Runner’s Knee: Why It Happens and How to Fix It (Before It Runs You Out of the Game)

You laced up, hit the trail, and now your knees are filing a formal complaint. If you’ve been sidelined by an achy, nagging pain at the front of your knee — especially during or after runs — you might be dealing with runner’s knee.

Officially called patellofemoral pain syndrome (PFPS), it’s one of the most common reasons runners swap their training schedule for an ice pack.

The good news? You can tackle it head-on with a bit of body awareness, targeted strengthening, and smarter running mechanics. The better news? No medical degree required — we’ll keep the anatomy simple and the advice actionable.

What Exactly Is Runner’s Knee?

Your knee is essentially a hinge joint — like a well-oiled door… until it’s not. The kneecap (patella) sits in a groove on the thigh bone (femur) and slides up and down when you bend and straighten your leg.

Trouble starts when that kneecap doesn’t track smoothly. Think of it like a train being pulled off its tracks — uncomfortable, noisy, and not great for long-term travel. The “off track” pull often comes from muscle imbalances or lower limb alignment quirks.

Two Sneaky Culprits: Weak Glute Meds and Foot Pronation

1.       Weak Gluteus Medius

This outer hip muscle keeps your pelvis steady and your thigh in line. If it’s weak, your thigh can drift inward every time you land, dragging your kneecap with it.

2.       Foot Pronation

When your arch collapses inward as you run or walk, your lower leg tilts in, adding even more stress to the knee — like misaligned car wheels wearing down your tires.

Put the two together, and you’ve created the perfect storm for kneecap irritation.

Two Quick At-Home Tests

No expensive equipment necessary — just a mirror, some water, and an open mind.

1. The Mirror Squat Test (Glute Med Check)

• Stand in front of a mirror, feet hip-width apart.

• Squat slowly as if sitting in a chair.

• Watch your knees.

  
  

If they collapse inward, your glute meds may be underperforming.

2. The Wet Foot Test (Arch Check)

• Wet the bottom of your bare foot.

• Step onto dry concrete or cardboard.

• Step away and check your footprint.

  
  

A normal arch leaves a crescent-shaped print with some space on the inside. The width of the ball of your foot should be about twice as wide as the arch of your foot. If the ball of your foot and arch are nearly the same width or you see your whole foot, you likely have low arches or overpronation.

Fixing the Problem: Strength, Stretch, and Support

Clamshell Exercise (for glute med strength)

• Lie on your side, knees bent, feet together.

• Lift your top knee while keeping your feet touching and hold at the top for 3 seconds.

• Lower slowly back down to start position.

  
  

Do: 2–3 sets of 12–15 reps per side.

Pro tip: Keep your hips stacked and don’t roll back — this is hip work, not a side-lying nap.

Runner’s Stretch for the Gastroc (for calf flexibility and better foot mechanics)

• Stand facing a wall with one leg forward and one back.

• Keep your back leg straight, heel on the ground.

• Lean forward until you feel a stretch in your calf.

  
  

Hold: 30 seconds, repeat 2–3 times per side.

When Orthotics Might Help

If your arches collapse like a beach umbrella in a windstorm, shoe inserts (orthotics) may help. But skip the one-size-fits-all versions — see a physical therapist or orthotist for a proper evaluation.

Running Form Faults That Can Make It Worse

Even strong hips and stable arches can’t save you if your running form is working against you. Keep an eye out for:

• Overstriding: Landing with your foot too far ahead of your body.

• Excessive bounce: Too much vertical motion wastes energy and pounds the joints.

• Crossover gait: Feet crossing your midline like you’re tightrope walking.

• Low cadence: A slower step rate increases impact per stride; aim for around 170–180 steps per minute as a starting point.

The Bottom Line

Runner’s knee is common, but it’s not a career-ending diagnosis. By spotting weak links — literally — and addressing muscle imbalances, foot mechanics, and running technique, you can get back to pain-free miles.

Your knees aren’t plotting against you; they’re just sending a “maintenance required” alert. Listen now, and you’ll thank yourself at your next finish line.

Check out my knee pain tracker in the Toolbox if you want to really dig in as to what is working (and not) for your particular knee pain situation.

Stay Well & Feel Good,

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Hi! I am Dr. Kim MacDonald. I am a physical therapist who specializes in empowering my patients to optimize how they move their bodies and improve their ability to do the things they love regardless of age, experience, or capabilities.

 My experience in the health care field allows me to teach the tools you need to ensure that you are working safely to improve your pain and maximize your physical potential.

If you would like to know more about how you can help yourself be healthier and live a more active lifestyle, join me here.