Exercises For Knee Pain In Runners

exercises-for-knee-pain-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

 

 

How To Manage Knee Pain In Runners

How-To-Manage-Knee-Pain-In-Runners

In the previous article on knee pain we’ve identified 10 Causes Of Knee Pain in Runners. It would be helpful if you read that one first and then come back here.

Impact, or rather repetitive impact, is what causes injury in runners. Forces of about 2-4 times your body weight travel up through your leg, knee, thigh, hip, pelvis and up into your spine, each time your foot strikes the ground. The problem is not only the impact, but the fact that it’s repetitive.

These forces shake and disturb the tissues of your lower body just like an earthquake shakes the walls of a building. But just as some buildings remain standing while others fall, impact from running does not equally disrupt all the tissues they pass through. The damage is concentrated in a few areas of great susceptibility (Source: The Runner’s Body), knees being one of those areas.

I became very passionate, a bit obsessed some might say, with what caused my knee injuries (meniscus damage) as a young athlete Karate-ka. Over the past 5 years I’ve learnt a lot from my coaches, personal experience, books, and even clients about what causes knee pain, knee injuries and how to best manage them. I’m not a therapist or doctor, just a runner, athlete and personal trainer, who has been there, learnt about it, shared the information and got results, and now eager to share with those who cannot train directly with me. If you have an injury it is always best to consult a therapist or GP before anything else.

Don’t get me wrong I am aware that certain injuries never heal, in fact no injury ever heals to bring the body to where it was before, however, we can manage those injuries so we are not in pain and the injury doesn’t aggravate too fast, too soon. We also want to keep training and competing.

The body also finds ways to work around an injury so you can perform the same exercise, at the same intensity, even after injury. The body is amazing at adapting, so don’t lose hope.

In this article I will recap some of the advice from the previous article on knee injuries, but go more in depth with each one, as well as including information which was not previously mentioned in any other article.

Let’s understand why knee injuries or knee pain occurs, what to do and how to manage it so we can continue running.

 

1. “Lubricate” your joints. Do your pre-running warm up.

Movement lubricates the joints as oil lubricates the parts of your car so your car runs smoothly and you don’t worry about it breaking down on the road.

If a car would have no oil the components would grind against each other, wearing out faster. Well, it’s the same with your knees and any other joints.

Synovial fluid is the lubricant in your joints. You want this fluid to be present in the joints, everywhere, especially before you begin a physical activity, but not only. That’s why it’s important to take the joints through the whole range of motion on a regular basis.

One of the ways we do that here at The Merisoiu Technique Institute is through the full squat. All the way down. If you can’t go all the way down you may use a little wedge, such as a thin book or a little stick, just so you go all the way down.

If you do have a wedge under your heels, to not shift your bodyweight too much on your toes as this will transfer the weight and pressure on the knee joint, rather than the quads and glutes when standing up.

Ensure your heels are rooted into the ground throughout the squat.

When you squat, you bend your knees and go straight down as if you were going to sit on a small nursery chair placed right underneath you.

The full squat is not only good for the knees, it also takes your ankle and hip joints through the full range of motion. In the same time it activates the stability muscles, which are very important for runners, and not only. We will talk more about stability muscles later in the article.

Another exercise you could so is to lie face down on the floor and slowly bend your leg behind you at the knee, breathing out on the lift. I do that particular exercise before I go running, about 20 times each side. If you do this exercise standing it’s slightly different as the knees are not on the same line. Try both and observe the difference.

Warm-up is critical to reduce early joint wear and tear. Get those joints oiled and they will stay healthy for longer.

 

2. Nourish

You didn’t see that coming, did you? Maybe you did. We think nutrition is only about recovery and weight loss, but it does more than that. Good nutrition means nutrients for the body, including your joints, and that includes your knees.

But it doesn’t really work from one day to another, it needs to be constant, so your body will absorb the nutrients, transport and deliver them in all corners of your body.

Some corners are more difficult to access, such as the medial knee meniscus. Knee meniscus is a cartilage, which is very durable and elastic. It’s like a shock absorber for the joint. It doesn’t have a blood supply, rather it gets oxygen and nutrients from the surrounding joint fluid.

There is some evidence that there are “canal-like structures opening deep into the surface of the menisci” which may “play a role in the transport of fluid within the meniscus and may carry nutrients from the synovial fluid and blood vessels to the avascular [tissue which does not contain blood vessels or lymphatics] sections of the meniscus”. Further study is needed to pinpoint the “exact mechanism by which mechanical motion supplies nutrition to the avascular portion of the menisci”. (Source: The Basic Science of Human Knee Menisci – Structure, Composition, and Function – Alice J. S. Fox, MSc, Asheesh Bedi, MD, and Scott A. Rodeo, MD)

If this is true then nutrients can reach the menisci and other cartilages throughout the body which don’t contain blood vessels, as well as to everything else from bones, to tendons and joints.

