Exercises For Knee Pain In Runners

In our last article on knee pain and injuries we talked about how to manage your knee pain as a runner, but not only. Before that we talked about the 10 causes of knee pain in runners. It’s good to read those articles first to understand the following exercises and why you should consider them.

Let’s begin…

 A. WARM UP

A study in the Journal of Orthopaedic and Sports Physiotherapy found that warm up performed at 60% of maximal effort resulted in 6% improvement in aerobic performance and a 7% improvement in anaerobic performance. (Source)

Another research has demonstrated that intense exercise preceded by a warm up resulted in less accumulation of blood and muscle lactate. A review in the journal Physician and Sports Medicine concluded that warming up reduces the risk of injuries, which is what we’re looking for here.

Your pre-running warm up:

1. Raises your heart rate.

 Have you ever felt really tired for the first 5-10 min of your run? Really feeling you just couldn’t do this? Then after 10 min or so you could just go on and on? That’s because it took your body, the whole system about 10 min to warm up and ready for the physical act of running.

Your body is like a furnace. To get heat from a furnace you have to put the wood in and light it up. It won’t give heat if there is no fire, will it? The same goes for your body. It will not give you the running energy you need until it’s prepared. You prepare it through warm-up.

Don’t be afraid to run out of breath in your warm up. You won’t get fatigued in 10 minutes. That’s just a common misconception.

2. Raises your body temperature. The synovial fluid we talked in the previous article becomes less sticky through movement. It is then able to squeeze into in the joint capsules, soaking the cartilage and providing a protective cushion.

3. Enhances neuromuscular pathways, increasing speed and efficiency of muscular contraction. Warm up switches your brain on. (Source)

 4. Improves coordination

 5. Improves elasticity and contractibility of the muscles, so they can fire up and get you running efficiently

6. Increases cardiovascular and respiratory systems efficiency

Your warm up should mimic the movements you will be doing in the main session. Static stretches are not recommended before running. In his book “Stretching Scientifically” Thomas Kurz says that “doing static stretches for a workout that consists of dynamic actions is counterproductive, and it certainly doesn’t prevent injuries (Shrier 1999; Pope et al. 2000)”.

Indeed I have read research on this topic before. There is still some debate whether pre-running static stretching increases or decreases running performance though. When I find the source, which skips my mind right now (although I looked through all my running books) I will come back and update this article. For now just know that for a dynamic movement workout you want a dynamic warmup.

There are countless warm up routines out there. Here is a quick warm up routine we use and you can use as well:

  • Light 10 min jog or brisk walk (depending on your fitness levels) to get your body moving
  • Fluid movement stretching to mobilise the joints, bring flow in your movement and allow the body to slowly open up and stretch out. This is something I learnt from my natural movement fitness coach and still utilise it today.

Running specific stretches. Find a 30-50m surface/runway and run up and down performing the following drills:

  • Butt kicks
  • High knees
  • Three steps and a jump – take 3 steps and then jump on the fourth (i.e. jump on the left leg and raise the right knee towards your chest)
  • Three steps, jump and lift the opposite arm – the opposite to the leg that’s off the ground (i.e. jump on the left leg, lifting the right knee and left arm up as high as you can)
  • Skipping on each leg – like a preschooler, you still know how to do that, right? – same as point 3 but skipping/jumping on each step instead of just the 4th
  • Skipping on each leg and lifting the arm opposite to the leg that’s up – same as point 4, but jumping on each step
  • Cross overs – this is a side movement, crossing the same leg in front and behind the other leg:
    1. Step 1: step with your right foot to the side
    2. Step 2: cross the left foot over/in front of the right foot
    3. Step 3: step with your right foot to the side again, in the direction you are moving
    4. Step 4: cross the left foot behind the right foot
    5. Repeat

Perform the cross over leading with the right leg (as in the example) and then leading with the left leg.

