Stretches and Exercises to Treat and Prevent Runner’s Knee
Plus, runner’s knee anatomy, causes, symptoms and risk factors.
by Brad Walker | First Published June 2, 2006 | Updated May 26, 2021
Runner’s knee (medically known as Chondromalacia Patellae), is a condition where the articular cartilage, located underneath the kneecap (patella), starts to soften and break down.
The cartilage underneath the kneecap is usually smooth and allows the knee joint to move freely as the knee bends.
However, as chondromalacia patellae worsens, the cartilage begins to break down, causing irregularities and roughness on the undersurface of the patella, which leads to irritation and kneecap pain.
What causes Runner’s Knee?
The major cause of runner’s knee is overuse and doing activities that your knees are not conditioned for. Activities that involve a lot of running, jumping or rapid change of direction are particularly stressful to the knee joint. Participants of basketball, volleyball, skiing, soccer, tennis, and other running related sports are particularly vulnerable to runner’s knee.
Other factors also contribute to runner’s knee, including trauma to the knee; being overweight; pronation (inefficient foot mechanics); and inadequate warm up before exercise.
Although chondromalacia can occur to anyone at any time, there are two distinct age groups that are most susceptible.
- The over 40’s, where general wear and tear of the knee joint is occurring due to age and degeneration.
- Teenagers, (especially girls) where rapid growth is causing structural changes to the legs and knees.
Runner’s Knee Anatomy
The anatomical diagram below is a front-on view of the muscles, bones, tendons and ligaments that make up the knee joint. In the very center of both diagrams is the patella, or kneecap.
Below the kneecap, the patella is attached to the tibia (shinbone) via the patella ligament. Above the kneecap, the patella is attached to the quadriceps muscle via the quadriceps tendon.
As the muscles around the knee contract and relax, the patella moves over the knee joint. Located underneath the patella is the articular cartilage.
Signs and Symptoms of Runner’s Knee
The major symptoms of runner’s knee are pain and tenderness in the area around the kneecap. Activities like walking, running and especially squatting, kneeling or jumping will cause increased pain and discomfort.
Other signs and symptoms include rubbing or grinding of the kneecap when the knee is flexed and straightened. Sometimes it is also possible to hear a clicking sound as the knee is moved.
Runner’s Knee Treatment
The initial treatment for runner’s knee is the same as most other soft tissue injuries. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. It is critical that the R.I.C.E.R. regimen be implemented for at least the first 48 to 72 hours. Doing this will give you the best possible chance of a complete and full recovery. The following two points are of most importance.
- Rest & Immobilization: Once runner’s knee is diagnosed it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
- Ice: By far the most important part. The application of ice will have the greatest effect on reducing swelling and pain. Apply ice as soon as possible after the injury has occurred or been diagnosed.
During the first 48 to 72 hours after an injury like runner’s knee, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi’s and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the swelling and pain of your injury.
- The next phase of treatment (after the first 48 to 72 hours) involves a few physiotherapy techniques. The most common methods used to do this include ultrasound, heat and massage.
- Next, start to incorporate some very gentle range of motion exercises for the muscle groups around the knee. The buttocks, hamstrings, quadriceps and groin are a good place to start.
- Once most of the pain has been reduced, it is time to move onto the rehabilitation phase of your treatment. The main aim of this phase is to regain the strength, power, endurance and flexibility of the muscles and tendons around the knee.
Runner’s Knee Prevention
Although it is important to be able to treat runner’s knee, prevention should be your priority. So, what are some of the things you can do to help prevent runner’s knee?
- Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well-structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
- Avoid activities that cause pain: This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
- Rest and Recovery: Rest is especially important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
- Balancing Exercises: Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: – your body’s ability to know where its limbs are at any given time.
- Footwear: Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.
- Strapping: Strapping, or taping can provide an added level of support and stability to weak or injured knees.
- Strengthening: Instead of me trying to explain how to do strength exercises, I simply found some great YouTube videos (below) that have clear visual examples and good descriptions of how to perform exercises for the muscles around your knees.
- Stretching: To prevent runner’s knee, it is important that the muscles around the knee be in top condition. Be sure to work on the flexibility of all the muscle groups in the leg, especially the quadriceps and hip flexors. See the videos below for two great stretches for these muscle groups.
Kneeling Quad and Hip Flexor Stretch (1:20) Kneel on one foot and the other knee. If needed, hold on to something to keep your balance. Push your hips forward. Regulate the intensity of this stretch by pushing your hips forward. If need be, place a towel or mat under your knee for comfort. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.
Standing Quad and Hip Stretch (1:20) Stand upright while balancing on one leg. Pull your other foot up behind your buttocks and keep your knees together while pushing your hips forward. Hold on to something for balance if needed. Hold the stretch position for a minimum of 20 seconds and then repeat on the opposite side.
Research and References
- Bahr, R. Maehlum, S. (2004) Clinical Guide to Sports Injuries, 1st Edition (ISBN: 978-0736041171)
- Beachle, T. Earle, R. (2008). Essentials of Strength Training and Conditioning, 3rd Edition (ISBN: 978-0736058032)
- Habusta, S. Coffey, R. Ponnarasu, S. Griffin, E. (2020). Chondromalacia Patella. StatPearls Publishing, Jan 2021.
- Martini, F. Tallitsch, R. Nath, J. (2009) Human Anatomy, 9th Edition (ISBN: 978-013432076X)
- McConnell. J. (1986). The Management of Chondromalacia Patellae: A Long Term Solution. Australian Journal of Physiotherapy, 32(4): 215-223.
- Physiopedia contributors. (November 30, 2019). Chondromalacia Patellae. Retrieved May 26, 2021, from https://www.physio-pedia.com/Chondromalacia_Patellae.
- Tortora, G. Derrickson, B. (2009) Principles of Anatomy and Physiology, 14th Edition (ISBN: 978-1118866096)
- Vijayalakshmi, A. Sangeetha, S. Ranjith, N. (2019). Chondromalacia Patellae: A Review. Research J. Pharm. and Tech, 12(1): 412-418.
- Walker, B. (2018). The Anatomy of Sports Injuries, 2nd Edition (ISBN: 978-1623172831)
- Wikipedia contributors. (2021, April 2). Chondromalacia patellae, In Wikipedia, The Free Encyclopedia.
About the Author: Brad Walker is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon (author page) has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 1,000's of verified customer reviews. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.
Disclaimer: The health and fitness information presented on this website is intended as an educational resource and is not intended as a substitute for proper medical advice. Please consult your physician or physical therapist before performing any of the exercises described on this website, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain.