If you’ve been sidelined by that nagging ache around the front of your knee—especially after a long run, a hike, or even climbing stairs—you might be dealing with Runner’s Knee.
Also known as patellofemoral pain syndrome (PFPS), Runner’s Knee is one of the most common overuse injuries we treat at Next Level Physio. But here’s the good news: it’s not a life sentence. And with the right approach, it doesn’t have to keep you from chasing your next goal—whether that’s a personal best or simply running pain-free again.
Let’s break it down.
What Is Runner’s Knee?
Runner’s Knee is a general term for pain around the kneecap, especially where the kneecap (patella) meets the thigh bone (femur). You’ll usually feel discomfort during or after running, when going downstairs, or when sitting for long periods with your knees bent.
But here’s the catch—while the pain shows up in the knee, the root cause is almost always somewhere else.
What’s Causing the Pain?
Runner’s Knee isn’t just a knee problem—it’s a body problem. While the symptoms present at the front of the knee, the real issue often lies in how the rest of your body moves—or doesn’t move—well enough to support you.
Let’s look at the most common causes in active adults:
Training Volume Spikes
Doing too much, too soon is one of the biggest culprits. That could mean increasing your weekly mileage too fast, throwing in extra speed sessions without a base, or suddenly adding more hills. Your joints and soft tissues need time to adapt. When the load increases faster than your body can recover, your knees are often the first to complain.
As a rule of thumb, keep mileage increases under 10 percent per week. And always pay attention to what your body is telling you—not just during your run, but the day after too.
Faulty Running Form
No runner has “perfect” form—but if your knees collapse inward, you’re overstriding, or your stride feels off, those small inefficiencies can cause big problems over time. Poor control during mid-stance and push-off can increase patellofemoral joint stress and lead to that persistent pain you can’t quite shake.
These issues usually stem from weaknesses higher up the chain—weak hips, poor glute activation, lack of core control, and misalignment between your ribcage and pelvis (your “stack”).
If the foundation is off, your stride suffers—and your knees absorb the consequences.
Muscle Imbalances (Especially at the Hips)
This is where things really start to click.
Research consistently shows that hip weakness—not knee weakness—is a primary driver in Runner’s Knee. The gluteus medius and external rotators are especially important. These muscles help control the alignment of your leg when your foot hits the ground. If they’re not doing their job, your knee collapses inward with every step.
That repeated stress adds up fast. And no amount of stretching or foam rolling will fix it unless you address the underlying strength and control issues.
How We Fix Runner’s Knee at Next Level Physio
At Next Level Physio, our proven 3-phase system helps runners get back to doing what they love—often in as few as six visits.
Root Cause vs. Symptoms
Our detailed physio evaluation is crucial to uncovering why you’re in pain. In physical therapy, there are always two diagnoses to consider:
- Symptoms — the pain you feel and can point to
- Root cause — the underlying reason you have that pain
Treating just the symptoms is like replacing tires on a car when the real problem is a misaligned axle. You’ll keep having the same issue until the root cause is fixed.
Our 3-Phase Treatment Approach
Phase 1: Retrain the Brain & Get Rid of Pain
We use cutting-edge regenerative treatments like shockwave therapy (EPAT), e-dry needling, and blood flow restriction therapy to quickly control pain without meds or downtime. Early on, we retrain your brain away from bad movement patterns and faulty running mechanics.
Phase 2: Rebuild Strength and Control
Pain relief is only the start. Next, we focus on rebuilding strength and resilience—especially in the hips, glutes, patellar tendon, and core—to prevent pain from coming back. Our one-on-one strength coaching ensures you master the right movements with precise muscle activation. No guesswork here.
Phase 3: Reload With Performance-Based Training
With a strong foundation, we progressively guide you back to full running. This phase is designed for runners and hybrid athletes who want to get stronger, move better, and stay injury-free for the long haul.
6 Key Exercises for Runner’s Knee Treatment and Pain Relief
You don’t need a laundry list of exercises—you need the right ones. Below are three of our Phase 1 and three Phase 2 exercises that we rely on daily in clinical practice. These moves are backed by research and proven results.
Phase 1 Exercises: Calm Pain and Restore Muscle Control
1. Clamshells, But Done Right
Target muscles: Gluteus medius, hip external rotators
Why: Rebuilds lateral hip stability, critical for proper knee tracking.
- Lie on your side with knees bent to 90 degrees.
- Keep your feet together and slide your top knee slightly forward.
- With a resistance band on tension, raise the top knee like a windshield wiper—keep hips stable and heels together.