  • Tiptoe walking – just as it says, walk on your toes; warm the calves
  • This is the final stage to get your cardiovascular system ready for launch. Look for a 250-300m relatively flat surface and:
    1. Run out at 20-25% (or 3/10) of your max speed
    2. Run back 50% (5-6/10)of your max speed
    3. Run out 20-25%
    4. Run back 70% (6-7/10)
    5. Run out 25%
    6. Run back 80% (7-8/10)
    7. Run out 25%
    8. Run back 85% (8-9/10)

Strides are to be done after all the prior warm up. The % is approximate of course. The idea is to get the “engine” running.

B. STRENGTHEN

Specific to runner’s knee are strength exercises. If you already have knee problems it is even more important to ensure you keep your stabiliser muscles strong and flexible (that’s the next topic).

Strong stability muscles ensure the knee stays aligned, moving smoothly in its groove and, as a result, helps to reduce wear and tear.

Exercises to consider are:

1. The Clock – the first most important exercise for me and my clients; when done properly it strengthens all stabiliser muscles including the glutes maximum, medius and minimus, adductors, as well as core muscles. It also strengthens the ankle and foot muscles.

2. The 360 Degrees – the second most important exercises for my personal knee maintenance so to speak

 

3. The Dunking Duck (or the Seesaw)

 

4. I’ve recently discovered the stability disc. I have one in the bathroom in front of the sink. Every time I brush my teeth I balance on it. I recommended this to my clients who have been balancing on one leg while brushing their teeth for a while now. This is their progression. Note: if your struggle with balance start just by standing on one leg while brushing your teeth. This exercise has a high risk of injury, so I recommend you hold on hand on the edge of the sink and don’t struggle to balance, place your foot down as many time as you need to. Safety first

 

5. The bridge

6. Holding a squat position with the back against the wall

7. Squat without support

8. Squat on one leg with support (aka pistol squat)

9. Squat on one leg without support

10. Step-up

11. Step-down


12. The Peterson step up


13. Side lying or standing leg raise – strengthens hip abductors and hip external rotators

You can find more or our own MoveWild exercises on our online 4 weeks programme. Check it out.

 

C. STRETCH

To understand how muscle tension is related to knee pain and injuries read the previous 2 articles on knee pain: 10 causes of knee pain in runners and How to manage knee pain in runners.

In this article we go through a list of major muscles and an easy to follow stretch for each so you minimise the tension applied on the structures around the knee, and stretching in general actually.  These are static stretches and should be done at the end of each running session.

1. Adductors (inner thigh)

  1. step to one side, feet wide apart, toes forward, bend one knee;
  2. you should now be in a side lunge position
  3. chest up, look forward, hands off the legs
  4. hold the stretch for 10-20 sec
  5. repeat on the other side

This is the same stretch as the deep adductor stretch below but both feet face forward (I don’t have a picture of it at hand).

2. Deep adductor stretch

  1. feet still wide apart as the previous stretch
  2. turn one foot out (similar to the Yoga warrior pose)
  3. bend the knee
  4. relax and let gravity pull you down and you perform a deep lunge
  5. back straight, chest up, look forward, hands off the legs, shoulders in line with the hips as best as you can, avoid leaning forwards
  6. hold the stretch for 10-20 sec
  7. repeat on the other side

 

3. Hip flexors

  1. keep the feet wide apart, as in the previous stretch
  2. one foot turned out with the knee bent (similar to the Yoga warrior pose)
  3. turn the back foot to face forward and let the back heel come off the ground as you bend the back knee as well (about 90 degrees angle)
  4. relax and allow gravity to pull you down
  5. push the back heel away to get a deeper stretch (without shifting the body weight off the front leg); if you already feel a stretch with the knees at 90 degrees there’s no need to push the back heel out, do this when your muscles become more flexible
  6. you will feel a stretch on the front of the back leg, at the hip
  7. chest up, look forward, hands off the leg, shoulders aligned with the hips
  8. hold for 10-20 seconds
  9. repeat on the other side

 

For an even deeper stretch lift the arm on the opposite side of the front leg (see picture above).

