Manage your exercise load to manage your pain

Exercise and physical activity is very good for your health and well-being. However, doing ‘too much, too soon’ may be a key reason you develop or continue to have knee cap pain?

If you are not sensible with how much exercise you do, other normally effective treatments may not actually end up helping you manage your pain. That’s why managing load is very important.

Take a look at the short video below to get some tips on how you can manage your exercise and physical activity loads (it’s less than two mins)!


Why do I need to be sensible with how much exercise I do?

The exact reason why people develop knee cap pain is unclear. However, experts around the world tend agree that doing ‘too much, too soon’ in relation to exercise may be a key reason.

There seems to be a spike in the number of people with knee cap pain following rapid increases to how much exercise you do – e.g. basic military training or ‘start to run’ programs (e.g. couch to 5KTM).

The number of people developing knee cap pain when completing basic military training has been reported to be as high as 32%.

In ‘start to run’ programs it can be as high as 17%.

There are no specific rules on how much exercise you should complete in order to avoid developing knee cap pain. It is also not clear exactly how quickly to increase exercise when returning to sports and other activities if you are recovering from knee cap pain.

The most sensible option is to monitor your pain levels during and after exercise. Experts frequently recommend that if you have a large increase in pain, or pain stays increased for more than 24 hours after exercise, you may be doing ‘too much, too soon’.

Further guidance on how much exercise you should do and how quickly to increase it can be provided by your physiotherapist.


Supporting articles

Barton 2016. ‘Managing My Patellofemoral Pain’: the creation of an education leaflet for patients.

Thijs 2008. Gait-related intrinsic risk factors for patellofemoral pain in novice recreational runners.

Van Tigglen 2009. Delayed vastus medialis obliquus to vastus lateralis onset timing contributes to the development of patellofemoral pain in previously healthy men: a prospective study.

Knee cap pain is common in runners. But, the good news is that through simple tips you can improve your knee cap pain. We recommend that if you have knee cap pain during running, you should:

  • Keep your pain at no more than 2/10 during running. For reference, 0 = no pain; and 10 = the worst pain you could imagine.
  • Knee pain needs to return to pre-training level within 60 minutes post-training, without increases in the following morning.

Here are 5 tips to help you achieve less pain during and after running (see the video, infographic and the text below):


1. Increase training frequency to decrease each session’s duration (for example, instead of running 5km, 3 times in a week, run 3km, 5 times in a week).

2. Decrease your running speed by approximately 10-20%. For example, if you normally run 5 minutes per km, try running at 6 minutes per km.

3. Try using a run-walk program where you have walking breaks. For example, run for 4 minutes, walk for 1 minute.

4. Avoid downhill and stairs running, and gradually reintroduce once pain has settled to an acceptable level (no more than 2/10).

5. Try increasing the number of steps you take per minute, without running faster. It is often achievable to increase by between 5 and 10%, and this frequently leads to less load on your knees. This can be done by thinking about taking shorter faster steps, using a metronome, or running with music at a set tempo (beats per minute) similar to how many steps per minute you aim to take. According to experts, this is likely to be most effective in people who take 170 or less steps per minute.

As your pain reduces, you may gradually reintroduce your normal running behaviour, including returning to longer runs, increasing speed, removing walking breaks and reintroducing hills and stairs. Try to only change one thing at a time, and ensure as you do this, your pain remains no more than 2/10.

For further information see the links: