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Runner's Knee: Exercise or Rest, Which is Best?

By: Nancy Howard : 11/18/2009 4:51:47 PM : 44 comments : 11,146 Views

Ask any runner, or non-runner for that matter, what one of the most common running injuries is and invariably many will mention patellofemoral pain syndrome (PFPS)--AKA runner's knee. It has been reported that as many as 70% of all runners will suffer at least one injury in their running careers, but this should not be a deterrent to anyone who is contemplating taking up running. With proper education and knowledge many people can run without incidence for years.

It was once believed that the high impact of running led to a greater incidence of pre-arthritis or osteoarthritis of the knee, but research has revealed that is no longer the case. Runners are at no greater risk than the general population to develop arthritis of the knee. In fact, according to an article published in the October 2007 issue of Runners World running can actually strengthen the connective tissues--ligaments, tendons--and muscles that support the knee, as a result the risk of doing damage to the cartilage, which is the main cause of osteoarthritis, is reduced.

But what happens if you develop a wonky knee? Should you embark on a rehab program designed to strengthen the knee or should you err on the side of conservative treatment and allow rest and time to heal?

In a recent study published in the October 2009 issue of the British Medical Journal, researchers compared the outcomes of participants with patellofemoral pain syndrome who underwent physical therapy and exercise treatments to other participants suffering as well, but who were instructed to rest.

The study participants ranged in age from 14-40 and all had been diagnosed with patellofemoral pain syndrome via their general practitioner or sports medicine doctor. All had to meet at least three criteria for PFPS, such as pain walking up or down stairs, pain upon squatting or running or from sitting for prolonged periods of time with knees flexed. Their symptoms had to have persisted for at least 2 months but no more than 2 years without any other underlying medical conditions such as osteoarthritis or patellar tendinopathy.

Researchers assigned some participants to an intervention program where they worked with a physical therapist for 6 weeks to help them develop the muscles-- quadriceps, glutes, and adductors--necessary to support the knee. The study subjects were also given instructions regarding PFPS and at home exercises to help improve knee function. The control group was instructed to rest and avoid physical therapy during the study period, however, they too were given instructions on at home exercises they could do for PFPS.

The researchers concluded that those participants who received the supervised physical therapy reported less pain during activity and at rest while experiencing better knee function at 3 months even though they were not completely healed from their injury. After a year, the exercise supervised group still reported less pain than the control group.

So what does this actually mean for you if you suffer from runner's knee?

Exercise seems to help lessen the pain associated with runner's knee, something I discovered in my own personal journey dealing with issue early on in my own running career. My running coach developed an in depth strength training program consisting of squats, hip adductions exercises and one of the best exercises for runners the single leg squats with toe touch.

It is important to note, however, if you are a runner suffering from knee pain, it is imperative that you receive proper diagnosis from your doctor or a sports medicine specialist. Never assume that every pain in the knee is runner's knee. Because the knee is a very complex joint, it is always best to have any prolonged pain checked by your doctor to rule out a more serious medical condition that can be aggravated by running or with exercise.

Have you suffered from runner's knee? If so, what measures did you take to resolve the matter? Would the risk of developing runner's knee keep you from taking up the sport of running?

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Comments (Scroll to end to leave a comment)

