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  • Writer's pictureWilliam Joyce

Navigating Runner's Knee: A Functional Podiatrist's Guide to Exercises, and Gait Retraining

As a functional podiatrist, your expertise extends beyond mere pain relief; you aim to restore optimal biomechanics and empower your patients to achieve peak performance. A common obstacle athletes and runners face is the vexing "Runner's Knee," scientifically known as patellofemoral pain syndrome (PFPS). This article delves into the origins of Runner's Knee, the pivotal role functional podiatrists play in its treatment, and an all-encompassing manual on exercises, their progressions, and the integration of gait retraining in your arsenal to aid patients on their journey to recovery.

Understanding Runner's Knee (PFPS)

Patellofemoral pain syndrome, colloquially called Runner's Knee, is a prevalent ailment afflicting runners and athletes. It materialises when the patella (kneecap) rubs against the femur (thigh bone), inducing discomfort and pain often described as a persistent ache below or around the kneecap. PFPS can stem from diverse causes including overuse, biomechanical irregularities, muscular imbalances, and inappropriate footwear choices.

Your Role as a Functional Podiatrist

As a functional podiatrist, your expertise resides in deciphering the intricate mechanics of the lower extremities. To combat Runner's Knee effectively, you must decipher its underlying causes and proffer holistic solutions comprising personalised exercise regimens, gait analysis, footwear prescriptions, and hands-on therapies. Empower your patients to become proactive participants in their recovery process by educating them about proper technique, strength training, and self-care practices.

Basic Exercises

  1. Quad Sets: Commence with fundamental quad sets to trigger and fortify the quadriceps muscles. Instruct patients to sit upright, legs extended, and contract the quadriceps, sustaining the contraction for a count of five. Begin with three sets of 10 repetitions, gradually augmenting the volume.

  2. Straight Leg Raises: Transition to straight leg raises, which demand patients to recline and elevate one leg while keeping it extended. This manoeuvre hones the quadriceps, hip flexors, and core musculature. Initiate with three sets of 10 repetitions per leg.

  3. Clamshells: To rectify hip muscle imbalances, introduce clamshell exercises. Guide patients to recline on their side with knees flexed at a 90-degree angle. Instruct them to elevate the top knee while preserving alignment. Perform three sets of 15 repetitions on each side.

  4. Bridges: Engage the glutes and hamstrings with bridge exercises. Patients should recline, knees bent, and feet flat on the ground. Direct them to elevate their hips, forming a straight line from shoulders to knees. Strive for three sets of 12 repetitions.

  5. Step-Ups: Gradually advance to functional exercises like step-ups. Patients can utilise a low step or platform. Initiate with body weight and incrementally introduce resistance. Aim for three sets of 10 repetitions per leg.

  6. Lateral Band Walks: Enhance hip abductor strength through lateral band walks. Secure a resistance band around the ankles and instruct patients to sidestep while sustaining band tension. Complete three sets of 12 steps in each direction.

  7. Eccentric Decline Squats: Address eccentric control by integrating decline squats. Patients can leverage a decline board or ramp. Encourage slow descent, accentuating controlled movement. Commence with three sets of 8 repetitions, progressively elevating the workload.

  8. Single-Leg Balance: Foster proprioception and stability via single-leg balance exercises. Patients should stand on one leg for increasing durations, progressing from stationary to dynamic manoeuvres.

Gait Retraining: A Game-Changer

Gait retraining is an invaluable tool in combating Runner's Knee. Analyse your patients' gait patterns to identify irregularities that contribute to the condition. Focus on cultivating efficient mechanics through:

  1. Cadence Adjustment: Encourage patients to increase their step rate to reduce stress on the knee joint.

  2. Footstrike Modification: Advise a midfoot or forefoot strike pattern to diminish impact forces.

  3. Posture Correction: Emphasise an upright posture and forward lean to promote proper alignment.

  4. Stride Length Optimisation: Opt for shorter strides to minimise joint loading.

  5. Hip Engagement: Highlight the importance of hip engagement and glute activation during each stride.

Progressive Treatment Journey

Monitor patients' progress meticulously and tailor treatment plans accordingly. Integrate manual interventions such as soft tissue mobilisation, joint manipulation, and proprioceptive training to maximise results. Gradually escalate exercise intensity, incorporate functional movements, and intensify resistance as strength and stability improve.


Runner's Knee may appear daunting, but armed with knowledge and strategic approaches, functional podiatrists possess the expertise to guide patients toward recovery and enhanced performance. By confronting underlying biomechanical issues, introducing targeted exercises, and leveraging gait retraining techniques, you empower patients to conquer Runner's Knee and stride confidently toward triumph. Remember, individualisation is key, so customise treatment strategies to suit each patient's distinct requirements for optimal outcomes.

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