runner’s knee. Tendon problems, meniscal injuries, ligament injuries, osteoarthritis and other conditions can produce knee symptoms too.
Can Runner’s Knee Be Prevented?
You can reduce some of the factors associated with runner’s knee, but it cannot always be completely prevented.
There is no single proven prevention programme that works for every runner. Recent research looking specifically at risk factors and prevention strategies found that many approaches have not demonstrated consistent effects on preventing patellofemoral pain across all populations.
That does not mean prevention strategies are pointless.
Instead, it means runners should focus on sensible principles that improve their overall ability to tolerate running:
- Increase training gradually.
- Build hip and knee strength.
- Allow adequate recovery.
- Avoid repeatedly running through increasing pain.
- Use comfortable, appropriate footwear.
- Introduce hills, speed sessions and longer distances progressively.
- Address recurring symptoms before they become persistent.
1. Avoid Doing Too Much, Too Soon
One of the most important things you can do is manage how quickly your running changes.
Runner’s knee frequently appears after a sudden increase in activity. This could involve increasing:
- Weekly mileage
- Running frequency
- Running speed
- Hill training
- Interval sessions
- Race preparation
- The length of your long run
A sudden change in training frequency, duration or intensity is recognised as a common contributor to patellofemoral pain.
Build your running gradually
If you have just started running, returned after an injury or taken several weeks off, avoid trying to immediately return to your previous training volume.
Instead, give your body time to adapt.
For example, before increasing your long run, you might spend several sessions becoming comfortable with your current distance.
The NHS similarly advises runners to increase distance and intensity gradually rather than making large jumps in training.
Do you need to follow the 10% rule?
You may have heard that mileage should never increase by more than 10% each week.
Although this can provide a simple framework, there is no universal percentage that is appropriate for every runner.
A beginner completing two short runs per week has very different requirements from an experienced marathon runner.
Pay attention to:
- Your current fitness
- Previous running experience
- Injury history
- Sleep and recovery
- Other sports and exercise
- How your knee feels during and after running
Your total physical workload matters more than one number.
2. Strengthen Your Hips and Knees
Running involves absorbing and producing force thousands of times during a typical session.
Strong muscles help your body manage those demands.
For people experiencing patellofemoral pain, exercise programmes targeting the knee are strongly supported, with hip exercises often incorporated depending on individual needs. The 2024 best-practice guidance for patellofemoral pain places exercise therapy and education at the centre of management.
The American Academy of Orthopaedic Surgeons also highlights conditioning of the quadriceps, hip abductors and hip external rotators when managing and reducing recurrence of patellofemoral symptoms.
Useful areas to strengthen include:
- Quadriceps
- Gluteal muscles
- Hamstrings
- Calf muscles
- Hip stabilisers
- Examples of strengthening exercises
Depending on your current ability, exercises might include:
- Squats
- Sit-to-stands
- Step-ups
- Split squats
- Lunges
- Bridges
- Calf raises
- Single-leg balance exercises
- Controlled single-leg squats
You do not necessarily need a complicated gym programme.
Regular, progressive strengthening that becomes more challenging as you improve is generally more useful than repeatedly performing very easy exercises.
NHS guidance also recommends exercises that strengthen the muscles supporting the knee for runners.
If you already have knee pain, the most appropriate exercises and loading level may be different, so consider having them assessed by a physiotherapist.
3. Give Your Body Time to Recover
More training is not always better training.
Running places stress on muscles, tendons, bones and joints. Your body adapts to that stress during recovery.
Training hard every day without allowing enough recovery can make it more difficult to tolerate your overall workload.
Your running schedule might therefore include a combination of:
- Running days
- Strength-training days
- Easier sessions
- Rest days
- Low-impact exercise
You do not necessarily need to avoid running on consecutive days if you are accustomed to doing so. The important point is that your training should be appropriate for your current conditioning and ability to recover.
Sleep, nutrition and general stress can also influence how well you recover between sessions.