The question is: what type of nutrients will your injuries receive? Bottom line…it’s in your hands, it’s a matter of choice.

Thus good nutrition = healthy joints

 

 3. Strengthen

Ensure your stability muscles in and around the joints are strong. As my Sensei once told us: small muscles are sneaky, large muscles are lazy. Small muscles don’t want to work and “ask” large muscles to take on more work.

Those small, microscopic muscles are very, very important when it comes to joint stability. And I have my natural movement fitness coach Michael Cohen to thank for introducing me to this important aspect of training.

Thus it is important to ensure you train those small, microscopic muscles so they stabilise the knee joint, not letting it go out of alignment and wear too fast, too early.

To do this it’s not enough to do hundreds of squats, jump and run, you need to work on slowing down your movement, practice all sorts of balance, strength and body weight transfer exercises regularly, whether you do it as a standalone routine, in between your other exercises or while waiting for the train or brushing your teeth (careful with balance exercises, safety first), do it regular, be consistent and you will reap the rewards of a fit and strong runner.

Small muscles are important but so are larger muscles which keep the knee from maltracking, such as the adductors and abductors, inside and outside the thigh respectively.

An imbalance in the strength of the muscles in the inside and outside of the thigh causes maltracking of the knee cap (patella) which sits and moves in its groove. This maltracking leads to patellofemoral pain syndrome or anterior knee pain, as it’s most popularly known.

Besides the adductors and abductors another important muscle to look after is the gluteus medius, located up on the hip and on the outside of the thigh. We all focus on strengthening the gluteus maximum, the buttocks, but the medius and even the minimus are important in stability. The gluteus medius work with the other muscle to keep the leg and knee aligned, preventing it from roll in.

If the knee rolls in, the vastul medialis and gluteus medius are not working properly, so the TFL takes over. If the TFL is overworked it can pull in the ITB, increasing the lateral pull on the kneecap. Because the ITB connects to the outside of the patella, the lateral pull in the kneecap can cause this tissue to become sore and inflamed. (Source: Running Well by Sam Murphy and Sarah Connors). Quite a vicious cycle isn’t it?

Remember one important thing: if one thing goes wrong in any part of your body it will have consequences throughout your body. Nothing is isolated from the whole. And injury is never really localised, it’s sends ripples throughout the body.

Also if there is an imbalance in any of the other body systems – physical, mental, emotional, chemical – the other systems will take resources, which should be used for specific tasks, to address the emergency and thus those tasks are not completed. If the resources are re-directed for too long then the whole system is thrown off. Makes sense right? I can’t really tell you the source of this statement because I’ve read so many books and articles that this is more of an intrinsic type of knowledge.

Let’s take an example:

  • You experience an injury in your right knee – physical
  • Your body starts sending more nutrients to the right knee to help recovery – chemical
  • Your mind starts paying particular attention how it’s moving, to protect the right knee from any further damage, so it takes some of the weight bearing responsibility usually met by the right knee, and places it on the left leg, causing you to limp – this is the mental / psychological system
  • If you limp for too long the left leg muscles will begin to store tension and your hips and spine will begin to alter their movement and alignment as well
  • If the injury lasts for too long, your mind is still busy with it, you can’t do much physical exercise, you can’t really run too much, you probably find it difficult even to go down the stairs. You begin to put on weight, you feel stressed, sad, maybe some signs of depression, anger, frustration etc – this is the emotional system affected by a physical injury

However we can’t avoid all injuries and this chain reaction, this just happens, it’s part of life. What I am trying to impress on you is that when injury happens you should take the necessary steps, even stop training for a week or two, to recover. Do not train through a serious injury, thinking you can “shake it off”. If you don’t recover properly you risk months of break from training instead of weeks.

I know it’s difficult and frustrating, I have been in that situation numerous times. Sometimes I take breaks, other time I’m stubborn and I don’t. Something I take the correct decision, other times I pay for my stubbornness.

Although anti-inflammatories or RICE-ing the injury works, as a temporary solution, you must find out what caused the problem to occur. As mentioned in the previous article on knee pain, if you haven’t been in an accident, haven’t had a fracture, or any other obvious reason for your knee to hurt, it could very well be one of the following reasons:

  • Foot overpronation
  • Inward rotation of the hip
  • Tight calf muscles
  • Weak gluteus medius – which can cause the leg to internally rotate more
  • Tight quadriceps – which can increase the loading of the patella, the shorter they are, the greater the pull over the knee
  • Knocked knees – knees falling in

 

The best thing to do when you suspect injuries is, of course, to see a physio, a sport medicine expert or even a GP and assess your injury, running form, muscle strength and flexibility.