SM-ARTGIRL 2/11/2010 9:46:09 PM	Though active, I had problem knees as a young adult, then on and off for most of my adult life. After a fall in 2006, I had a chronic knee condition for over 12 months that really got me down I can tell you! I tried osteopathy, remedial sports therapy, rest, cycling, swimming. What has really worked is gaining confidence with weight and resitstance equipment. Somehow, since I joined curves several months ago, I have NO knee pain. This week I am finally able to begin running without pain. I am doing alternate days and following the c25 program.	44
SOREKNEE1 11/30/2009 8:26:13 PM	Help needed!!! I am currently training for a 2.4 km run in 11.30.I can do the distance but after doing some grueling physical work drainlying, my knees feel really sore wher i try and run.Pains below the knee to the left.So its the inside below the patella.Tendonitis.Really painful if i run on it.What exercises can one do to alleviate the pain and how long can it take to heal with rest.I have no pain when walking only if i try and run...Both knees are saw, but i would say the right one is worse.Any help would be good on this.My email is wayne.parfitt@xtra.co.nz thanks	43
BANANIE41 11/24/2009 8:30:44 AM	I have and have found a couple of things that help it to heal or stretch it - working out on the elliptical and also doing one of the weight machines and for the life of me I can't think what it is...but they both seem to help.	42
TERRI77 11/23/2009 12:30:31 PM	I've had knee pain for a few days and was able to run through it, and knee pain for several weeks that didn't go away until I rested it for about 2 weeks while on vacation. Definitely persistant pain should be attended to.	41
MARATHONMOM26.2 11/23/2009 1:34:40 AM	I have been diagnosed with this, as well as some other (associated but unique) issues with my knee. I have tried resting and I have tried PT and exercise. I find that what I do varies based on how I'm feeling. The most important thing I've learned is to listen to my body. There are good weeks and bad weeks, but I haven't quit running! Its been 6 months now and I do wish I were better already, but I guess this takes time to heal...	40
ETCHILDE 11/22/2009 1:53:04 PM	I remember running track in high school. My knees hurt a lot. Maybe this is what was happening to me. I assumed it was because I was training hard for high hurdles.	39
YANSKA 11/20/2009 9:17:22 AM	Great article. I'm at the beginning of my jogging career and have had a little bit of pain in my left knee. I'd love to head problems off at the pass, and this article will help me do that. Thank you! On to my first Turkey Trot on Thanksgiving! Woo hoo!	38
RWILLIAM56 11/20/2009 9:10:42 AM	I found this out before the article came out in Runners World. My right knee gives me all kinds of trouble when I DON'T run! When my knee acts up, I have to remember that it's telling me to get out there and run--just a couple of miles, and it doesn't hurt at all the next day. Everyone keeps telling me I need to stop running, and I just ignore them (politely, of course!).	37
BENJAMINSBABY 11/20/2009 12:41:51 AM	I have an injured knee right now and since it hurts too much to run, I am currently doing lower-impact exercises like water aerobics and the elliptical. I also wear a knee brace, which helps a little.	36
ROYALETBONE 11/20/2009 12:37:29 AM	I don't know if I ever had 'runners knee'- I've suffered various ailments off and on for years. , as I dislocated my knee when I was a teen. Now I have arthritis in all my joints. Sigh. As they say, motion is the lotion. I've learned over an over an over that I have to exercise to be able to have a full and happy life. I'm just starting to do a bit of jogging- but the key, key element for me is doing the other exercises- lunges, and squats, and keeping very strong quads and etc. Working on stretches (slow, slow), seems to keep me more injury free. That said- I just took a tumble on Halloween, and am pleased that I'm back at it all. Hooray for underlying health!	35
GLOW8211 11/19/2009 9:03:12 PM	I have been having problems with my knees, but I'm finding the more I walk, etc. the better they are starting to feel. THANK YOU ALL FOR SHARING! MAYBE ONE DAY I CAN RUN A MARATHON, TOO!! :-) I SURE WOULD LOVE TOO!!	34
PLUMBUNNY 11/19/2009 7:51:43 PM	When my knee acts up, I take it easy. No running. But the stationary bike seems to relieve the pain so I can run again.	33
MRS.DOYLE 11/19/2009 2:21:36 PM	Just slightly off topic....I damaged a knee cap by falling over. The pain lasted for a year. Then I started jogging and the pain gradually eased until it has now completely gone. I think I have strengthened the leg muscles to such an extent that they have taken pressure of my knee and allowed it to heal.	32
MYSPARKS7 11/19/2009 1:55:44 PM	Yes, I work with a physical therapist who helped me.	31
LIGHTNINGRUNNER 11/19/2009 11:36:50 AM	I have runner's knee. I currently am wearing the cho-pats bands under the knee cap on both of my knees. This helps so much for the tracking of the knee cap. I am printing this out for my 16 yo daughter has the same issue but due to marching band which is very physical.	30
BUTTERRUM163 11/19/2009 10:28:01 AM	Have been having a little achy pain in my left knee. I have just started running again and am hoping that the pain goes away. If not I do have a Dr. apptmt coming up in the 1st of Dec. will have it checked then.	29
OMRIS99 11/19/2009 10:24:40 AM	I had a major knee injury from a fall, completely unrelated to running, but have been getting back on my running schedule slowly. The physical therapy was what helped the original injury heal the fastest, and it improved more quickly once I started being active again. This research makes perfect sense to me.	28
