Recovering from Runner’s Knee: A Guide to IT Band Syndrome, Patellofemoral Pain, and Patellar Tendinopathy

Introduction

Runner’s knee is a common issue among runners, causing pain that can sideline training and races. Whether it’s IT Band Syndrome, Patellofemoral Pain Syndrome, or Patellar Tendinopathy, addressing the root cause with proper rehab and training modifications is key to recovery. This guide will help you understand these injuries and provide actionable steps to get back on the road pain-free.

Many runners attempt to push through knee pain, but doing so can lead to chronic issues that require longer recovery times. By identifying symptoms early and implementing effective rehab strategies, you can minimize downtime and stay consistent with your training.

Understanding the Injuries

IT Band Syndrome (ITBS)

ITBS is characterized by pain on the outer knee, caused by compression between the iliotibial band and the femur. The iliotibial band is an extremely strong structure that provides protection and strength to our femur, stabilizes the knee, and is responsible for up to 14% of our energy storage and release when running. IT band pain often results from excessive mileage, increase in training volume or intensity and sometimes poor running mechanics. The pain is typically worse when running downhill or after prolonged running. ITBS is more common in males, endurance runners, novice runners and trail runners due to the narrow paths on trails. Left untreated, ITBS can lead to compensation patterns that contribute to hip or lower back pain.

Patellofemoral Pain Syndrome (PFPS or Runner’s Knee)

Often referred to as “runner’s knee,” PFPS presents as pain around or behind the kneecap. This condition is often aggravated by an increase in training load, prolonged sitting, squatting, or running, especially on hills or uneven surfaces. This condition is often found in females, or adolescents who specialize in sport early. People that have PFPS present with decreased quad and hip strength, this plays a key part in the rehab process. One of the #1 predictors of success in runners with PFPS is early treatment! PFPS is also a condition that is more likely to come back once you’ve had it already and will not go away on its own. 

Patellar Tendinopathy (Jumper’s Knee)

This condition affects the patellar tendon, leading to pain just below the kneecap. It is often caused by repetitive stress, inadequate tendon resilience, and sudden increases in training intensity. It is common in adolescent males and jumping athletes. Patellar tendinopathy pain is usually localized to the tendon itself and worsens with activities that require forceful knee extension, such as sprinting or jumping, however tends to feel better following a warm up. Proper loading strategies that gradually strengthen the tendon and muscles surrounding the knee are essential for recovery.

Rehab Strategies for Each Injury

Strength & Stability Focus

Running is a single leg activity! When we are running, we are absorbing 4-5 times our body weight through one leg at a time. If we are not able to properly absorb that amount of force repetitively over time, this can lead to increased stress on our knees and ultimately cause injury. Here are some areas you should focus on to improve your strength and in time, your ability to absorb and produce force when running. 

• Glute and Hip Strengthening: Weak hip muscles occur as a result of having knee pain. In order to prevent secondary injury, decrease pain, and return to running, hip strength is crucial. Here are a few examples of great hip strengthening exercises for runners: 

• • • Glute Bridge March
      

       

    • Wall Mini Band Fire Hydrant
      

       

    • Mini Band Lateral Walks
      
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• Quad and Hamstring Balance

• • • Goblet Rear Foot Elevated Split Squat
      

       

    • Single Leg Hamstring Bridge
      

• Isometric Holds: Especially in the beginning stages of recovery, isometric exercises can be extremely helpful at reducing tendon pain. We recommend 5 sets of 45 second holds to start. Here are some that may be helpful: 
  
  • • Decline (heels propped) Wall Sit
      
    • Kneeling Lateral Plank
      

       

    • Mini Band Double Leg Hip Extension Iso Hold
      

Mobility & Tissue Recovery

• Foam Rolling: You may have heard of foam rolling the IT band as an intervention for pain. However, the IT band is an extremely strong structure that can withstand over 2,000 pounds of tensile force without stretching. With that being said, foam rolling directly over your IT band isn’t going to do much, except cause tissue desensitization to pain. Instead, try rolling out the surrounding muscles such as the glutes, quads, hamstrings and calves to reduce tightness and improve tissue mobility. 
• Dynamic and Static Stretching: Incorporate dynamic stretches before running (such as leg swings and hip openers) and static stretches after workouts to improve flexibility. Pay special attention to the hip flexors, hamstrings, and calves, as tightness in these areas can contribute to knee pain.
• Soft Tissue Work: Manual therapy, including massage and instrument-assisted soft tissue mobilization (IASTM), as well as dry needling, can help alleviate muscle tension and enhance recovery.