4. Warm Up Before You Run
You do not need an elaborate 30-minute warm-up before every easy run.
However, starting with a short period of lower-intensity movement can help prepare your body for the demands ahead.
The NHS recommends approximately 5 to 10 minutes of brisk walking or gentle jogging as a way to warm up before running.
Depending on the type of session, your warm-up could include:
- Brisk walking
- Easy jogging
- Controlled squats
- Leg swings
- Calf raises
- Gentle running drills
A faster interval or hill session will usually benefit from a more progressive warm-up than a relaxed recovery run.
5. Be Careful When Adding Hills and Speed Work
Running uphill, downhill or at a faster pace changes the demands placed on your legs.
That does not mean hills or intervals are bad for your knees.
They are valuable parts of running training.
The problem often comes when several new demands are added at once.
For example, imagine increasing your weekly mileage while also introducing:
- Hill repeats
- A new speed session
- A longer weekend run
Your knee is now being asked to tolerate several training changes simultaneously.
A better approach is to introduce changes progressively so you can see how your body responds.
6. Wear Comfortable Running Shoes
There is no single running shoe that prevents runner’s knee for everyone.
Your shoes should primarily be:
- Comfortable
- Suitable for running
- In reasonable condition
- Appropriate for the surface you normally run on
The NHS recommends using suitable running shoes and notes that expensive footwear is not necessarily required for beginners.
If your current trainers are worn out or consistently uncomfortable, replacing them may be sensible.
However, repeatedly buying new shoes is unlikely to solve persistent knee pain if the underlying issue relates to training load, strength or another physical factor.
Do you need special insoles?
Not necessarily.
Foot orthoses may be appropriate for some people with patellofemoral pain, but they are not required by every runner. Best-practice recommendations favour tailoring supportive treatments such as orthoses to the individual rather than using them routinely for everyone.
7. Listen to Early Warning Signs
One of the most useful habits for runners is learning the difference between ordinary training discomfort and pain that is progressively worsening.
Pay attention if knee discomfort:
- Appears earlier during each run
- Becomes more intense from week to week
- Persists after running
- Interferes with stairs or everyday activities
- Is still noticeably worse the following day
- Changes your running technique
- Makes you reduce weight through one leg
Do not wait until you can barely run before changing your training.
Sometimes temporarily reducing the distance, frequency or intensity of running is enough to allow irritated tissues to settle while you work on strength and rehabilitation.
Patellofemoral pain management commonly involves adjusting activity while gradually rebuilding tolerance rather than simply avoiding movement indefinitely.
8. Don’t Assume Complete Rest Is Always the Answer
When knee pain develops, runners often make one of two mistakes:
Mistake one: continuing exactly the same training despite increasing symptoms.
Mistake two: stopping all physical activity for weeks and hoping the problem disappears.
The best approach is often somewhere in between.
Depending on your symptoms, you may be able to temporarily reduce running while maintaining fitness through activities such as:
- Cycling
- Swimming
- Walking
- Strength training
- Cross-training
AAOS guidance suggests temporarily changing aggravating activities and using lower-impact exercise where appropriate when dealing with patellofemoral symptoms.
The aim is usually to return gradually to the activity you actually want to do.
9. Progress Strength Training Too
Just as your running needs to progress, your strengthening programme should progress.
If you complete exactly the same easy exercises for months, your muscles have little reason to become stronger.
Progress could involve:
- Increasing resistance
- Adding repetitions
- Increasing the range of movement
- Moving from double-leg to single-leg exercises
- Increasing movement control
- Adding running-specific movements
The progression should still be manageable.
For someone already experiencing patellofemoral pain, NHS musculoskeletal guidance commonly recommends exercises that are challenging but manageable and progressively increased as they become easier.
10. Don’t Obsess Over Perfect Running Technique
There is no single perfect running style.
Runners naturally differ in:
- Stride length
- Foot strike
- Cadence
- Leg alignment
- Arm movement
- Trunk position
Some runners with persistent patellofemoral pain may benefit from gait retraining, but this should usually be based on an individual assessment rather than trying to copy somebody else’s running form.