We’ve only mentioned the anterior knee pain above. In the previous article I went through a few other possible caused of knee pain. Make sure you check it out.

However, bottom line, seeking professional advice and strengthening your knee and rehabilitating after an injury is essential. Keep you stability muscles strong and you can reduce the risk of knee injuries.

In a future article I will give you some exercises that work to strengthen your stability muscles and stabilise the knee joint.

 

4. Stretch

As we’ve seen in the previous article on knee injuries in runners there are muscles that connect to the knee cap.

Sometimes we experience knee pain because those muscles pull on the knee joint because they’re too tight, too short, because you don’t take the time to ensure they come back to their regular length through stretching and mobility exercises.

To help correct reduce the risk of knee injuries you have to stretch each part involved in stability, protecting or moving the knee. When you stretch have this list in front of you and follow it after a few runs. At a minimum you should stretch the following muscles:

  • Adductors (inside of thigh)
  • Hip flexor (from of thigh, at the hip joint)
  • Hamstring
  • Calf
  • Tibial muscles
  • Glutes
  • Quadriceps

In the next article I will share with you our MoveWildTM  post running stretch movements which will stretch almost every muscle in your body.

 

5. Mobilise

Ensure that your body is not only flexible but the joints are mobile and move smoothly through the whole range of motion. Remember the synovial fluid we talked about right at the beginning of this article, yes? Take the joint through the whole range of motion to “oil” the whole joint.

Besides the knee joint itself, particular for knee pain and knee injuries is the ankle joint. If the ankles are too stiff they can’t absorb part of the impact and it sends more of it to the knees.

If you are a minimalist runners your ankles should feel like they’re going through the whole range of motion – it depends on how you run of course.

If you are a heel striker chances are your ankles need a bit more mobility work.

This article is getting waaaay to long so in the next article on knee pain I will share with you a method of testing your ankle mobility and a few ways to improve your ankle mobility as well.

 

6. Diversify

Running on the same route, same surface and same direction over and over again you place roughly the same stress on the same joints over and over again, thousands and hundreds of thousands of times. No wonder running is associated with knee injuries and not only. It’s the repepetitive stress the same way in roughly the same place that causes the problem.

  • Change the surface you run on. Running on different surfaces will also challenge your musculoskeletal, neuromuscular and cardiovascular systems in different ways
  • Change the route every once in a while
  • If you run on a track change the direction you run in
  • Run on grass or asphalt rather than concrete, where possible.
  • If you run on the side of the road, run on the other side as well, balance it out, especially if it’s a cambered road

I emphasize to my clients to “balance it out”. Everything you do on or with one side of the body, do it on or with the other side of the body as well.

Try brushing your teeth with your other hand from time to time, challenge your body and brain to do things differently.

 

7. Nerve flossing

Nerves form the communication network between your brain and the rest of your body. They send information from the body to the brain, and vice versa, about movement, digestion, pain, injuries, body position and so on. They play a big role in your posture and perception of pain.

This is proprioception – “sense of self” – which was developed by the nervous system to keep track of and control the different parts of the body.

Nerves can get sore and inflamed, just like muscles, and can affect movement. We cannot stretch the nerves as we would stretch muscles, but we can mobilise them. If there is anything bothering the nerve along the way, or the nerve gets stuck (as it can happen to the sciatic nerve which travels in and out of joints and muscles), “nerve flossing” or nerve mobilisation can help with that.

Of course it is always recommended to see a therapist or GP to ensure there isn’t a more serious case going on.

We can’t touch nerves as we touch muscles, to stretch and move them around. So we have to “floss” them instead. Nerve flossing means putting the nerve on tension and then move a structure of the body (i.e. the head) around, which moves the nerve in and out of the tensed position. It’s a sort of sliding or gliding motion that creates motion between the tissues.

Think about sliding the dental floss in between your teeth. If we compare the dental floss with the nerves and the teeth with the muscles, the difference is the dental floss (nerves) will be stationary, and the teeth (muscles) will move forward and back, essentially creating a similar movement.

However keep in mind that the nerve should never be held in a tensed position as it can damage it and the blood vessels supplying it. It is also important for the movements to be performed very slow. It’s better to perform the exercises slow and less of them, then fast and cause damage.

The two most important nerves for runners are the sciatic nerve and the femoral nerve (Source: Running Well by Sam Murphy and Sarah Connors). Both of them emerge from the vertebrae of the lower back.

I haven’t created any videos on nerve flossing myself but here are 2, one for the sciatic nerve and another for the femoral nerve, you can try:

 

Sciatic nerve flossing / mobilisation

Above the back of the knee the sciatic nerve divides into two nerves: the tibial and the peroneal nerves. The tibial nerve travels to the foot and innervates the heel and sole of foot. The peroneal nerve travels sideways along the outer part of the knee and into the upper foot. This is the connection with our knee discussion.

