If running, jumping, squatting or stairs cause pain around your kneecap, this version is for you. The aim is to keep doing activities your knee tolerates and gradually return to harder training. You do not need to do every exercise in one session or tolerate increasing pain to keep playing sport. This guide combines activity adjustments with strengthening the knee and hip muscles.
1🦴 What is front-of-knee pain, and who is this guide for?
The kneecap is the bone at the front of the knee. It moves along the lower end of the thigh bone as the knee bends and straightens. Pain around or behind it that worsens with running, stairs or squatting may be patellofemoral pain. Training intensity, sudden activity changes and muscle capacity matter when choosing a programme. However, muscle weakness or the way you walk alone cannot establish the cause of pain.
Softening of the cartilage behind the kneecap is called chondromalacia. Front-of-knee pain and this cartilage finding do not mean the same thing, and imaging alone does not fully explain pain. Not every painful kneecap needs an MRI; an examination helps determine whether further assessment is needed. Education and appropriate exercise therapy are the foundations of treatment for patellofemoral pain. Insoles, supportive taping or an assessment of running technique may help some people. These are selected after assessment and do not replace exercise.
If you are having difficulty planning for a competition or returning to training, physiotherapy can help select and progress exercises. Track changes in symptoms throughout the programme. Improvement within a few sessions is not promised, and consistency matters. If you have not improved after about 6 weeks of regular exercise and activity adjustments, arrange an examination to review the programme. Significant limitations or new symptoms should be assessed sooner.
2🏠 Daily habits to adjust
📉 Match your training load to your knee’s current capacity
When your knee hurts, reduce the parts of your training that increase the pain. Keep doing activities you can tolerate so that reducing the load does not become complete inactivity. After each change, check how your knee responds that day and the following morning.
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- Reduce duration, speed or the number of jumps according to your symptoms. Do not increase all of them at once.
- Set aside exercises that cause sharp or increasing pain and choose a lower-impact activity.
- When returning, first establish a volume you can tolerate, then work towards greater speed or intensity.
⏱ Consider pain during exercise together with the next-day response
Mild, brief discomfort may occur when you begin exercise therapy, but sharp or increasing pain is not a signal to continue. Stop if you limp or change how you move to finish an exercise. More pain or swelling after the session also means the programme needs to be lighter.
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- Before starting, note your usual pain level and ability to walk.
- Reduce the range or load during the movement. If the pain does not settle, do not perform that exercise.
- If symptoms are worse the morning after a session, reduce the load next time and do not increase it until they settle.
🏃 Use tolerable activity in place of painful running and jumping
If running or jumping makes your knee hurt, you can temporarily use light stationary cycling or walking on level ground. This helps maintain physical activity while reducing the painful load. Returning to inclines and greater speed should match your knee’s tolerance.
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- Adjust the bicycle saddle so your knee does not fully lock when the pedal is at its lowest point.
- When you resume running, choose a route and speed that do not increase pain.
- Do not change your running technique on your own using unnatural steps. Practise with a physiotherapist if a change is needed.
🪑 Change your leg position during prolonged sitting
Keeping the knee bent in class, at a desk or in a car can increase front-of-knee pain. Before the pain builds up, move your leg slightly forwards into clear space or get up for a brief movement break. Do not force the knee straight or straighten it through pain.
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- Adjust the chair so your foot is supported and your knee is not tucked under the seat.
- During meetings or travel, choose a place where you can easily change your leg position.
- Gently bend and straighten the knee a few times, paying attention to pain and ease of movement.
🪜 Use stairs slowly with the handrail
If stairs are painful, slow down and hold the handrail. To reduce the strain, you can bring both feet onto the same step each time. If one knee hurts more, lead with the less painful leg going up. Going down, place the painful leg on the lower step first.
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- Place your foot on the step and find your balance before taking the next step.
- Keep the supporting knee aligned with the foot and do not let your body drop quickly.
- If your knee gives way or you cannot bear weight, stop practising stairs and get examined.
🧎 Reduce painful knee bending when working near the floor
Kneeling and deep squatting may be uncomfortable while the knee is painful. Use a chair or a raised work surface for tasks near the floor, and do not bend the knee into a range that increases pain. This adjustment does not mean knee bending is permanently forbidden.