Clinical guidelines recognise gait retraining as a potential intervention for selected runners with patellofemoral pain.
Changing your technique unnecessarily can simply transfer load somewhere else.
If your running style is pain-free and working well for you, there may be no reason to dramatically change it.
What About Running Cadence?
Cadence is the number of steps you take per minute.
Increasing cadence slightly can alter running mechanics in some runners, and gait retraining may sometimes be incorporated into physiotherapy for patellofemoral pain.
However, every runner does not need to reach the same cadence, and there is no magic number that guarantees injury prevention.
If cadence or running technique appears relevant to your knee symptoms, it is better considered alongside:
- Training load
- Strength
- Mobility
- Running history
- Current symptoms
rather than treated as an isolated solution.
A Simple Weekly Knee-Strength Routine for Runners
For a runner without an existing knee injury, a basic strength routine might include:
Squat or sit-to-stand
Targets the quadriceps and gluteal muscles.
Step-up
Develops single-leg strength and control.
Split squat
Challenges the hip and knee through a running-relevant position.
Calf raise
Strengthens the calf complex, which plays an important role in running.
Bridge or hip-strengthening exercise
Develops the muscles around the hips and pelvis.
You might perform strength work two or three times per week, depending on your training schedule and experience.
This is a general example rather than a personalised exercise prescription. If an exercise causes significant or increasing knee pain, stop and seek appropriate professional advice rather than repeatedly pushing through it.
How Do I Know If I’m Increasing My Running Too Quickly?
There is no perfect formula, but your body often provides useful feedback.
Signs that you may need to reduce or adjust training include:
- Pain increasing from run to run
- Persistent soreness the following day
- Reduced ability to complete usual daily activities
- Increasing stiffness
- Needing to alter your running style because of pain
- Declining performance despite increasing effort
Try to look at your overall training pattern, rather than one isolated session.
If Saturday’s run caused no symptoms but your knee became painful after several harder sessions close together, cumulative workload may be relevant.
Can I Run With Runner’s Knee?
If running is producing clear knee pain, continuing to increase your mileage is usually not a sensible strategy.
NHS advice recommends avoiding running with a painful knee and seeking assessment if symptoms persist.
That does not necessarily mean you need months away from running.
Depending on the cause and severity, a physiotherapist may help you:
- Reduce training temporarily
- Identify a tolerable running level
- Build strength
- Address movement or load-related factors
- Gradually return to your usual distance
- Reintroduce speed and hills
The appropriate plan differs from person to person.
What Should You Do If Runner’s Knee Has Already Started?
If you are already experiencing pain around the kneecap, prevention advice alone is no longer enough.
Start by reducing activities that repeatedly aggravate the knee.
Then consider:
- Reviewing recent changes in training.
- Temporarily reducing running volume or intensity.
- Maintaining appropriate physical activity where comfortable.
- Beginning suitable hip and knee strengthening.
- Gradually rebuilding running tolerance.
- Getting assessed if symptoms persist or repeatedly return.
Exercise therapy and education are central components of contemporary best-practice treatment for patellofemoral pain.
When Should You See a Physiotherapist?
Consider a physiotherapy assessment if:
- Knee pain repeatedly returns when you run
- Symptoms have not started improving after modifying your training
- Pain is affecting stairs, squatting or everyday movement
- You are unsure which exercises are appropriate
- You are returning to running after an injury
- Your knee pain is limiting your training for an upcoming event
- You want help progressing safely back to your usual distance
At Amesbury Physiotherapy, an assessment can look beyond the painful area and consider factors such as your training history, strength, movement, current running demands and rehabilitation goals.
For runners in Amesbury and the surrounding Wiltshire area, physiotherapy can also help create a structured return-to-running plan rather than relying on repeated cycles of resting and restarting.
When Should Knee Pain Be Checked More Urgently?