4. Back chain stretch (including calves and hamstrings)

  1. standing, cross the left leg over the right
  2. bend down and reach for your toes
  3. hold for 10-20 seconds
  4. repeat on the other side
  5. uncross legs, bring feet next to each other
  6. bend down and touch your toes, or get as close as you can

 

5. Calf and tibia stretch. We have a few types of stretches here:

a) Light calf stretch

  1. step forward with one leg, while keeping the back leg straight and the back heel firmly rooted into the ground behind you
  2. you will find yourself in a high front lunge (make sure you have space between your legs for better balance)
  3. slowly transfer your body weight on the front leg, keeping the body straight and the back heel on the ground
  4. hold for 10-20 sec
  5. repeat on the other side

b) Deeper calf stretch

  1. step with one foot forward, leg straight, heel on the ground and pulling toes up and towards your head
  2. keep the back foot firmly rooted on the ground and toes forward
  3. bend the back leg and transfer your body weight on it as if you want to sit on a high bar chair; stick your bum out, un-tuck your tailbone
  4. keep your back straight and your chest out and up
  5. look ahead
  6. to get a deeper stretch pull your toes up toward your head or touch your front toes (but keep your trunk straight, even if you bend from your hips)
  7. hold for 10-20 seconds
  8. repeat on the other side

 

c) Tibialis anterior stretch

1. Standing, place the left foot in front of your right foot to form a T position

2. Bend from your hips and reach for your toes

3. Hold for 10 -15 sec

4. Turn the same foot (left) to face the other way

 

5. Reach for your toes

6. Hold for 10-15 sec

7. Repeat on the other side

To learn more about flexibility and mobility check out our other articles on the topic:

Methods, Types Of Stretching And When To Stretch
Factors That Limit Flexibility And Mobility
Flexibility And Mobility – What Is The Difference
Factors Leading To Running Injuries – Flexibility And Mobility

D. MOBILISE

Each joint has its role to play in running. When joints are flexible they take up some of the impact of running, this way the impact distributes on a larger surface.

Ankle mobility

One good and simple example of how this works is the relationship between the ankle joint and the knee. If your ankles are not flexible enough to take on the pressure when you run, the pressure will be taken on by the knees. So let’s look at how to test and mobilise your ankles.

Testing your ankle mobility:

  1. Place the tested foot about 4 inches (10 am) from a wall
  2. Make sure your foot is straight with toes pointed forward
  3. Attempt to get your knee to touch the wall without lifting the heel or letting your knee move in any direction than forward.
  4. If you can touch the wall without the knee buckling in or shifting out and with the heel on the ground you have pretty good ankle mobility
  5. Test on both ankles and mark with a couple of pieces of tape (one for the left foot, the other for the right) how far from the wall you are so you can test again

How to increase or improve your ankle mobility:

1. Stretch and foam roll the soft tissues around the ankle – often the ankle mobility is limited by the soft tissues around it (i.e. calf, tibialis anterior). Below you have a classic but very effective calf stretch from GMB with a straight and bent leg. In the video you will see the exercise performed with a straight leg and with a bent leg. When bending the leg you load the ankle more which works on the joint itself.

The Yoga downward dog is also a great exercise to stretch the calf.

2. Balance disc – this is a really great little exercise I do as my daily routine. I mentioned it above for knee strength exercises. Place this disc in front of the sink and every evening and morning when you brush your teeth balance for a little bit. Besides helping with ankle mobility is also strengthens your stability muscles, win-win!

As mentioned before this exercise has a high risk of injury, so I recommend you hold on hand on the edge of the sink and don’t struggle to balance, place your foot down as many time as you need to. Safety first.

 

3. Place the foot on a book, or a wedge, bend the ankle until the heel almost lifts off the ground (don’t let it come off though) and move the leg and foot in all directions for 1-2 min on each ankle

There are many ways to mobilise your ankle, but you don’t need a dozen, you need one or two to do them regularly. Knowing a dozen and doing none won’t help. Just choose 1 or 2 from the list, create a little schedule for yourself and practice them.