Gradual Return to Running

The key to successfully rehabbing a runner's knee is carefully following a return to run program. Physical therapists are extremely knowledgeable on what can help decrease loads on the knee in the beginning stages of your program and know how to gradually expose you to the demands of running. 

Everyone’s rehab looks a little bit different and the PTs at Kinetic are also here to help you adjust your plan depending on your specific needs and goals. Giving yourself time to safely and effectively get back to running will ultimately make all the difference in your performance. 

Our clinic also has a free download for a Return to Running Scorecard to see if you are ready to get back to running after an injury. Check it out if you’re wanting to get back to the trails or treadmill after dealing with a setback.

The Role of Objective Assessment & 3D Running Analysis

One of the most effective ways to diagnose the root cause of a runner's knee is through objective assessment by a performance physical therapist. At Kinetic Sports Medicine and Performance, we use evidence-based evaluation techniques to analyze strength, mobility, and movement mechanics.

• Muscle Strength Assessment: Identifies imbalances and weaknesses that may be contributing to knee pain.
• Functional Movement Screening: Evaluates how your body moves during running-specific activities.
• 3D Running Analysis: Provides a highly detailed assessment of your running gait, detecting inefficiencies that may not be visible in traditional observation-based assessments. This technology allows us to pinpoint factors such as excessive pronation, stride asymmetry, and impact forces that could be contributing to your pain. By addressing these biomechanical issues, we can implement targeted interventions for long-term injury prevention and performance improvement.

Kinetic offers all of these services in our clinics. Check out our Athletic Performance Lab page to learn more.

Training Modifications for Faster Recovery

• Adjust running volume and intensity:
  • Reduce mileage and avoid high-impact activities until symptoms improve. Gradually reintroduce running, starting with shorter, slower runs before increasing distance and speed. Start with uphill or incline treadmill walks or run before running downhill, as running downhill places additional strain on the knees.
• Cadence and stride adjustments: 
  • As you’re easing back into running, another way to reduce impact forces on the knee is by increasing cadence and avoiding over-striding. Increasing your cadence (steps per minute) by just 5-10% reduces impact on the knee by 15%. 
• Cross-training options: 
  • Incorporating low-impact activities like swimming, cycling, and elliptical training can maintain cardiovascular fitness while reducing strain on the knee and make for a smoother transition to return to run. Strength training should remain a priority, focusing on controlled, pain-free movements.
• Footwear considerations: 
  • Proper shoes provide the necessary support and cushioning for your foot mechanics. Generally, a zero-drop shoe can decrease loads on the knee joint. Whenever changing shoes, be sure to ease into the change to avoid secondary injury. Custom orthotics also may be beneficial for those with biomechanical issues.

When to Seek Professional Help

If pain persists despite self-care, a movement assessment from a physical therapist can identify imbalances and provide personalized rehab strategies. Physical therapy can include:

• Manual therapy (massage, cupping, dry needling, etc.) to address soft tissue restrictions and improve joint mobility.
• Progressive loading programs to safely strengthen the knee and surrounding muscles.
• Running gait analysis to identify inefficiencies and optimize movement patterns.
• Return-to-run programs tailored to your recovery timeline and training goals.

At Kinetic Sports Medicine and Performance, we offer specialized treatment plans to help Milwaukee runners recover and prevent future injuries. Our team works with runners of all levels to develop customized strategies for pain relief and performance optimization. Learn more about our Running Physical Therapy if you’re a local runner looking for specialized care.

Conclusion

Recovering from runner’s knee requires a combination of strength training, mobility work, and smart training modifications. By taking a proactive approach, you can return to running stronger and more resilient. Consistency with rehab exercises and proper recovery strategies will not only help you overcome current injuries but also reduce the risk of future issues.

If you’ve dealt with runner’s knee in the past or are currently experiencing knee pain, visit Kinetic Sports Medicine and Performance for a comprehensive assessment and rehab plan tailored to your needs!