Femoral nerve flossing / mobilisation

The femoral nerve supplies the front of the thigh, quadriceps muscles. The quads assist with knee extension.  All quadriceps attach to the patella (knee cap). If you have a non-specific knee pain it’s worth considering the femoral nerve. As always when it comes to nerves it’s best to see a therapist or GP.

 

These exercises can also be incorporated as post running stretches if you don’t already have a stretch routine or want to build on the one you have. Try them out and see how it goes.

 

8. Running form

Foot strike

Pronounced heel strikers are more likely to develop patellofermoral pain syndrome, just like new runners are more likely to suffer tibial bone strains because they have not achieved the bone adaptations yet. (Runner’s Body)

Heel strikers seem to experience greater impact shock than even the knocked knee runners – those whose knees rotate inwards as discussed above.

 

Overstriding

Overstriding can also be a possible cause of knee pain.

There is some evidence that altering a runner’s form and strengthening certain muscles (i.e hip abductros and hip external rotator) may reduce the degree to which impact forces concentrate in particular areas, in our case the risk of patellofemoral pain syndrome PFPS or runner’s knee. (Runner’s Body)

If reducing the impact is a mean to reducing the risk of knee pain then shortening your stride and landing with the foot flat under your hips instead of in front of your body is worth the work.

Nicholas Romanov’s Pose Method of Running and Danny Dreyer’s Chi Running technique take the same approach, shorter strides, landing under the body.

Using your quad muscles will lead to overstriding, heel striking and knee pain. Instead use the hamstrings to lift the ankle on a straight line under your hip and have a slight lean in the body (from the ankle). Here’s a video on how to “pull” your leg up under the body.

 

9. Stride frequency or optimum pace

The faster we change support the less we interrupt the gravitational pull and the faster we run as well.

A faster stride will keep your stride length short and enable you to land under the body, instead of ahead of the body as discussed above.

Furthermore as you land under the body the only way you can land is flatfoot. You can also land on your toes, but keep in mind that your heels touch the ground ever so slightly, just “kisses” the ground.

The less we counteract with the gravity and the less time we spend on the ground, the less load we place on joints, ligaments and tendons which in turn reduces the changes of injuries. For those running high mileage this is crucial.

A high rate of stride frequency does not demand a huge muscular effort, on the contrary, you actually use less muscle. Of course at the beginning it will be difficult, any changes you make to anything will be difficult at the beginning until the body adapts.

To use less muscle we need to take advantage of the pull of gravity. Why work against gravity by pushing the whole body forward, when we can use gravity as free energy to PULL us forward. Being pulled by something is a lot easier than you pushing your body to move.

To take advantage of the pull of gravity we must understand how the lean works. It’s actually simple really:

  1. Stand facing a wall about 10 cm away
  2. Hold your body straight and look forward
  3. Hold hands in front of you to meet the wall
  4. Lean your WHOLE body from the ankle and catch yourself with your hand, letting your elbows bent as if you were doing a press-up against the all
  5. Push yourself back and repeat
  6. Then do the same on one leg only
  7. Then do the same but it a bent knee and bodyweight slightly distributed more on the ball of the foot (a little, as in 55% of your bodyweight, not too much)

Also have a look at this video.

Attention to:

  1. Your body alignment, do not stick your bum out behind or push your hips forward
  2. Avoid sinking your hips as you meet the wall, hold your abs tensed
  3. Don’t lift yourself on the heels. The heels come off the ground as a consequence of you leaning, you don’t lift your heel to push your body forward.
  4. Think about the leaning tower of Pisa – that’s how your lean should look like, at a smaller scale of course, we need to learn only a few millimetres to harness the power of gravity

 

The optimum pace or stride frequency is 180 steps per min (counting left and right) or around 90 steps counting only one side.

But hold one a second, won’t this be hard work? Yes, it will, going from 150 or less to 180 is quite a jump.

As a recreational runner the easiest way to do this is to get a stop watch or a metronome app and learn and practice the rhythm. Run with the metronome and count 1,2,3,4, 5,6,7,8 alongside the metronome. Develop a counting rhythm so that when you go for your regular runs you just count and don’t need to worry about turning the app on.

At times throughout your run pick two points (i.e. from where you are to a bench, a tree, the corner of the street etc) and run at 180 beats per minute to that point. Then run as you normally do. This is Fartlek training. Short bursts of faster runs. This will ensure a smooth and gradual transition to the new pace without burning yourself out.