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- Keep frequently used items at a height that avoids the need for a deep squat to reach them.
- If sitting on your knees hurts, choose another position. A soft mat does not replace changing a painful position.
- As tolerance improves, increase the range gradually and do not ignore increasing pain.
👟 Choose comfortable shoes and make changes gradually
Your shoes should feel comfortable and stable for your activity. Buying a particular model does not guarantee relief from kneecap pain. If you change shoes or training surfaces, first try them with lighter activity. Ready-made insoles help some people but are not necessary for everyone.
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- Choose new shoes if your current pair is worn out or slippery.
- Do not add insoles or a large change in heel height alongside several other programme changes.
- If new shoes increase pain, reduce activity and reconsider the footwear.
🔥 Begin the session with light movement
Before strength exercises, prepare your body with easy walking or cycling. A warm-up should not continue through increasing pain. At the end of the session, gradually reduce activity intensity and use only comfortable stretches.
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- Start your warm-up with an activity the knee tolerates.
- Try strength exercises without weights or with a lighter load first.
- Do not force or bounce into a stretch. A gentle muscle stretch is different from joint pain.
😴 Allow recovery between sessions
Scheduling hard leg sessions back to back can make load management difficult. Separate strength-training days from days of lighter activity, and ease the programme if pain has increased. Regular sleep and a programme you can sustain help you stay consistent.
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- On lighter days, keep comfortable movement; you do not need complete bed rest all day.
- Do not make up for a missed workout with two hard sessions back to back.
- If you have persistent night pain or a clear change in symptoms, raise it during an assessment.
🍽 Choose a programme you can maintain
To keep exercising, choose a realistic goal and a workable programme. Sudden training changes combined with a strict diet can make symptom tracking and recovery difficult. Weight loss is not required treatment for everyone with kneecap pain, and your eating plan should suit your needs.
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- Briefly record the exercises and activities you complete so you can follow your progress.
- If needed, seek professional help with sporting goals or weight changes.
- If exercise does not fit around work or study, change the session time rather than abandoning the programme.
3🏋️ Home exercises
Tightening the front thigh muscle (Quad Set)
This exercise works the front thigh muscle without bending and straightening the knee. Start with 2 to 3 repetitions, holding each contraction for up to 10 seconds; increase as tolerance improves. Stop with new, sharp or increasing pain.
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Before you start: This exercise works the front thigh muscle without bending and straightening the knee. Sit or lie on your back on a bed or stable mat with the leg extended. If this position hurts, first adjust it or reduce the amount of exercise.
How to do it:
- Gently press the back of the knee into the bed or mat and tighten the front thigh muscle.
- Hold the contraction within your tolerance, without holding your breath.
- Relax the muscle completely and rest before the next repetition.
Movement tips: Keep the knee comfortable and nearly straight, without lifting the heel off the surface. Breathe calmly and fully relax the muscle between contractions. Feeling the front thigh tighten is expected, but the pressure should not increase knee pain.
Amount, repetitions and progression: Start with 2 to 3 repetitions, holding each contraction for up to 10 seconds; increase as tolerance improves. Reduce the amount if pain or swelling increases afterwards.
Stop immediately if: Stop the exercise if new, sharp or increasing pain develops.
Common mistakes: Do not hold your breath or lift the whole leg instead of tightening the thigh muscle.
Easier version: Use a gentler, shorter contraction. If it still hurts, do not perform it.
Straight leg raise
This exercise works the front thigh muscle while keeping the knee straight. As an example, perform 10 repetitions with a 3-second pause; start with fewer if this is too much. Stop if new, sharp or increasing pain develops in the knee or back.
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Before you start: This exercise works the front thigh muscle while keeping the knee straight. Lie on your back on a stable mat with the opposite knee bent and that foot on the floor. Keep the exercising leg straight. Do not use an ankle weight for now.
How to do it:
- Tighten the front thigh muscle of the exercising leg to keep the knee straight.
- Slowly lift the leg only as high as you can control without arching your back.
- Pause briefly, then slowly lower the leg onto the mat.
