Patellofemoral pain syndrome is a mouthful to say but an accurate description of what structures are involved in the condition more commonly referred to as “runner’s knee.”
Although runner’s knee is the terminology used for many different types of knee injuries, it is only genuinely related to one condition that affects your knee cap (patella) and your thigh bone (femur) and how they move.
Runner’s knee is not patellar tendonitis, IT band syndrome, or knee joint arthritis.
If you’re a runner dealing with pain around your knee cap that you can’t figure out and won’t go away with rest, then this article will provide essential information on what causes runner’s knee and, more importantly, provide five exercises you can use to eliminate the root cause of your knee pain.
Let’s dive right in!
What Causes Patellofemoral Pain Syndrome?
Patellofemoral pain syndrome is caused by increased force and pressure between your patella and the trochlear groove of the femur when running.
When properly aligned, these two structures glide while spreading the force across the joint surface. The more contact or congruency your patella has with the femur, the less pressure you’ll feel while decreasing the risk of injury.
In a healthy non-injured knee, your top thigh muscle, the quadriceps, will contract to press the patella into the groove on the femur. This action helps you to generate and accept force while running and reduces stress on the two structures. Additionally, your buttocks muscles, gluteus maximus, and medius will contract to keep your thigh and leg in proper alignment.
Runner’s knee develops when there is poor alignment between your pelvis, hip, knee, and ankle.
The altered alignment will reduce the contact area between the patella and femur, increasing pressure on the region that remains in contact. The poor alignment won’t cause problems immediately but will begin to wear down the joint surfaces over time. Repetitive stress due to increased pressure on the joint causes runner’s knee pain.
Therefore, solving runner’s knee pain has to address the root cause of the altered lower extremity alignment with running.
What Causes Poor Lower Extremity Alignment in Running?
Researchers previously believed that your patella moved on top of the femur. They also thought tightness in your lateral quadriceps and the distal IT band would pull on the patella and tilt it laterally. They also believed that your medial quadriceps, when weak, would allow the patella to move laterally.
Although this theory makes logical sense, recent research has shown a different mechanism that alters lower extremity alignment.
Altered lower extremity alignment happens due to the movement of your femur under the patella, not the other way around. With runner’s knee, your femur will often move toward the midline of your body and rotate inwards. The stationary patella will slide outward as the femur moves and turns inward.
This picture of a runner demonstrates what it looks like when the femur rotates inward during running.
Have you tried to tape your patella before runs to reduce pain? Taping your patella is a common strategy to minimize runner’s knee pain. Although taping temporarily relieves pain, it fails to address the root cause of the problem.
To address the root cause of runner’s knee pain, you need to activate, strengthen, and improve the function of your gluteus maximus and medius muscles.
Biomechanically, when your foot hits the ground while you run, the gluteal muscles activate to help slow the inward rotation of your femur. Runner’s knee pain primarily arises due to runners not knowing how to “turn on” their gluteal muscles. The lack of gluteal activation and strength creates an overuse of the quadriceps, which adds compression to the patella in the altered alignment, further driving up the pain.
The “fix” for runner’s knee is to learn to “turn on” your gluteal muscles and then learn to use them in running specific motions. By activating your gluteal muscles, you will be able to keep proper lower extremity alignment which will reduce pressure under your knee cap and solve your runner’s knee pain.
The 5 Exercises To Solve Patellofemoral Pain Syndrome
Exercise #1
Kneeling Fire Hydrant
This exercise activates the gluteus maximus muscle in three different ways.
Moving your leg behind you, away from your body, and by rotating away from your body, you “turn on” all three parts of the gluteal muscle. These are also the motions that are opposite of what happens with alignment that causes runner’s knee.
The key to this drill is holding the position for 30-60 seconds for two repetitions.
Holding your muscle contracted will remind your brain where the muscle is and how to use it. Holding the fire hydrant drill will help re-wire your neuromuscular system so that you can access your gluteal muscles while running.
Exercise #2
Side Lying Abduction Hold
The side-lying abduction hold exercise specifically targets the gluteus medius. This muscle sits on the outside of your hip and is directly responsible for controlling pelvic drop and whether your femur moves during running.
This exercise works on the same concept as the kneeling fire hydrant to re-wire your motor pathways.
Hold this drill for 30-60 seconds and perform two repetitions.
Exercise #3
Side Plank Clamshell
The clamshell is a widespread exercise, and you’ve probably done it in rehab, but you’ve probably done it for repetitions. The clamshell is one of the best exercises to get your gluteal muscles to activate to control and prevent internal rotation while running.
By holding this exercise isometrically, you activate the external rotation fibers of your gluteus maximus while also incorporating your oblique core muscles.
Hold this drill for 30-60 seconds for two repetitions.
Exercise #4
Runner’s Lunge
Optimizing your alignment while running is something that takes practice. Just “turning on” your glutes isn’t enough. You need to learn how to use your gluteal muscles while running!
The Runner’s Lunge is a drill designed to help you move through a running-specific motion while focusing on your alignment. Additionally, this exercise trains hip and knee bending to aid shock absorption, reducing impact forces during running.
As you get used to this exercise, you can add speed so that the drill more closely resembles running form.
Perform 10-15 repetitions on each leg for two sets
Exercise #5
Quick Squat Drop
The quick squat drop is all about learning to land softly. This exercise will help you quickly bend your hips and knees while keeping good lower extremity alignment, promoting loading through your leg muscles versus the knee joint. This exercise works quickly to help you reduce pressure at your patellofemoral joint by learning to use a “hip hinge” versus running with an upright posture.
Perform 10-20 squat drops for two sets
Next Steps
These five exercises will help treat the root cause of patellofemoral pain syndrome. As you build your skill in doing these exercises, you can transfer that movement knowledge to running itself.
Watch the video above for specific instructions on how to perform these essential runner’s knee pain exercises.
Now, work on these drills to return to long runs and hitting PRs!