For the more competitive runner, you can have a separate interval session. Run at 180 bpm for 30 sec or 1 min, or 5 min (depending on your fitness less and your current pace), then make the recovery run your regular pace. In time your body will learn the new pace as it gradually transition. Remember your goal is to get your body accustomed to the new pace. This will be your new comfort zone. So don’t make the intervals super difficult, it’s not that kind of running interval session.

 

10. RICE your injury

When you do get injured, injuries must be given the appropriate attention. Ensure you rest, ice it, compression (strap the joint) and elevate. Read this article on RICEing your injuries.

 

11. Anti gravity

Running in shallow and deep water as part of you running training reduces the impact on your joints.

Or better yet here is an antigravity treadmill

Have you had the opportunity to try an antigravity treadmill? ILeave a comment below and let us know how it is.

Of check out this underwater treadmill

These are all good ways to either recover from injuries or get a good workout without pounding the ground.

 

There you have it, how runners can manage their knee pain. There is much more I would have liked to cover here, but I hope it will give you a better idea of knee pain and injuries.

Keep in mind that I am not a therapist or medical professional, so take this article, and all article on running injuries, as general information. The author takes no responsibility for any injuries and damage occurred as a result of following the advice from their article and books.

Sources:

  1. Donna Finando and Steven Finando “Trigger Point Therapy”
  2. Sam Murphy and Sarah Connors “Running Well”
  3. Danny Dreyer with Catherine Dreyer “Chi Running”
  4. Nicholas Romanov “POSE Method Of Running”
  5. Nicholas Romanov with Kurt Brungardt “The Running Revolution”
  6. Ross Rucker and Jonathan Dugas, Runner’s World “The Runner’s Body”
  7. Danny Abshire “Natural Running”
  8. Kinetic Health
  9. The Basic Science of Human Knee Menisci by Alice J. S. Fox, MSc, Asheesh Bedi, MD, and Scott A. Rodeo

10 Causes of Knee Pain in Runners

10-Causes-of-Knee-Pain-in-Runners

One of the most common injuries in running happens around the knee because of the impact they need to absorb. We put our knees under pressure with every step, when walking, sitting standing and, of course, running. What we do and how it do it, not only when we run but all the time (this is true for everyone not only runners) is essential for healthy knees.

The kinetic chain means that every part of the body is connected to another part of the body, in such a way that a problem in one area of the body may cause problems in another area are of the body. Nothing in the body is isolated and nothing happens in only one part of the body.

If you have an injured little toe be sure that your body is adjusting to that injury as you cannot use the little toe as you normally would. Those small adjustments can lead, in a few weeks, to tight muscles on the opposite side of your body, for example. Tight muscles will eventually affect your alignment and send pressure to joints, ligaments and tendons, which is not normally their job to do.

That is why an injury, no matter how small should be taken care of as soon as possible, so as to not allow the small problem to escalate and become a major problem.

MOVEMENT

Movement “squeezes” synovial fluid – joint “lubricant” – into the joint. This is why it’s important to take the joint through the full range of motion. For example, if you never take your knee into full flexion, the parts of the surface that don’t come into contact can degenerate more quickly.

We regularly practice full squats, a movement which besides strengthening stability muscles around and within the joints, it also take the ankles, knees and hips through their full range of motion.

MUSCLES

Muscles do the hard work, they are the workers in the body. The brain sends them information with instructions to contract and produce movement, by pulling on the bones.

Since they are connected to the bones, joints and ligaments, injuries (strains or pulls) or weakness in the muscles can cause the knees, and other joints, to take too much pressure, do more than their part of the job and degenerate faster. They basically say “that’s not my job!!”.

THE NERVOUS SYSTEM

The nervous system is the means by which your body components communicate. It’s the network that allows the brain to community with the muscles to produce movement. It’s also the communication channel for the body to send information of position in space to the brain, which then places the body in the best position to avoid injury.

For example, when you run into a ridge on the ground, your body send a message to the brain, which then sends a message back to the rest of the body to assume the best possible position to avoid injury. That includes the arms and head. When you lose balance your arms go the side straight away, that’s why.

Going back to the nerves, if there is a problem with one of the nerves, for example the dreaded sciatic nerve, the effected nerve can refer pain in another part of the body, and that includes the knee.

In the sciatic nerve example, if you have ever suffered by a trapped or irritated sciatic nerve, known as sciatica, you probably felt the sharp pain going down the back of the leg.

A nerve problem refers pain, it’s not usually localised.

RUNNING INJURIES

Running is more associated with chronic injuries than acute ones. That means that the knee injury happens gradually, through time, and symptoms just show up at a later stage.

It’s a build up of stressing certain areas of the body. The reason running is so hard on the joint, ligaments, tendons and muscles is repetitive impact.