Movement tips: Do not bend the knee as the leg rises; keep the pelvis and back still on the surface. Move slowly and breathe normally. Put the leg down and rest between repetitions. Feeling the thigh muscle work is normal, but new knee or back pain is not a reason to continue.
Amount, repetitions and progression: As an example, perform 10 repetitions with a 3-second pause; start with fewer if this is too much. Increase only as control and tolerance improve. Reduce the amount if pain or swelling increases afterwards.
Stop immediately if: Stop if new, sharp or increasing pain develops in the knee or back.
Common mistakes: Do not bend the knee or arch your back to lift the leg higher.
Easier version: Lift the leg less and reduce repetitions. Keep the knee straight and the movement controlled.
Opening the upper knee while lying on your side (Clamshell)
This exercise works the muscles at the side of the hip. As an example, do 10 repetitions on each side with a pause of up to 3 seconds; start without a resistance band. Stop the exercise if you feel pain in the groin or a joint.
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Before you start: This exercise works the muscles at the side of the hip. Lie on your side on a stable mat, support your head and bend both knees comfortably. Stack your feet and keep the hips aligned. Start without a resistance band.
How to do it:
- Keep your heels touching.
- Slowly open the upper knee, only as far as you can without rolling the pelvis backwards.
- Pause briefly, then slowly lower the knee.
Movement tips: Keep the heels together and do not let the upper hip roll backwards. Lifting the knee higher is not the main goal. Breathe normally, move slowly and lower the leg between repetitions. You may feel the side-hip muscles working, but do not tolerate groin or joint pain.
Amount, repetitions and progression: As an example, do 10 repetitions on each side with a pause of up to 3 seconds; start without a resistance band. Reduce repetitions if pain increases afterwards and progress according to improving tolerance.
Stop immediately if: Stop the exercise if you feel pain in the groin or a joint.
Common mistakes: Do not roll the pelvis backwards or separate the heels to open the knee further.
Easier version: Open the knee less and continue without a band. The exercise should not become more painful.
Side-lying leg lift (Side-Lying Hip Abduction)
This exercise works the muscles at the side of the hip. Start with 2 to 3 repetitions on each side and gradually increase as the exercise becomes easier. Stop if new or increasing pain develops in the back, groin or outer hip.
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Before you start: This exercise works the muscles at the side of the hip. Lie on your side on a stable mat and support your head. Place the lower leg straight or slightly bent on the mat, whichever is comfortable. Keep the upper leg straight in line with your body. Change position if lying on your side hurts.
How to do it:
- Stack your hips and point the toes of the upper foot forwards.
- Slowly lift the straight upper leg without bringing it forwards or rotating the pelvis.
- Slowly lower the leg, place it on the surface and rest before the next repetition.
Movement tips: Keep the exercising leg in line with your body without rolling the pelvis backwards. Lift only as high as you can maintain this position. Do not hold your breath, and pause between repetitions. Feeling the side-hip muscles work is expected, but back or joint pain should not increase.
Amount, repetitions and progression: Start with 2 to 3 repetitions on each side and gradually increase as the exercise becomes easier. Return to a smaller amount if pain or swelling increases afterwards.
Stop immediately if: Stop if new or increasing pain develops in the back, groin or outer hip.
Common mistakes: Do not bring the leg forwards or roll the pelvis backwards to lift it higher.
Easier version: Lift the leg less and keep repetitions low. Keep the upper leg straight.
Glute bridge
One complete performance of the movement is one repetition; a group of repetitions is a set. The bridge works the buttock muscles and pelvic control. As an example, do one set of 8 to 12 repetitions with a 3 to 5-second pause. Stop if new back pain or sharp or increasing knee pain develops.
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Before you start: The bridge works the buttock muscles and pelvic control. Lie on your back on a stable mat with both knees bent comfortably and both feet on the floor. If this position itself hurts your back or knee, do not do the exercise for now.
How to do it:
- Gently tighten the buttock muscles and keep your feet on the floor.
- Lift the pelvis to a comfortable height without arching your back.
- Pause briefly, then lower the pelvis slowly and with control.
