Why Your Knees Hurt When You Exercise

By: E. Lucas Zelazny, ATC

When was the last time you ran, climbed stairs, squatted, or knelt down without your knees hurting? Have you ever thought there could be a relatively simple answer to solve your knee pain troubles for good?  It is important to make the distinction as to why you are having knee pain in the first place. Overuse injuries refer to injuries sustained from repeated action (such as doing too many squats using poor form over a long period of time) as opposed to acute injuries, which occur in an instant (such as a fall directly to your knee).


Patellofemoral Pain Syndrome, or PFPS, is one of the most common overuse injuries that causes knee joint pain. The primary cause of this condition is due to improper movement of the knee cap (See Fig 1.). This means that when the knee is bent or straightened, the knee cap, instead of moving in a straight line in the groove at the bottom of the femur, veers off to the outside of the groove causing the associated pain.

Fig 1 – Lateral Maltracking of the patella

Do you notice any of the following symptoms while performing any specific movements or exercises?

  • Pain behind or around the knee cap
  • Increased pain with running, jumping, squatting, or descending stairs
  • Occasional knee buckling or locking
  • Catching, popping, or grinding sensation during walking
  • Overall stiffness of the knee


Fig 2-Male and Female Q Angle Comparison
Fig 2-Male and Female Q Angle Comparison
Figure 3-Patellar Glide Test

Yes? Well these uncomfortable symptoms typically are associated with specific muscular imbalances and bony structural abnormalities, which include the following:

  • Tight outer thigh muscles (See Fig 4)
  • Weak inner thigh muscles (See Fig 4)
  • Increased Structural Q-angle (knock knees) (see Fig 2.)
  • Poor thigh muscle flexibility
  • Knee cap moves too much or too little (See Fig. 3)
  • Flat feet

If you are experiencing these symptoms and recognize the above predisposing risk factors then you can be confident that there is a fix for these painful symptoms.




Fig 4- Showing Medial and Lateral musculature acting on the patella
Fig 4- Showing Medial and Lateral musculature acting on the patella

If you are ready to address this pain it is time to get in touch with one of the following professionals. Physicians, physical therapists, and certified athletic trainers can make the clinical diagnosis of PFPS. Management can be challenging, however studies have shown that a well-designed non-operative therapy program will allow for patients and clients to return to recreational activities if the program is followed diligently. In order to best assess your knee pain you will be put through a thorough evaluation, which includes a functional movement screen as well as a physical examination to pinpoint the cause and severity of your injury. (See Fig 5&6)

Fig 5-Patellar Tilt Test
Fig 5-Patellar Tilt Test

Treatment and Rehabilitation

It is important to understand that a chronic overuse injury is brought on by long periods of improper movement inducing stress on the body’s moving structures.  The first step to getting better is acknowledging that taking a break is what is best at times. Reducing the improper loading of the knee joint and its surrounding structures is the first stop on the road to pain reduction. Things such as deep squats/lunges, running, jumping, and other high load and high impact movements can detrimentally affect the rate of recovery. In order to continue to exercise, alternative activities such as low intensity cycling, swimming, the use of a rowing machine or elliptical can be implemented to maintain your fitness level while reducing stress on your healing joint.

Fig 6- Patellar Apprehension Test
Fig 6- Patellar Apprehension Test

4 Steps to Reducing Knee Pain

  1. Reduce high impact/high stress activities and implement more low impact cardiovascular fitness measures. (Ex: Cycle instead of running)
  2. Always warm up tissues prior to exercising (Ex: warm heat pack over the knee joint, cycling for 5 minutes to get blood flow to the area, etc.).
  3. Perform each of the foam rolling techniques, therapeutic exercises, and stretches in the attached video 3-4 days per week.
  4. Ice the knee for 20-30 minutes following exercise.






Dixit, Sameer, M.D., and John Difiori, M.D. “Management of Patellofemoral Pain  Syndrome.” – American Family Physician. N.p., 15 Jan. 2007. Web. 28 Jan. 2016.

“Patellar Maltracking and Subluxation.” Anterior Knee Pain. N.p., n.d. Web. 28 Jan. 2016.

“Pre Patellar Bursitis.” N.p., n.d. Web. 28 Jan. 2016.

“Ski Alignment and ACL Injuries.” Foot Factor: Ski Boot Alignment,

ACL Injuries, Anterior Cruciate. N.p., n.d. Web. 28 Jan. 2016.


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