Each time your foot touches the ground impact forces travel upward through your lower leg, knee, thigh, hip, pelvis and spine. It’s like an earthquake, shaking everything.

So our job here at The Merisoiu Technique Institute is to help you calm down that earthquake, reduce pressure on your joint and enable you to run stronger for longer.

CAUSES OF KNEE PAIN WHEN RUNNING

The topic of this article is knee injuries or almost any kind of knee pain (doesn’t necessarily have to be an injury for the knee to hurt).

There can be many, many reasons your knees hurt. In this article we mention some of the most common knee pain causes, but it’s not an exhaustive list. In subsequent articles we will take each one and see what we can do to prevent or treat the injury or, if it’s something serious, whom to talk to solve the problem.

Thus, here’s what may cause your knee pain:

1. Surfaces you run on

Let’s begin with the surface you run on. When you run on the same surfaces over and over again there’s a gradual accumulation of the same forces applied on the same areas of the body time and time again, over thousands of steps.

That is why it’s important to add variety to your running surfaces, concrete, off road, track etc. We will talk a bit more about this later in the article.

2. Your running shoes

The shoes you choose are critical to injury or injury prevention. If your shoes are too tight, or they don’t allow for a natural bend of the foot, or don’t allow for the toes to expand, or don’t give the support you personally need your stability can be compromised.

That compromised stability will cause instability in the knee as well. Remember the body sends signals to the brain, my means of the nerve network, to position the rest of the body (including spine, arms, neck and head) in the most efficient way to avoid injury. If the information is not accurate the brain can’t act in your best interest.

A word of caution, today’s cushioned shoes mask the pain of running heavily and incorrectly. If you don’t believe be test it yourself. Take your shoes off and run 50m. You will notice how heavy you actually run. Don’t worry your body will soon begin to adjust and realign to reduce that impact. There’s an immediate foot-brain-body communication and the whole system will begin to adjust.

However, this doesn’t mean you should run barefoot, it only means you should learn the natural or barefoot running mechanics with the regular shoes one. It can be done, you can run with your shoes with less impact.

3. Your training

Same as with the running surfaces if you do the same routine over and over again you will stress the same areas of the body time and time again. If you also run the same route all the time then this is even more true.

Bring variety into your running training to reduce the risk of overuse injuries as well as to create adaptation and make progress.

It is worth, and actually important, to keep a running journal where, besides writing down distance and pace, you will note any niggles and pains during the sessions. You can then go back and maybe identify what caused the injury.

It may have been new running shoes, new route, change in speed, distance, too much, too soon and so on.

4. Change and speed

Increasing mileage, frequency or intensity by more than 10% per week can overload a body that’s not prepared for the effort, thus increasing the risk of running related injuries and, of course, knee injuries.

Running too fast while not prepared is another cause for injury. This is common when a runner transitions from distance running to interval running too quickly.

Distance running and interval running are two different types of running all together. Each requires different muscles and, actually, a different body. Just look at Mo Farah – a distance runner vs Usain Bold – sprinter.  Two different body types.

5. Running form

Your knees may hurt from continuous impact on landing and push off. That is why the running techniques we teach, with elements extracted from POSE Method, Chi Running and Natural Running, are meant to re-train your body to land softer, lighter and reduce the push-off – we pull, not push.

Since we’re talking about running technique, let’s talk about how you can address your running form to reduce the pressure on your knees as well as other joints throughout your body

 

a) Poor alignment when running

Alignment literally means arrangement in a straight line. That’s how you want to see and positions your body when you run. But most runners bend from the hips and they form this crocked line.

What’s stronger or more stable 20 bricks on top of each other on a line, or 20 bricks with just on brick sticking out?

A heel striker will bend from the hips even more pronounced because of the way the hip tilts to allow for the heel strike. If you kept your pelvis aligned you wouldn’t be able to comfortably heel strike.

 

b) Running gait – foot turnout

If your feet turn out as you run it can cause knee pain at any distance because it causes the knee to rotate inwards with every foot strike.

Consequently this will overwork the ligaments and tendons in the knee and lead to knee problems and pain.

See a more detailed explanation of a few knee injuries and conditions at point 4 below.

 

c) Heavy heel striking and landing ahead of the body (overstriding)

Pronounced heel strikers are more likely to develop patellofemoral pain syndrome, because impact forces are transferred more aggressively from the foot to the knee with this type of running.

Impact may can cause knee pain and heel strikers experience greater impact shock. However it can also be caused by excessive rotational forces, which come with a heel strike. A heel strike allows for the foot to rotate in either direction until the foot lands and grounds.

When you heel strike you are also probably landing in front of your body, it’s usually the case since you can’t comfortably heel strike if you land under your body/hips. When you land ahead of your body you are essentially breaking your forward momentum, you’re going against gravity, and you pay for it in the long run (no pun intended).