Movement tips: Keep both sides of the pelvis level and do not let the knees collapse inwards. Breathe normally. Put the pelvis down on the mat and rest between repetitions. Feeling the buttock muscles work is normal, but lifting higher should not cause back pain or knee pressure.
Amount, repetitions and progression: As an example, do one set of 8 to 12 repetitions with a 3 to 5-second pause. Reduce the amount if pain or swelling increases afterwards. Add sets only as tolerance improves.
Stop immediately if: Stop if new back pain or sharp or increasing knee pain develops.
Common mistakes: Do not arch your back or let the knees collapse inwards as you lift.
Easier version: Lift the pelvis less and reduce repetitions. If pain persists, do not do the exercise.
Wall-supported squat (Wall Squat)
This exercise works the thigh muscles through a small, controlled knee bend. As an example, do one set of 8 to 12 repetitions within a small, comfortable range. Stop with sharp or increasing pain, or if you lose control of the knee.
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Before you start: This exercise works the thigh muscles through a small, controlled knee bend. Rest your back and buttocks against a wall and place your feet a comfortable distance forwards. Use a dry, non-slip floor. Start without weights, after you can tolerate simpler exercises.
How to do it:
- Space your feet comfortably and keep them flat on the floor.
- Slide your back a little way down the wall, bending the knees only within a comfortable range.
- Gently push through your feet to return to the starting position.
Movement tips: Keep the knees aligned with the feet and the feet on the floor. Adjust the depth to your control and symptoms. Breathe normally as you move down and up, and rest between repetitions. Feeling the thigh muscles work is expected, but increasing pain or loss of movement control means you should stop.
Amount, repetitions and progression: As an example, do one set of 8 to 12 repetitions within a small, comfortable range. If pain or swelling increases afterwards, reduce the amount or range. Progress as tolerance improves.
Stop immediately if: Stop if sharp or increasing pain develops, or if you cannot control the knee.
Common mistakes: Do not let the knees collapse inwards or lift your feet off the floor to move lower.
Easier version: Move down less, or use a simpler thigh-strengthening exercise.
Squat with one foot forwards and one back (Split Squat)
Use this exercise when you can do simpler exercises without increasing symptoms. Once you tolerate the simpler movements, try 8 repetitions on each side as an example. Stop with sharp or increasing pain, the knee giving way, or loss of balance.
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Before you start: Use this exercise when you can do simpler exercises without increasing symptoms. Stand beside a fixed support with one foot forwards and the other back, at a comfortable distance. Hold the support with your hand. Start without weights.
How to do it:
- Keep the front foot flat on the floor and gently distribute your weight between the feet.
- Bend both knees a little and lower your body, keeping the front knee aligned with the foot.
- Slowly return to standing before pain increases or movement control is lost.
Movement tips: Use a small, comfortable range; the back knee does not need to reach the floor. Keep the pelvis facing forwards and the front foot on the floor. Breathe normally and rest between repetitions. Muscle effort is expected, but do not continue with more pain or instability.
Amount, repetitions and progression: Once you tolerate simpler exercises, try 8 repetitions on each side as an example. Reduce the amount if pain or swelling increases afterwards. More repetitions or load should follow better tolerance and control only.
Stop immediately if: Stop with sharp or increasing pain, the knee giving way, or loss of balance.
Common mistakes: Do not let the front knee collapse inwards or lift the front foot to finish the movement.
Easier version: Reduce how far you lower yourself and use more help from the support.
Controlled step-down
This exercise practises control when stepping down and is added after simpler movements are tolerated. As an example, do 8 to 12 repetitions on a low step with support. Stop with sharp or increasing pain, or if you lose knee control or balance.
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Before you start: This exercise practises control when stepping down and is added after simpler movements are tolerated. Put the exercising foot on a low, stable step and hold a handrail or firm support. Choose a height that allows slow movement without the knee collapsing inwards.
How to do it:
- Gently transfer your weight onto the leg on the step and keep the pelvis level.
- Bend the supporting knee slightly to bring the free heel towards the floor.
- Before losing movement control, use the supporting leg to return slowly to the top.
Movement tips: Keep the knee on the step aligned with the foot, without letting the pelvis drop to one side. Bring the free heel gently towards the floor. Do not hold your breath, and rest between repetitions. If you lack control, choose a lower step or a simpler exercise.
