This common overuse injury comes down to muscle weaknesses.

One of the most common injuries in runners and other athletes alike causes pain right behind and around the knee cap. It’s known as patellofemoral pain syndrome or better known as “runner’s knee” thanks to the prevalence of it among runners. “This injury is usually due to movements that load the knee joint on a flexed position,” says Kim Kaiser, M.D., an assistant professor of orthopaedic surgery and sports medicine at the University Kentucky and team physician for UK athletics. 

Any time you hit your stride, you add impact to a bent knee as you take that leap forward, and this is what can cause the pain, especially if your mechanics are off. Running stairs and doing squats can cause the same reaction. In fact, a telltale sign of runner’s knee is more pain when you’re running downstairs or descending steep hills, Kaiser says. 

The good news: Runner’s knee isn’t a structural problem, meaning your ligaments and cartilage are OK, Kaiser says. The problem lies in how your muscles function through the repeated movement of a run. 

“Patellofemoral pain is most often a result of abnormal mechanics caused by problems up- or downstream from the knee, forcing the patella to bump against the femoral groove,” says William Roberts, M.D., professor of family medicine and community health at the University of Minnesota and a past president of the American College of Sports Medicine. Think of it like a train car: The patella is like a train on the femoral groove railroad track, says Roberts. When the train and track don’t run smoothly against one another, pain occurs. 

The most common culprit of this uncomfortable rubbing is muscle weakness and tightness around the legs and core. Here, we outline where those issues occur, plus what you can do to remedy it. 

Cause: Weak Hips and Inner Quads

“Runners have strong hip flexors and usually weaker posterior hip muscles, like the gluteus medius,” Kaiser says. With weakness in this area, the femur tends to rotate inward, making the patella strike the edge of the femoral groove, causing pressure and pain, Roberts explains. “But by building these muscles you can keep the femur from rotating inward during the weight-bearing phase of your running gait,” he says. 

Solution: Strength Exercises

Kaiser offers these exercises for a mini strength routine that targets all the right muscles to keep your knee and hip in proper alignment. Do them as bodyweight-only or use a resistance band around your thigh, right above the knee joint. Aim for three sets of 15 reps each. 

Clamshell: Start lying on one side, propped up on your forearm, shoulder over elbow and hips stacked. Externally rotate top hip while lifting top knee toward the ceiling, while feet stay glued together. Lower back down and repeat.

Donkey Kick: Start on all fours, shoulders over wrists and knees right under hips. Extend one leg up and back, raising it to hip height with foot flexed. Press heel toward the ceiling, making sure back stays flat and knee points straight down. Lower back to hip height and repeat.

Fire Hydrant: Start on all fours, shoulders over wrists and knees right under hips. Keeping knee bent 90 degrees, lift it out to the side and up toward the ceiling. Make sure you don’t drop into the opposite hip. Lower back down to the floor and repeat. 

Straight Leg Raise: Sit or lie faceup, legs straight out. Lock out leg as you lift it straight up toward the ceiling. Hold for three to four seconds, then lower back down and repeat. The key is to keep the leg totally straight. You can make sure you’re working the vastus medialis oblique (VMO)—that inner thigh muscle you’re targeting—by placing your hand on the muscle above the knee, slightly toward your midline. It should activate while you lift and hold your leg.

[Blast through a series of HIIT sessions to boost running strength and prevent injury with the IronStrength Workout.]

Cause: Tight Hamstrings or Hips

While weak muscles can cause a misalignment in running form that leads to knee pain, so can tight muscles. Typically, runners will find this limited range of motion in their hamstrings or hips, Kaiser says. 

Solution: Stretch and Foam Roll

The best way to avoid and treat tightness is by working on overall flexibility—in other words, stretching and foam rolling every day, Kaiser says. To stretch your hamstrings, simply lie on your back and pull one leg gently back toward your chest. For your hips, perform a running lunge: With one foot in front, place the opposite knee on the ground and press your hips forward, engaging through your back glute.

To get into your piriformis—the small muscle under the glute max that helps with hip rotation and can also cause tightness—do a figure four stretch. Lying on your back, cross left ankle over right knee, grab the back of the right thigh and pull it toward your chest. 

Using a lacrosse ball or tennis ball to roll out the posterior glute muscle, IT bands, quads, and hamstrings is also a good idea, Kaiser says.

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