If your foot stops, as it does when you land in front of the body, and the body keeps moving, your knee becomes the transfer point for all the force. It takes more than its share.

Landing ahead of your body with a locked knee or ahead of your body with an over bent knee, both variations put a lot of stress on the knee join, tendons, ligaments and cartilage.

Also landing wide (with a wide space between your feet, wider than the hip width) ahead of the body with a locked knee and ankle can cause ITB (iliotibial band) pain.

You are landing outside your natural hip width (feet are too wide apart when landing), which causes the legs to bow out so you can move forward. This causes too much lateral movement and your hips need to compensate and adjust which stresses the IT band.

To reduce the impact on your knee join all you have to do is to pick up your feet and land under the body by leaning your body from the ankles, or run with your upper body in front of your foot strike (same thing said a different way).

 

d) Downhill running technique

Most think going downhill is actually better or easier than uphill. Think again. While running uphill your muscles burn, which means they take the load – remember muscles are the workers of the body – downhill muscles relax, and your knees take the load.

There is up to 10 times your body weight with each step when running downhill (Source: Danny Dreyer with Catherine Dreyer “Chi Running”)

6. Structures around the knee

Besides running form, shoes and surfaces you run on, another reason you suffer from knee pain may have something to do with the structures around the knees (i.e ligaments, tendons, cartilage, muscles)

 

a) Patellofemoral pain syndrome (PFPS) or anterior knee pain (where it’s usually felt) is a classic and common chronic injury in runners. It accounts for roughly 20% of all running injuries (Source: Ross Rucker and Jonathan Dugas, Runner’s World “The Runner’s Body”)

The cause of anterior knee pain when or after you run can come from structures which are connected to the knee joint, such as muscles, tendons or ligaments.

If any of the structures around the knee pull incorrectly, or exert too much or too little force, the knee cap can be pulled out of alignment or out of line and it doesn’t roll smoothly as it should.

Misalignment can be caused by strength imbalance of the muscles on the inside (adductors) and outside (abductors) of the thigh, for example the gluteus medius which is a stabiliser muscle.

If the knee rolls in as a result of weak inner and outer thigh muscles, the gluteus medius (gluteus minimus can also be included here) and a muscle called vastus medialis obliquus, can’t do their job properly, so the tensor fasciae latae (TLF) takes over.

But if the TFL has to do more than the job it’s supposed to do it can pull on the illiotibial band (ITB), increasing the lateral pull of the knee cap, again pulling the knee out of the alignment.

A lot to take it isn’t it? The body is not formed of separate pieces, it’s a whole unit. Anything that happens anywhere in the body will have a ripple effect throughout the rest of the body.

If you just run for a bus from time to time you don’t need to know these things, although you should, as general knowledge. Most people know more about how their car functions than how their body works. Which is weird, since they’re driving their body 24/7.

However, if you are a runner and you want to continue running for many years to come, it is essential to understand the basics of running mechanics so you understand how to design your training, when to pull back and when to push on. There’s a difference between productive and destructive pain.

Sometimes the best strategy is to rest and be able to run in 2 weeks, than to push on and be off training for 3 months because of the escalating injuries.

Going back to patellofemonral pain syndrome or anteriot knee pain, to  solve this problem you must find out what is causing your knee to roll in, it could be:

  • Overpronation of the foot
  • Inward rotation of the hips
  • Tight calf muscles
  • Weak abductors
  • Tights adductors
  • Weak gluteus medius (that’s part of the abductors actually)
  • Other tight structures around, below or above the knee (see quadriceps at point 7)
  • Other causes

 

b) Iliotibial Band (ITB) Syndrome

The ITB runs down the outside of the leg and is a thickening of the normal fascia that surrounds the thigh.

To give you a short definition, fascia is a thin membrane that connects or attaches every structure, muscle, internal organs.

ITB attaches to the Tensor Fasciae Latae (TFL) at the front of the hip and to part of the gluteus maximus at the back of the hip.

The TFL goes down to the outside edge of the tibia and to the head of the fibula (the 2 bones forming your shin). It also attaches to the patella (knee cap). If there is any tightness or any problem with the TFL your knee will also be affected.

ITB syndrome is the second most common injury in runners. ITBS is usually felt as a localised pain on the outside of the knee when the leg is bent. It’s usually worse going up and down the stairs and running downhill.

ITB pain can be caused by biomechanical alignment problems such as:

  • Bow legs
  • Overpronation
  • Leg length different

ITB pain can also be caused by training, such as running on the camber of the road on the same side of the road for too long, or on a track when you don’t change direction and run the same way all the time. These 2 cases load one leg more than the other.

Another cause of ITBS can be weak hip stabilisers which increase tension on the IT band upon landing .

