Runner's knee (patellofemoral pain): exercises that help

How it is recognisedStrong evidence

The JOSPT guideline grades pain reproduced on squatting as the main diagnostic test. Stairs, running, jumping and long sits with the knees bent are the other usual triggers.

Sources 4, 5, 2

It does not always go away on its ownEmerging evidence

In one long-term follow-up, 57% of those who replied reported an unfavourable recovery 5 to 8 years later. Only 19% of the original group replied, so treat that figure with care; 98% of those X-rayed had no arthritis. Having pain for more than 12 months at the start predicted a poorer outcome.

Source 11

Weak hips: a common story that is not provenMixed evidence

Hip weakness did not predict later kneecap pain in a meta-analysis of 18 prospective studies; thigh weakness did, in military recruits. Hip exercise still reduces kneecap pain. So do the hip work, without assuming weak hips caused the problem.

Sources 13, 6, 8

Exercise reduces kneecap painStrong evidence

Both international consensus statements say exercise reduces pain in the short, medium and long term and improves function. A Cochrane-based review of 31 trials (1,690 people) found very low-quality but consistent evidence.

Sources 2, 3, 7

Combine hip and knee exercisesStrong evidence

The consensus statements and the JOSPT guideline (grade A) recommend hip and knee exercises together in preference to knee exercises alone. Hip work should target the side and back of the hip. Knee work can be standing, such as squats, or seated, such as resisted knee extension.

Sources 2, 3, 5, 6

Hip work first may ease pain a week soonerEmerging evidence

In a 6-week trial of 199 people, a hip-focused programme reduced pain a week sooner than a knee-focused one. The guideline suggests hip work may take priority early, which is why stage 1 below starts there.

Sources 5, 8

For runners, managing training load matters as much as exercisesEmerging evidence

In 69 runners over 8 weeks, education on managing symptoms and training load did as well alone as with added exercise or with gait retraining. Exercise did raise strength, and gait retraining did change running mechanics, but neither added symptom relief.

In 151 adolescents aged 10 to 14, four weeks of reduced activity guided by pain, then home exercise, then a planned return to sport, left 86% of those who answered reporting success at 12 weeks. There was no comparison group.

Sources 9, 10, 5

Shallow squats and part-range extensions load the kneecap leastEmerging evidence

In a lab model of 10 healthy people, stress behind the kneecap was lower in squats from about 45° of bend to straight, and in seated knee extensions from 90° to 45°. The plan uses those ranges first.

Source 12

Insoles and tape: short-term help for someMixed evidence

Off-the-shelf foot insoles are recommended for short-term relief, alongside exercise, for up to 6 weeks; the guideline aims them at people whose feet roll in more than usual. The average effect may be too small to matter, and responses vary a lot.

Kneecap taping may give short-term relief alongside exercise, but its value as a first treatment is unclear.

Sources 2, 3, 5

Load first: cut back just enough

Before adding exercises, trim running distance, hills, stairs, deep squats and long sits with your knees bent, just enough that daily pain stays within the pain rule. Keep moving; avoid total rest.

Sources 5, 9, 10

What the guidelines advise against

Knee, kneecap or lower back mobilisation on its own and electrotherapy are not recommended. The JOSPT guideline advises against knee braces, sleeves and straps, and against dry needling.

Sources 2, 3, 5

Stretches are optionalMixed evidence

Calf, quadriceps and hamstring stretches are fine if they feel good. Tightness in these muscles has been linked with kneecap pain, but the guideline lists stretching only as an add-on to exercise. The knee pain hub has a table of which stretch suits which pain.

Sources 5, 14, 15, 16