Runner’s knee usually develops gradually, but not all knee pain should be assumed to be a running overuse problem.
Seek appropriate medical advice promptly if you experience:
- Severe knee pain
- Significant swelling
- Inability to put weight through the leg
- A major traumatic injury
- A knee that repeatedly gives way or locks
- Rapidly worsening symptoms
- Feeling generally unwell alongside a hot or swollen knee
The NHS advises seeking medical assessment when knee pain is severe or associated with significant swelling.
Frequently Asked Questions About Preventing Runner’s Knee
What is the best way to prevent runner’s knee?
There is no single guaranteed method. A sensible approach is to build running gradually, maintain hip and knee strength, recover adequately, wear comfortable running shoes and respond early if pain begins to increase.
What causes runner’s knee?
Runner’s knee can have multiple contributing factors. Sudden changes in running volume or intensity, reduced muscle capacity and repetitive loading of the patellofemoral joint may all be relevant.
Does strengthening prevent runner’s knee?
Strengthening the muscles around the hip and knee is strongly supported as part of managing patellofemoral pain and maintaining physical capacity. However, research does not show that one strengthening programme can guarantee prevention in every runner.
Are squats good for runner’s knee?
Squats can be a useful strengthening exercise for many runners. If you already have knee pain, the appropriate depth, resistance and volume will depend on how irritable your symptoms are. Exercises should be progressed according to your individual tolerance.
Should runners strengthen their glutes?
Hip and gluteal strengthening is commonly included in programmes for runners with patellofemoral pain, particularly alongside knee-focused exercise.
Do running shoes prevent knee pain?
No shoe can guarantee that you will avoid knee pain. Comfortable, appropriate running shoes are sensible, but training load, conditioning and recovery also matter.
Should I stretch before running?
A short warm-up is useful before running. You do not need an extensive stretching routine to prevent runner’s knee, but mobility work may be appropriate when a specific restriction is relevant. The NHS recommends beginning with several minutes of brisk walking or gentle jogging.
Is runner’s knee the same as arthritis?
No. Runner’s knee commonly refers to patellofemoral pain, which is different from osteoarthritis. Pain at the front of the knee can have several causes, which is why persistent symptoms should be assessed rather than self-diagnosed.
How long does runner’s knee take to improve?
Recovery varies considerably. Some people improve relatively quickly after adjusting their training, while others need a longer period of progressive rehabilitation. NHS musculoskeletal guidance notes that meaningful improvement from exercise rehabilitation may take several weeks and sometimes around 12 weeks or longer.
Should I completely stop running if my knee starts hurting?
If running clearly aggravates your knee, reducing or temporarily stopping painful running may be appropriate. Complete inactivity is not always required, and alternative exercise or a reduced running load may be possible depending on your symptoms. A physiotherapist can help determine an appropriate level.
Key Takeaways: How to Reduce Your Risk of Runner’s Knee
If you want to keep running while looking after your knees, focus on the fundamentals:
- Build your mileage and intensity gradually.
- Strengthen your hips, thighs and calves.
- Give yourself enough recovery between demanding sessions.
- Introduce hills and speed work progressively.
- Wear comfortable running shoes appropriate for your activity.
- Do not repeatedly run through worsening knee pain.
- Adjust training early if symptoms appear.
- Seek physiotherapy advice for persistent or recurring knee pain.
There is no perfect running technique, magic shoe or single exercise that makes runner’s knee impossible.
The aim is to develop a body that is strong enough and well conditioned enough to tolerate the running you want to do.
Keep Running With Confidence
Knee pain does not automatically mean that running is bad for your knees or that you need to give up the sport you enjoy.
Often, the solution is understanding why your knee is struggling with its current workload and then progressively rebuilding its capacity.
If knee pain is affecting your running, training or everyday activities, Amesbury Physiotherapy can assess your symptoms, identify relevant contributing factors and help you work towards a safe return to running.
This article provides general information and is not intended to diagnose an injury or replace individual medical or physiotherapy advice.