 

Hip mobility

On the same principle it’s important to keep all joints nice and mobile, and that includes the hip joint.

The hip is the connection, the bridge, between the upper and lower body. In order for your limbs to move freely and smoothly your hip needs to move freely and smoothly.

Think about it this way:

  • the hips and shoulders move the arms and legs
  • the arms and legs move the hands and feet

 

When running you flex and extend the hip over and over again. Without good hip mobility the hip extension is limited, and compensations begin to occur, which can contribute to many running injuries.

The hip must also internally rotate during the running gait to get that hip extension and glutes optimisation. The glutes can’t function effectively if the hip extension ability is limited.

One of the compensations occurring as a result of limited hip rotation and subsequent hip extension is knee hyperextension and lumbar extension.

The video below gives more detailed information and exercises to improve your hip extension:

 

E. DIVERSIFY

…. your training sessions and exercises to continue making progress and shift the degree of impact.

While being consistent with your training is imperative for success, doing the same thing over and over again can lead to plateauing and eventually even regression.

Let’s go into a little bit more detail to understand how the body adapts and what we need to do to continue making progress, whatever our goal may be.

Hans Seyle described the General Adaptation Syndrome (GAS), which looks like this (this is a graph I created myself based on the original):

 

Let’s understand what this actually means, keeping in mind how this applies to your knee health.

 

The Stimulus

This is your new training routine, or knee exercise, or when you come back after months or years of not training. Even if you have always been training, when you start a new routine, that’s the stimulus that (re)starts the adaptation process.

 

The Alarm Phase

Whether we talk about a new diet, lifestyle, training routine, or exercise for the knees, this is when the tough gets tough and where most people give up.

The alarm phase follows the beginning of your training routine, or a new training routine, the initial stimulus.

Any stimulus will initially lead to a decrease in performance in the alarm phase. And this phase can last for days or weeks. During this period, you may experience fatigue, stiffness and soreness and a temporary drop in physical performance. You may feel you’re not going to make it. This is also when the adaptations in the nervous system occur. So it’s a key phase of the process.

Without going through the alarm phase there would be no adaptation, and no progress. If you patiently and intelligently push through it, you will breakthrough to the next phase…

 

The Adaptation

If you “survive” the alarm phase, adaptations begin to occur. This is where you reap the rewards for all the hard work you’ve put in. Your nervous system has adapted to the new stimulus and now you begin to notice muscular and aerobic adaptations. This is progress in performance, this is where you knees become stronger, muscles more flexible, joints more mobile.

At this stage there are skeletal adaptations also taking place and that is why it is essential not to grow the muscle mass too much too soon, as to allow the skeletal changes to take place, otherwise it will lead to joint damage. This doesn’t apply to our knee exercises, but it’s good to know for other types of training. Either way slow progress is best. It’s about building strong foundations first.

If we talk about strengthening knee stability muscles, your muscles’ adaptive response would be becoming stronger.

 

The Plateau

We’ve all heard about the plateau. This is the stage when you adapt to a certain routine and you feel you’re not getting as much out of it as you did at the beginning.

It’s part of the adaptation process and unless you give the body another routine, or exercise, to stimulate the body, or knee, to go through the alarm and adaptation phases again, you’re not going to make much progress.

Furthermore if you stay for too long in the plateau your performance will slowly begin to decrease as you reach the exhaustion phase which can lead to over training. Here’s the picture again:

 

To escape the plateau and elicit further adaptations you may:

  • Schedule a break from training:
    • complete rest and recovery and regeneration or
    • an active break where you can engage in other types of training like balance and fluid movement or try a different sport such as swimming or cycling if you are a runner
  • Changes in your routine:
    • Progress specific exercises in your routine
    • Change your whole routine or just some of the exercises
    • Change only certain variables in your routine:
      • number of repetitions of the same exercise
      • number of sets
      • less rest between sets
      • longer time performing each exercise
      • increase weights
      • increase resistance
      • change running terrain (i.e flat to hills, off road to road)
      • change your pace
      • change running route

Quick note here: if you progress your routine it is recommended to change only a variable at a time (such as number of reps or sets) and only by 10% or less to avoid injuries.