LAURIE5658 11/19/2009 10:09:40 AM	I have been very fortunate so far in my newbie running career as I have not suffered any knee problems thus far...knock on wood. Piriformis issues perhaps that was cleared up with new running shoes, but no knee issues. If i should start to develop knee problems, this article is very informative and will help me pursue the correct direction to take. Thank you, Nancy!	27
MRSMITH04 11/19/2009 10:06:53 AM	I must agree with the the comment from #14. We MUST be sure that what we are suffering from is "runner's knee" not something more serious. While training for a half marathon, my wife was suffering from knee pain that was getting progressively worse. After a "runner's knee" diagnosis from her doctor, and his clearance to work through the pain, she kept running. After continued pain, she got a second opinion and found a stress fracture in her tibia just below the tibial head behind the insertion of her patella tendon. Continuing to run could have caused the bone fragment to displace which would have required surgery and most certainly done severe soft tissue damage in her knee. Potentially sidelining her for months. The lesson here is be sure of what you have before you "work through" the pain. Get the proper pictures taken, an X-Ray didn't show her fracture, an MRI was needed. So insist on proper follow through from your doctors.	26
IMJUSTFLUFFY 11/19/2009 10:04:40 AM	I'm having problems with right knee...it started with sharp stabbing pains in right side/front & then I started walking more than usual & it developed into more pain, then swelling! I am trying to keep it straight now & I hobble around here which has started pain in my back now! Every time I walk on unlevel ground it causes more problems! Just try going to the toilet & keep your leg straight! HA...doesn't work too good! Patience is not my virtue so this is really depressing as I was so happy when I actually walked 3 miles and now I'm down to 0. Everyone tells me to ice it! I'm not into ice...it tenses up my muscles so tight that it causes more stress! So, I'm practicing "patience"...I guess it's time I learned it! ha ha	25
EMLG11 11/19/2009 9:56:05 AM	I started having a lot of knee pain after I started exercising. I was doing primarily elliptical. I started trying to balance moving forward and backward more and now have minimal to no pain. I have also added in more leg strengthening moves like the ones noted above.	24
JUICYSWEETS 11/19/2009 9:50:48 AM	I tore my meniscus three years ago and had surgery. My dad just tore his last year and thick headed like he is he waited till the summer to have surgery. Running every day until his knee would be stiff as a board when it wasn't in motion.	23
ARCHIMEDESII 11/19/2009 9:50:34 AM	Oh yeah... I've had runner's knee and every other knee problem out there. ugh... a long time ago, I tore my ACL. As a result, I've had off/on problems ever since. It took a long time to recover. When I was running, I was alright most days. Every now and then, I would have a flare up with my knee and I would lay off running to allow the knee to recover. Knee injuries are the worst !	22
CHRIS3215 11/19/2009 9:47:26 AM	I dont have runners knee. BUT if I dont use my treadmill & or treadclimber. I get water on both of my knees which is very painful & I cant stand or put any pressure on them at all. So keeping active I have to do.	21
LOVEPAINTING 11/19/2009 9:32:19 AM	I already have the osteoarthritis in both knees - so running will just hurt more. I try to do very fast paced walks instead.	20
JESS5280 11/19/2009 9:26:37 AM	I had runner's knee or rather patella tendonitis. It was so painful! I went to physical therapy twice a week leading up to my marathon and once a week for another month and a half after. Stopping running completely for about a month and really focusing on my lower body strength has really helped me. Hopefully I'll run pain free during my next marathon.	19
REESE1004 11/19/2009 9:03:14 AM	Great article. I am actually suffering from runner's knee right now, and had to undergo physical therapy. Within one or two sessions the constant pain in my knee started to subside. I do the exercise given to me at home one a day and what use to be constant pain is now occasional. I am happy to learn that physical therapy does indeed help with improving this condition and one could be back to running in no time.	18
WENDYRS 11/19/2009 8:50:29 AM	I have always been worried about the damage I've done to my body, having been 400 pounds for many years. Now that I'm down to 165, I'm trying to strengthen the muscles around my knees with the elliptical, walking, biking, hiking, stretching...anything that I can do to prepare my knees for what I'm ready for now: running. I am hoping to get to the gym more often this winter, and really gear up in the spring for some "real" running. I am hoping that this regimen will keep me from enduring any knee pain. But yes, fear of knee pain (and foot and ankle pain) has kept me from running for many years!	17
TIAGAYEPFA 11/19/2009 8:39:22 AM	I've been training for my first Half-Mararthon, which is this Sunday, and before this had never had knee pain. After my 10 mile training run, I had this weird pain and didn't run for 2 weeks. My next run was 11 miles, and at mile 7, I was in a lot of pain. I finished the run, but went to see a Sports Medicine doctor, who diagnosed it as Runner's Knee, gave me a brace to wear and I've been going to physical therapy for 4 weeks now, and continuing to run. I haven't had any pain in the last week. I've been doing all the stretching exercises, and getting in a whirlpool once a week. The doctor said she was glad I came in at the first signs of pain instead of waiting! So I hope to run my 13.1 miles this Sunday with little pain, or I'll be running through the pain!	16