Amount, repetitions and progression: As an example, do 8 to 12 repetitions on a low step with support. Reduce the repetitions if pain or swelling increases afterwards. Do not add this exercise if tolerance or control is insufficient.
Stop immediately if: Stop with sharp or increasing pain, or if you cannot control the knee or lose your balance.
Common mistakes: Do not let the knee collapse inwards or suddenly drop your body weight onto the free leg.
Easier version: Use a lower step and more help from the handrail. Return to a simpler exercise if needed.
Front and back thigh stretches (Quadriceps and Hamstring Stretch)
These are two separate, gentle stretches for thigh flexibility. As an example, hold each stretch for 30 seconds and repeat 2 to 3 times on each side. Release the stretch if you feel pain in the knee, groin or back.
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Before you start: These are two separate, gentle stretches for thigh flexibility. For the front thigh, stand beside a fixed support; for the back thigh, sit on a firm chair. Do not do the standing stretch if you cannot safely balance or hold your ankle.
How to do it:
- For the front thigh, hold the support and gently bend one knee.
- Hold the ankle on the same side and maintain only a gentle stretch. Do not force the knee to bend.
- Slowly put the foot down. Then, for the back thigh, sit on a chair and place one heel forwards on the floor.
- With your back straight, lean slightly forwards from the hips until you feel a gentle stretch behind the thigh, then slowly return.
Movement tips: In the standing stretch, keep the knees close together and the pelvis facing forwards. In the seated stretch, keep the front leg comfortably straight without rounding your back. Breathe normally, hold without bouncing and release between attempts. A muscle stretch is expected, but do not tolerate knee, groin or back pain.
Amount, repetitions and progression: As an example, hold each stretch for 30 seconds and repeat 2 to 3 times on each side. If pain increases afterwards, reduce the amount or range. Progress only with a gentle stretch and no joint pain.
Stop immediately if: Release the stretch if you feel pain in the knee, groin or back.
Common mistakes: Do not bounce into the stretch or round your back when leaning forwards in the seated stretch.
Easier version: Reduce the range and duration. Do not do the standing stretch if holding the ankle is difficult or painful.
4🏟️ Gym training principles
When returning to running and sport, combine strength training with adjustments to activity volume. A gym session is not a contest against pain. Correct movement and knee tolerance take priority over rapid progress.
Starting and finishing the session
Start with easy walking or cycling that does not increase pain. A few light movements let you check how comfortable the knee feels. At the end, gradually reduce intensity and use only gentle stretches. Warming up does not make increasing pain acceptable.
Choosing weights and progressing
Choose the weight for what your knee can manage in this session, rather than your previous record or a teammate’s weight. Choose a range you can control; once that is established, increase repetitions or load. Swinging your body to finish a movement is not a sign of a suitable load. If pain or swelling increases after the session, return to the last tolerable amount; progress differs between people.
Movement technique and breathing
During leg exercises, keep the knee aligned with the foot and the foot supported on the surface. Breathe out during effort and do not hold your breath. Choose depth according to comfort and control; bending the knee further does not by itself make the exercise better.
Exercise order and rest
Coordinate your gym session with your running or team training programme. After warming up, do the selected movements that you can control with concentration, and rest between them. If fatigue makes your knee fall inward or your movement speed up, delay the next set until your breathing and movement control are suitable again. Finishing quickly is not the goal of returning to sport.
Painful exercises and alternatives
If an exercise increases pain, reduce the load or range, or choose an easier option. No movement pattern is forbidden for everyone. What you cannot currently control or tolerate is unsuitable for this session.
- Use a shorter range and support, or a simpler thigh exercise, instead of painful squats (lowering and rising without a chair) or lunges (lowering with one foot forwards and one back).
- For painful jumping or running, choose low-impact aerobic activity you can tolerate.
- If a machine increases pain even when correctly adjusted, choose another exercise instead of continuing with incorrect technique.
On a painful day
When symptoms are worse, lighten the programme and keep comfortable movement. Making up for the previous session with more weight makes load management harder. New symptoms, obvious swelling or instability should be assessed first.