Six to eight weeks it’s usually when you should consider progressing or changing your routine.

In the strength section for knees pain I shared with you several exercises. You can choose 2 or 3 to work on for a 6-8 weeks, then change to another 2 or 3 for the next 6-8 weeks, then come back to the first ones, or finds others.

 

The Exhaustion Phase

According to Hans Seyle’s General Adaptation Syndrome (GAS) continuous exposure to the same routine, or stimulus, will eventually lead to overtraining. This is due to the inability of the body to tolerate the cumulative stress of the same stimulus over a period of time.

This is one of the reasons I consider variation is key.

The exhaustion phase is characterised by a decrease in physical performance, as well as monotony, soreness and fatigue.

So the aim is to keep the body in the adaptation phase as long as possible. And to do this you need:

  • periods of rest scheduled into the programme
  • change the stimulus on a regular basis

See the Plateau Phase for details on how to do this.

When you change the stimulus while in the plateau phase your graph would look somewhat like this:

 

Observe how you continually change the level of adaptation, it goes up and down , up and down …. but it never comes all the way down again, it just keeps going.

The same process applies to strengthening your joints, in this particular case your knees. Use the exercises provided in this article, or others from other professionals, stick with those you feel are right for you, discard those you feel are not, and keep in mind that diversifying your training is an important aspect of joint health.

Nerve flossing, running form and optimum pace are all ways to manager your knee pain. I explained in more detail in my previous article How To Manage Knee Pain In Runners.
If you’d like to take on a Move Wild exercise programme we have 2 routines, each 4 weeks long, ready for you:

 

 

Check them out, sign up and let us know how you’re getting along.

Sources:

  1. Sam Murphy and Sarah Connors “Running Well”
  2. Danny Dreyer with Catherine Dreyer “Chi Running”
  3. Nicholas Romanov “POSE Method Of Running”
  4. Nicholas Romanov with Kurt Brungardt “The Running Revolution”
  5. Ross Rucker and Jonathan Dugas, Runner’s World “The Runner’s Body”
  6. Danny Abshire “Natural Running”
  7.  Thomas Kurz “Stretching Scientifically

 

 

alexandramerisoiu
Alexandra Merisoiu, The Body Engineer, is the Founder of The Merisoiu Technique - Institute Of Health And Human Movement and Dracula’s Retreat. She is also a qualified Low Back Pain Management and Prevention Exercise Instructor and REPS registered.

She specialises in working with runners, beginners and advanced, who want to run faster, further, with less effort and fewer injuries. This is done through natural movement fitness and running technique and mechanics drawn from the many disciplines Alexandra has studies throughout the years, including long distance running.

Since 1995 she has explored how the body and mind works. She has done this through using many different sporting techniques and working with a wide variety of highly respected coaches. Throughout her Martial Arts career she has achieved 3rd Dan Black Belt in Karate Shotokan, runs her own Karate club and is IJKA 2017 triple World Champion, 2016 WMO Martial Arts British National and European Champion. She still competes at an international level.

It is through these learnings, and drawing inspiration from respected natural movement names such as MovNat, IdoPortal and POSE Method of running among many others, that she has created The Merisoiu Technique and has established her own unique transformational programs that incorporate thousands of years of knowledge with Natural Human Movement.

Alexandra’s mission is to challenge the status quo of how to achieve the truly strong, fit and powerful body a runner needs to perform at their best level. This is done through building strong, lasting foundations in the natural outdoor environment; reducing the risk of injuries and educating people on the power of the fundamentals of natural human movement and running mechanics.

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