Patellofemoral pain syndrome (anterior knee pain) is common in runners with ITBS as the internal rotation of the thigh comes with the weak hip stabilisers.

So strengthening the adductors and abductors, as well as the glutes of course, can help both knee pain and IT band pain.

 

c) Patella tendonitis or tendinosis

Tendonitis is an inflammation, while tendinosis is degeneration of the tendon.

This pain is usually at the bottom of the kneecap. Causes of patella tendonitis:

  1. Microtrauma – tiny damage to the tendon fibres
  2. Excessive excrentric overload of the quads – overload while the muscles are lengthening – which can be caused by overpronation again, turning-in of the hips or knees or excessive tightness in the quads.

 

d) Bursitis or Pes Anserinus tendonitis

Problems with this tendon are not as common but they can happen. The cause is usually tight muscles on the inside of the legs, adductors.

Tendonitis happens when the tension on the area is too great, causing inflammation of the tendon and the underlying bursae.

The pes anserinus tendon runs along the inside of the knees and is a combination of the 3 tendons of the sartorius, gracilis and semitendinosus muscles.

The semitendinosus muscle is part of the 3 muscles that form the hamstring. The other two are biceps femoris and semimembranosus.

The actions of the semitendinosus and semimembranosus is extension of the thigh and flexion of the leg, as well as assisting in the internal rotation of the leg at the knee. Problems with these 2 muscles, tightness, trigger points, injury can send pain to the back of the thigh and knee and well as a portion of the calf.

Since we are talking about hamstrings, excessively tightened hamstring muscles can overload the quadriceps, which, in turn, can refer pain to different areas of the knee. Which leads us to…

7. Quadriceps

All four muscles that form the quadriceps attach to the patella (kneecap) through a common tendon via the patellar ligament to the tibia. Well that’s a mouthful.  Just remember the quads attach to the kneecap.

The four quadriceps muscles and pain associated with them:

  1. Rectus femoris – may cause anterior knee pain
  2. Vastus lateralis – pain may be referred to the back of the knee; pain can go all the way up to the hip on the outside of the thigh
  3. Vastus medialis – can refer pain on the front towards the inside of the knee, going up the thigh as well; may cause buckling of the knee
  4. Vastus intermedius – pain over the front of the thigh; no direct knee pain, but it can affect the other muscles which then cause knee pain

Of course the muscle-pain correlation is not isolated. It’s more to give you an idea of which muscle may cause which pain and where you’d feel it. There may be one or more causes of your knee pain, as we’ve seen above.

I added the quadriceps as a separate bullet point because it’s often overlooked by runners as a cause of knee pain.

Many, if not most, runners forget to stretch and massage their thighs and if they suffer from knee pain the cause may not always be a problem like tendonitis or anything structural, it might actually be very tight quadriceps.

That is why stretching is important, among many other reasons. If you do experience any knee pain, you know, at least, you can exclude one of the possible causes.

By the way, you can overload the quadriceps due to excessively tightened hamstring muscles. So stretch those hamstrings and quadriceps.

Sudden overload through misstep or fall can also overload the quads. But this is less of a repetitive running injury, it’s a sort of accident injury. The later can’t always be avoided, no matter how much you train, it’s part of the game.

8. Cartilage problems

The menisci can be damaged or torn by low level twists. There is usually a clicking in the knee, and pain when squatting. The knee may also lock or give way. The pain is usually felt on the inside of the knee with the knee bent.

I have to add I have first-hand experience with the menisci. Since the age of about 12, because of high intensity training in karate during the growth spurt, both my knee menisci damaged (grade 3 damage) to the point where I could barely walk.

Fast forward, natural movement fitness helped re-align, re-adjust and re-educate my body and body mechanics, to the point where today I can run, jump and practice karate without knee pain 95% of the time. The damage is still there, but their pain isn’t, so I dodged the surgery and I’m able to do everything I want without pain.

It all boiled down to perfecting the art of movement. Perfecting is not quite the correct word, there’s no such thing as perfect mechanics, it’s more like fine tuning.

By the way this doesn’t mean you should ignore your doctor. Everything I write in this article and on this website is not meant to replace any medical treatment or specialised advice.

9. Nerve referring pain

This is a very, very complex situation and only an expert can give you any advice here. All I can say is that if you feel pain travelling it may have something to do with the nerves. When a nerve is damaged, trapped or injured in any way it’s not usually localised, it refers pain in another part of the body.

10. Accidents

A twisting injury or a fall can cause damage to the knee’s structure. You should get an immediate diagnosis.

 

All the underlined topics will have their own articles so look out for them.

 

Sources:

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

Disclaimer: information in this article and on this website is not meant to replace any medical or expect advice; you should always check with your doctor.