If your knee hurts when you run, climb stairs, or squat, your first instinct may be to focus on the knee. But sometimes, the bigger picture includes what’s happening at your hip.
Patellofemoral pain, often called runner’s knee, is pain around or behind the kneecap. It is common in runners and can make everyday activities, including climbing stairs and sitting for long periods, uncomfortable.
Although the pain occurs at the knee, effective treatment often involves more than the knee itself.
1. Your Hip Helps Control Your Knee
Your hip muscles help control your pelvis and thigh as you run, land, and change direction. In particular, the hip abductors and external rotators contribute to controlling lower-extremity movement.
Research has found associations between patellofemoral pain and factors such as altered movement patterns and reduced hip strength in some individuals. However, these findings don’t mean that weak hips cause every case of knee pain.
Running mechanics are complex, and pain can be influenced by several factors, including strength, training history, tissue capacity, and the demands placed on the knee.
The takeaway? Your knee doesn’t work in isolation.
2. Strengthen More Than Just the Knee
When runners experience knee pain, strengthening the quadriceps is often an important part of rehabilitation. These muscles help manage the forces placed on the knee during running and other activities.
But strengthening the hips can also be beneficial.
A well-rounded program may include:
- Hip strengthening: Side steps with a resistance band, side-lying hip abduction, or single-leg exercises.
- Quadriceps strengthening: Squats, step-ups, or controlled knee extensions.
- Movement control: Single-leg squats or step-downs, adjusted to your current ability.
- Gradual return to running: Building mileage and intensity as symptoms and capacity allow.
The best exercises depend on your symptoms, current strength, and tolerance. You don’t need to perform every exercise at once. Consistency and appropriate progression matter more than having a complicated routine.
3. Check Your Training Load
Strength isn’t the whole story. Sometimes, the knee is simply being asked to do more than it can currently tolerate.
Think about what has changed recently:
- Have you increased your weekly mileage?
- Have you added speed work or hill repeats?
- Have you started running more frequently?
- Have you returned to training after time off?
A sudden increase in training demands can outpace your body’s ability to adapt.
Temporarily reducing mileage, speed, or hills may help calm symptoms while you build strength and gradually restore your running tolerance. The goal isn’t to avoid loading the knee forever. It’s to find a manageable level of activity and progress from there.
4. Focus on Capacity, Not Just Pain
Pain is one piece of the puzzle, but your long-term goal should be to improve your ability to tolerate running.
That means considering three things:
- Strength: Can your hips and thighs generate and control force?
- Movement: Can you perform running-related tasks with adequate control and without significant symptom aggravation?
- Load: Does your current training match your body’s capacity?
Addressing only one factor may not be enough. Stronger muscles won’t necessarily solve knee pain if your training load remains excessive, and reducing mileage alone may not restore the strength needed to handle your usual running routine.
When Should You Get Your Knee Evaluated?
If knee pain keeps returning, limits your running, or makes stairs and daily activities uncomfortable, a physical therapist or sports medicine clinician can help identify the factors contributing to your symptoms.
Not all knee pain is runner’s knee. Swelling, locking, instability, significant pain after an injury, or an inability to bear weight warrant prompt medical evaluation.
The Bottom Line
Knee pain doesn’t always mean the knee is the only place that needs attention.
For runners with patellofemoral pain, combining quadriceps and hip strengthening with appropriate training-load management can be an effective approach. The key is to understand what your body can tolerate now and build toward the demands you want to handle later.
Don’t just chase the pain. Build the strength and capacity that help you keep running.
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