Pain around the front of the kneecap, especially on stairs, squats or after sitting a while? That is often patellofemoral pain, also known as runner’s knee. When it comes to fixing it with exercise, one debate comes up again and again: should you train your glutes or your quads? The truth is more useful than picking a side.
In this guide we explain what patellofemoral pain is, settle the glutes versus quads question, and show you what actually works.
What Is Patellofemoral Pain?
Also called runner’s knee, it is pain around or behind the kneecap where it meets the thigh bone. It is one of the most common knee complaints, especially in runners and active people. It typically comes on gradually and flares with activities that load the kneecap, like stairs, squatting, running and prolonged sitting. It is usually an overuse and load-distribution issue rather than serious damage.
Signs of Patellofemoral Pain
The hallmark is a dull ache around the front of the knee, often hard to pinpoint exactly. It tends to worsen with stairs, especially going down, squatting, running, jumping and sitting for long periods, sometimes called the theatre sign. You might notice grinding or clicking too. If your knee pain fits this front-of-knee, activity-related pattern, runner’s knee is a likely cause.
The Glutes vs Quads Debate
So where do glutes and quads come in? The kneecap needs to track smoothly, and that depends on the muscles controlling the knee and hip. The quads directly control the kneecap, while the glutes control the hip and thigh position above the knee. Both influence how load goes through the joint, which is why both get talked about. The question people ask is which to prioritise.
Why Quads Matter
The quads attach to the kneecap and control it directly, so quad strength has an obvious role. Weak or poorly coordinated quads can mean the kneecap tracks less smoothly and the joint takes more strain. Strengthening the quads is a long-standing, well-supported part of managing the condition, and for many people it makes a real difference on its own.
Why Glutes Matter
Here is where it gets interesting. The glutes control your hip and stop the thigh rotating and collapsing inward, which changes the angle the kneecap tracks at. Weak glutes can let the knee fall inward under load, increasing strain on the joint. Adding glute and hip strengthening to a program has strong evidence behind it, often improving symptoms more than working the knee alone.
The Truth: It Is Not Either/Or
Here is the honest answer to the glutes versus quads debate: it is not a competition. The best evidence shows that combining quad strengthening with glute and hip strengthening works better than either alone. Rather than picking a side, a good program addresses both, along with the whole leg. The either/or framing is the wrong question, the real answer is both, done well.
How to Train for Patellofemoral Pain
A good program builds strength in both the quads and the glutes, progressed gradually. It also manages your load, so you reduce aggravating activity while you build capacity, and addresses movement and technique. Exactly which exercises and how much depends on you, which is where individual guidance helps. The principle, though, is clear: train the whole system, not just one muscle.
When to See a Physiotherapist
If your knee pain is persistent, limiting your activity, or not responding to your own efforts, a physiotherapist can help. They confirm the diagnosis, rule out other causes, and build a tailored strengthening and load plan for your quads, glutes and beyond. Get it checked promptly if there is significant swelling, locking, giving way or pain after an injury, as these suggest something else.
Common Questions About Patellofemoral Pain
What is patellofemoral pain?
It is pain around the front of the kneecap, also called runner’s knee, common in active people. It flares with stairs, squatting, running and prolonged sitting.
Should I train glutes or quads?
Both. The best evidence shows combining quad and glute or hip strengthening beats either alone. It is not an either/or choice.
Is patellofemoral pain the same as runner’s knee?
Yes, runner’s knee is a common name for patellofemoral pain, reflecting how often it affects runners, though non-runners get it too.
Will strengthening fix it?
For most people, a progressive program strengthening the quads, glutes and hips, alongside load management, is highly effective. It is the mainstay of treatment.
When should I see a physio?
If it is persistent, limiting you, or not improving, or if there is swelling, locking or giving way, see a physiotherapist for a diagnosis and plan.
How BeFit Can Help
At BeFit Training Physiotherapy, we get to the bottom of the problem and build a plan that trains the whole leg, glutes and quads included. Our sports physiotherapy and strength and conditioning teams ease your knee pain and build lasting strength, and a mobility assessment can pinpoint what is driving it. Initial consultations run for 45 minutes, one-on-one.
Our team at Edgecliff and Coogee would be glad to help. No referral is required, and HICAPS is available on-site for immediate health fund claiming.
Book an appointment at BeFit Training Physiotherapy — no referral needed.
Edgecliff: (02) 9327 7749 | Coogee: (02) 7205 2805 | befittrainingphysio.com/book-now
Related Services at BeFit
Learn more about how our team can help:
Sports Physiotherapy
Strength & Conditioning
Mobility Assessment
Further Reading
5 Proven Ways to Beat Patella Tendinopathy
How to Know If Your Knee Pain Needs a Physiotherapist
References
Lack S, et al. Proximal muscle rehabilitation is effective for patellofemoral pain: a systematic review with meta-analysis. Br J Sports Med. 2015.
Collins NJ, et al. 2018 Consensus statement on exercise therapy and physical interventions for patellofemoral pain. Br J Sports Med. 2018.
Australian Physiotherapy Association. Clinical guidelines. physiotherapy.asn.au.