Reps: 3 sets of 15–20 per side
Frequency: 2–3 times per week
[Insert video demo here]
2. Isometric Standing Hip Abduction
Target muscles: Glute medius
Why: Activates hip muscles that help keep your knee aligned every step.
- Stand beside a wall, body aligned.
- Bend the knee closest to the wall, raise the foot on the same side.
- Push the knee into the wall as if pushing it away.
Reps: 3–4 sets of 30–60 seconds holds
Frequency: 2–3 times per week
[Insert video demo here]
3. Isometric Spanish Squat
Target muscles: Quadriceps and patellar tendon
Why: Strengthens quads without aggravating knee pain.
- Version 1: Loop a pull-up band behind your knees, lean back into a squat with vertical shins, and hold.
- Version 2 (no band): Stand with back of knees against the bottom of a chair seat secured against a wall, lean back into a suspended squat and hold.
Duration: 30–45 seconds per hold
Reps: 8–10 holds
Frequency: 2–3 times per week
[Insert video demo here]
How to Add These Phase 1 Exercises Into Your Week
- Running days: Use as a warm-up
- Non-running days: Complete a 12–15 minute standalone strength session
- Busy days: Do 1–2 exercises while watching TV or between meetings
Phase 2 Exercises: Build Resilience and Bulletproof Your Knees
Once you’ve mastered Phase 1, these progressions build serious glute and hip strength, reinforce knee stability, and reduce injury risk.
4. Bulgarian Split Squat with Hip Hinge
Target muscles: Quads, glutes, hamstrings, core (strong focus on glute medius)
Why: Builds single-leg strength and activates the posterior chain, taking pressure off the knee.
- Place one foot forward on the floor, heel down; rear foot on a bench, laces down.
- Hinge slightly forward at the hips, keep your core tight.
- Lower until back knee nearly touches the ground and front thigh is parallel to the floor.
- Drive through your front heel to stand.
Reps: 3–4 sets of 8–12 per leg
Frequency: 2 times per week
Pro Tip: Start bodyweight, add dumbbells or kettlebells as you get stronger. Control over speed is key.
[Insert video demo here]
5. Walking Lunge with Hip Hinge
Target muscles: Glutes, hamstrings, quads, core
Why: Mimics running mechanics and improves control, hip hinge shifts load off knees.
- Stand tall, feet hip-width apart.
- Step forward, landing with knee stacked over ankle.
- Slight hip hinge as you lower into the lunge.
- Drive through front heel and bring the back leg forward into next rep.
Reps: 2–3 sets of 10–20 steps (5–10 per leg)
Frequency: 2 times per week
Pro Tip: Maintain smooth control, start bodyweight, then add dumbbells once form is solid.
[Insert video demo here]
6. Single-Leg Dumbbell Hip Thrust
Target muscles: Gluteus maximus, hamstrings, core, spinal erectors
Why: Maximizes glute strength and size for power and knee stability with minimal joint stress.
- Sit on floor with upper back against bench, dumbbell on one hip.
- Plant feet shoulder-width apart with knees bent.
- Brace core, drive hips up until body is a straight line from shoulders to knees.
- Pause and squeeze glutes at top, then lower slowly.
Reps: 3–4 sets of 8–12 reps
Frequency: 2 times per week
Rest: 2 minutes between sets
Pro Tip: Start light or bodyweight. Avoid arching lower back. Progress by adding padding under foot or using a barbell later.
[Insert video demo here]
Key Takeaways from These Exercises
- All three Phase 2 exercises promote single-leg strength, pelvic stability, and glute dominance—the perfect combo to prevent and fix Runner’s Knee.
- The hip hinge in Bulgarian Split Squat and Walking Lunge shifts load to the posterior chain, sparing the knee.
- Hip thrusts safely and effectively build strong glutes without stressing knees or ankles.
- Incorporate these exercises 2–3 times per week to steadily build resilience. Remember: form always beats load.
Final Thoughts: Don’t Let Runner’s Knee Keep You on the Sidelines
Pain is your brain’s way of telling you something’s off. The longer you ignore it, the more likely it becomes chronic and threatens your running future.
The good news? Most Runner’s Knee cases are fixable—without surgery.
If you’re over 40 and serious about running pain-free for decades, treating strength and movement as part of your training is non-negotiable.
At Next Level Physio, with locations in Raleigh, NC, Cary, NC, Woodcliff Lake, NJ, and Montclair, NJ, we specialize in helping runners overcome knee pain and get back to their best.
Ready to get rid of your knee pain once and for all? Want to learn how to run stronger and smarter after 40?Subscribe to our YouTube Channel for exercise demos, expert tips, and inspiring success stories.