Runner's Knee: Why the Front of Your Knee Hurts and What Helps

A dull ache around your kneecap that shows up a few weeks into a new running plan is one of the most common complaints among beginners. It often has a nickname: runner's knee. The name is a little misleading, since cyclists, hikers, and skiers get it too, but runners are near the top of the list. Here is what it is and what helps, using MedlinePlus, the National Library of Medicine's consumer health site, and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS).

1. What runner's knee is

MedlinePlus files runner's knee under anterior knee pain: pain at the front and center of the knee. Its list of alternative names includes patellofemoral syndrome, chondromalacia patella, runner's knee, and jumper's knee. NIAMS describes runner's knee as pain or tenderness close to or under the kneecap, and notes it is common in runners but also affects people who hike or cycle.

To understand why it hurts, picture the joint. The kneecap (patella) sits over the front of the knee, and as you bend and straighten your leg, its underside glides over the bones of the knee. Two strong tendons hold it in place: the patellar tendon below it and the quadriceps tendon above it. MedlinePlus explains that anterior knee pain may occur when the kneecap does not move properly and rubs against the lower part of the thigh bone.

2. Why new runners get it

MedlinePlus lists several reasons the kneecap may not track well. The ones most relevant to beginners:

• Doing too much activity that stresses the kneecap, such as running or jumping
• Tight or weak muscles at the front and back of the thigh
• Muscle imbalance and a weaker core
• Flat feet or abnormal lower-leg alignment
• Excess body weight, which increases stress on the kneecap

MedlinePlus also says it is more common in people who increase their activity level or training intensity. That is exactly what a new running plan does.

3. What it feels like

According to MedlinePlus, anterior knee pain is a dull, aching pain felt in one or more places:

• Behind the kneecap
• Below the kneecap
• On the sides of the kneecap

A grating or grinding feeling when you bend the knee is common. Symptoms are often more noticeable with:

• Deep knee bends
• Going down stairs
• Running downhill
• Standing up from a squat, or after sitting for a while

That last pattern, pain when you stand after a long sit, is worth noting when you describe your symptoms to a provider.

4. What helps

MedlinePlus says anterior knee pain often improves with a change in activity, exercise therapy, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naproxen, and that surgery is rarely needed. Its list of self-care steps:

• Rest the knee for a short period.
• Change the way you exercise.
• Strengthen and stretch the quadriceps and hamstrings.
• Strengthen your core.
• Lose weight if you are overweight.
• Use shoe inserts or orthotics if you have flat feet.
• Tape the kneecap to improve how it tracks.
• Wear the correct running shoes.

5. What "change the way you exercise" can mean for a runner

MedlinePlus does not give a running plan, but its list points to a few practical adjustments to discuss with a provider:

• Reduce downhill running and stair work for a while, since both make symptoms worse.
• Avoid increasing your training quickly; NIAMS lists raising intensity too fast as a sports-injury risk factor.
• Swap some runs for lower-stress activity while you work on strength.
• Add thigh and core strengthening to your week, which matches the exercises MedlinePlus recommends.

6. When to see a provider

MedlinePlus says to contact your provider if you have symptoms of this disorder, and especially if your knee feels unstable or swells. During an exam, a provider may press on the kneecap, check its alignment, and ask you to do a single-leg squat to look at muscle balance and core stability. X-rays are often normal, and MRI is rarely needed.

NIAMS also gives a general rule for any sports injury: don't try to work through the pain. If a movement hurts, stop.

7. Key takeaways

• Runner's knee is pain at the front of the knee, behind, below, or beside the kneecap.
• It often comes from the kneecap tracking poorly, with tight or weak thigh muscles, a weak core, flat feet, or a fast increase in training.
• Downhill running, stairs, deep knee bends, and standing after sitting tend to make it worse.
• MedlinePlus says it usually improves with activity changes, exercise therapy, and NSAIDs; surgery is rare.
• See a provider if the knee feels unstable or swells.