A sustainable programme
Return to running, jumping or high-impact sport gradually. Check your tolerance of daily tasks and simpler movements before adding speed and jumps. If you plan to compete, assessment and an individual programme can help choose the stages of your return.
As an example, choose 3 or 4 tolerable exercises and train 2 to 3 days a week. This is a starting example, not the required amount for everyone. Also check each exercise’s amount and your knee’s response.
When should you stop a set?
Stop that set with sharp or increasing pain, the knee giving way, or loss of control. Review the range, amount and exercise choice before repeating it. For symptoms needing urgent help, follow this article’s warning section.
- Do not add repetitions to finish the programme while pain is increasing.
- Do not lift weights while holding your breath, swinging your body or losing your balance.
- Do not respond to worse symptoms after a session by increasing the load on your own.
5⚠️ Which symptoms need urgent assessment?
Do not continue exercising with these symptoms. How soon to seek help depends on the symptom:
- Seek urgent medical help now if your knee is hot or red and you also have any of these symptoms: a very high temperature, feeling hot or cold, or shivering.
- If knee pain is very severe, the knee looks deformed or is very swollen, you cannot move the knee, or you cannot put any weight on the leg, seek urgent medical help now. This applies even without an obvious injury.
- If the knee locks, gives way or clicks painfully, seek urgent medical help now and do not force it.
- If you have severe, persistent pain at rest or at night, seek assessment of the cause.
6✅ Summary and next steps
To return to sport, keep tolerable activity and do not ignore sharp or increasing pain. Knee and hip strengthening, load adjustments and consistency work together. Start simple exercises with correct technique and add load or harder exercises only when the knee responds well. If progress stops or correct execution is not possible, the programme and diagnosis need reassessment.
For assessment of knee pain and advice on suitable exercises, call Dr Jalil Emad’s clinic on 09137825207, or book an appointment online. In an emergency, do not wait for the clinic to reply; follow the instructions in the warning signs section.
To learn about assessment and treatment of problems inside the knee, read this page: Surgery inside the knee using a camera (arthroscopy)
Related guides: Service page: Surgery inside the knee using a camera (arthroscopy) · Also related: Total Knee Replacement Surgery: Postoperative Care and Rehabilitation
This guide is educational and does not replace an examination or a programme tailored to your circumstances.
7📚 Scientific references
View scientific references
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- NHS Dynamic Health: Patellofemoral knee pain. Checked 2026-10-09. https://www.dynamichealth.nhs.uk/help-and-advice/knee-pain/patellofemoral-knee-pain/
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- NHS Bexley: Patellofemoral Pain Syndrome. Checked 2026-10-09. https://msk-bexley.nhs.uk/conditions/knee-pain/patellofemoral-pain-syndrome-pfps
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- NHS: Strength exercises. Checked 2026-10-09. https://www.nhs.uk/live-well/exercise/strength-exercises/
- NHS: Balance exercises. Checked 2026-10-09. https://www.nhs.uk/live-well/exercise/balance-exercises/
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- NHS: Knee pain. Checked 2026-10-09. https://www.nhs.uk/symptoms/knee-pain/
- AAOS OrthoInfo: Patellofemoral Pain Syndrome. Checked 2026-10-09. https://www.orthoinfo.org/diseases--conditions/patellofemoral-pain-syndrome/
- AAOS OrthoInfo: Knee Conditioning Program. Checked 2026-10-09. https://www.orthoinfo.org/recovery/knee-conditioning-program/
- Gateshead Health NHS: Knee Osteoarthritis (OA). Official patient guidance
- Maidstone and Tunbridge Wells NHS: Knee soft tissue injury, non-follow-up. Official patient guidance
- Ophey M, et al. Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy. Knee Surg Sports Traumatol Arthrosc. 2025;33(2):457–469. doi:10.1002/ksa.12367. ePub 2024-07-24. PubMed 39045713
- NHS Greater Glasgow and Clyde: Self-help information – Knee Pain. Checked 2026-10-09. Official self-help and assessment guidance
- NHS MyHealthLondon: Strength and flex workouts — definitions of repetition and set only. Checked 2026-10-28. Definitions of repetition and set