JESSE-BIRD 11/19/2009 8:31:52 AM	I started this year suffering with runner's knee. I went through 5 very painful months. My doctor says stretch, stretch, stretch. It most definitely helps. In 2008 I tore my achilles tendon. My doctor said my tendons are over worked, over stretch. I need to stretch my muscles. Not just a 2 second bounce stretch. I hold each stretch for about 2 minutes. I now do extensive stretches every day, usually twice a day. I am a runner, a cyclist, a tennis player. I want to stay active. I am amazed at how the stretching has helped me to stay injury free. Every time I get injured, I sit on the couch and eat from depression. That's when I gain weight. The older I get, stretching is very important for me to stay active.	15
JMONTIE 11/19/2009 7:53:44 AM	In the past, I've worked for an orthopedist. Getting the proper diagnosis is very important. There's just no way the average person can self diagnose and come up with the proper course of action.	14
ETHEL_MERMAID 11/19/2009 7:44:12 AM	Great advice, Nancy! I have a host of problems deriving from my crooked pelvis, and I rely on my orthopedist's advice. The biomechanics of the knee, ankle and foot are related to the hip's, or as the ol' song goes: "With the leg bone connected to the knee bone, and the knee bone connected to the thigh bone, and the thigh bone connected to the hip bone. Oh mercy how they scare!" And that's why I take 'em all to the doc!	13
DIANE1253 11/19/2009 7:12:20 AM	I walk, not run due to feet problems	12
LILASIAGO 11/19/2009 12:04:47 AM	I was having IT band pain and bought a foam roller. My knees have felt great since I started using it for just five minutes after my runs.	11
AHHGEE 11/18/2009 11:38:16 PM	I don't have a runner's knee - I just have an old knee! It is the bane of my existence! I have never liked running, not because of concern for my knees, but because of my bra size. :-/	10
MRSKRISTINA 11/18/2009 10:51:01 PM	Oh my gosh, I have suffered from this since high school. I first noticed it when going up and down stairs, but it got to the point where I couldn't sit cross-legged for very long at all. I have started taking glucosamine and chondroitin and have really focused on strengthening my legs and core- I cannot believe the difference. My knees don't make the horrible cracking/grinding noise they used to (well... not nearly as much) and I feel much stronger. I had always been afraid of over-exerting my knees and injuring it further, but after a professional's advice, I now realize that I need to strengthen the surrounding muscles to take the pressure from my knee.	9
SCATTERBOLT 11/18/2009 10:42:15 PM	I've had a variety of knee pain, but it's always been relieved by stretching/strengthening my quads, switching shoes and slowing down! I'd love to see a similar article on plantar fasciitis and achilles tendonitis!	8
SARBAH77 11/18/2009 9:45:43 PM	I've been diagnosed with Runner's Knee in both knees. The irony, of course, is that I have arthritic damage in my right knee. Those of us with chronic and constant knee pain often feel that Runner's Knee is the modern day "tendonitis" diagnosis. "We don't know what's wrong. Take some pain meds and go to PT." It's frustrating, in a lot of ways, and this article certainly doesn't indicate how vague a diagnosis it is. In addition, it has come and gone and I've never really received permanent relief. However, almost six weeks ago, I underwent a high tibial osteotomy in order to shift the load bearing from the damaged part to the undamaged part. I am curious to see if, once I'm fully recovered, I ever deal with runner's knee again.	7
GIANNA345 11/18/2009 9:32:52 PM	No. I haven't had knee problems yet, and yes, I do plan to keep running, as soon as my stress fracture heals. I'll try to incorporate some of the exercises you recommended in the hope that I won't develop knee problems. Thanks, Nancy! Janet	6
LORI-LU 11/18/2009 7:39:12 PM	After years of running leading to my training for a marathon this year, I finally began to suffer from knee pain. I was diagnosed with Runner's Knee. Weeks of PT didn't help. I got an MRI and the result was severe osteoarthritis in both knees�bone on bone in the left. The Xray and MRI show that my knee caps genetically do not track in the femoral groove. I would caution people to consult a Sports Medicine doctor BEFORE they start running to see if their knees are predisposed to getting arthritis. There are many other non-weight-bearing, lower-impact exercises that are less harmful: cycling, swimming, walking, rowing. Be smart; not stoic. Don't run through pain. Some amount of discomfort is to be expected when going from couch to running, but alarm bells should go off if your joints ache while you're not running, ache in the morning; prevent you from sitting on your knees, etc.	5
KKLENNERT809 11/18/2009 6:53:17 PM	I have knee pain from time to time, but I don't think its runners knee. If it ever would get painful enough, I would be seen by a dr.	4
JUHOEG 11/18/2009 6:29:54 PM	I do a lot of walking because I am afraid to damage my knees by running.	3
NOGAINER 11/18/2009 6:11:51 PM	love em	2
ELAINEKIDO 11/18/2009 5:03:02 PM	so this is what I have because my is giving me hell for the past month and I went to the doctor on monday did an xray and what was the result Osteoarthritist of the knee or running 's knee I always run on the treadmill or on the beach, so what the doctor say walk in the pool for 30 min and ride the bike for as long as I can,and rest I start to do that so I hope it help,	1