Prevent Knee Pain

author : AMSSM

comments : 2

Triathlete requests stretching and movement tips to prevent runner's knee.

Member Question:

I've started doing a lot of extra exercise this year since signing up for my first Tri and have also been learning about technique & stretching the hard way, as I have had a couple of injuries with my knee. However, I have changed my swim stroke to freestyle (and gone to a swim technique class), started stretching more as well as doing a couple of other things. Simply though, I think it is running that is the culprit with my sore knee & tendons. My question is: Do you guys do any strength exercises to build up your knees or connected muscles? Is there something simple I should be doing? Some particular stretches perhaps. Excuse my lack of knowledge, but let me know if you can shine a light.

Answer by Anna Monroe, M.D.
Member AMSSM

Runner’s knee is extremely common, and fortunately there are some exercises that can help treat and prevent the pain. 

First, let’s talk about the causes of runner’s knee so that the exercises make more sense. You mentioned you have been increasing your activity this year, and overuse is a big contributor to this running injury. Slowly increasing mileage (by no more than 5-10% per week) and introducing other elements (speed, terrain change such as hills) one at a time can help prevent overuse injuries. 

Other causes of runner’s knee include a person’s anatomy (the particular way your body is put together) and biomechanics which have to do with gait, alignment, etc. There is debate about the role shoes play in runner’s knee, and there is not enough information at this point to recommend one shoe or another. Changing your anatomy is pretty hard in the absence of major surgery, so addressing biomechanics becomes the primary target.

Simply, you want to focus on building up the large muscles in your body- glutes, abdominals, and back (the “core”) so that these muscles don’t fatigue during a run and leave the slightly weaker thigh muscles surrounding the knee to pick up the slack. If that happens, the knee sometimes gets irritated.

I would recommend starting a basic strength routine 2-3 times a week. It’s easy to add these on to the end of a run, and you don’t even need a gym!

1. Single Leg Squats: Stand on one leg. Squat down until you reach about a 45 degree angle. For reference, a 90 degree angle would bring your thigh parallel to the ground, so about halfway to parallel is your goal. Make sure that your knee is in line with your ankle, and sit back and down like you are aiming for a chair behind you. Straighten up, and repeat. Your goal is to build to 3 sets of 15, and if it becomes really easy, you can add some hand weights to challenge yourself. Doing these single leg rather than with both legs really works each leg equally so that a weaker side does not get to free-load off the stronger side!
2. Bridges: Start lying on your back with your knees bent, feet flat on the ground. Your knees should be about hip width apart, and your heels should be fairly near the ischial tuberosities or “sits bones.” Lift your hips several inches off the ground keeping your knees parallel. You will look like a ramp from your kneecaps to your hip creases. Hold for 2-3 seconds, and lower down. Repeat. Build to 3 sets of 15. If this exercise becomes easy, do it with single legs. One leg takes a turn in a straight position while the other does the work of raising and lowering the body. Then switch legs to balance things out.
3. Planks: Assume a push-up position with hands flat on the ground, wrists under shoulders. Strongly engage the abdominal muscles to support the back. Hold for 30-60 seconds. Rest for a minute, and repeat 2-3 times as your strength grows. You can also do planks from your forearms, and if they become easy hold for longer or lift one leg at a time to challenge yourself.
4. Step-ups: Find a platform or bench about 2 feet off the ground. Step up with one leg. Keep that leg on the bench, and step up and down with the opposite leg. After 15 reps, switch legs. Aim for 2-3 sets of 15 reps per leg.

After these strengthening exercises, you can add some stretching. For runners, hamstring (back of the thigh) stretching is key. While lying on your back, straighten both legs on the floor. Bend one, grab behind your thigh, and straighten the leg as much as possible into the air without overstretching it (creating pain). Hold for 30 seconds, and repeat on the opposite side. Aim to complete 6 sets of 30 seconds of stretching per side if you can.

Finally, quadriceps (front of the thigh) stretching can be helpful too. From a standing position, bend one leg. Reach back and grab your sock or pants hem. Pull the heel towards the buttock, and hold for 30 seconds per side. Again, try to fit in several sets of this stretch each session.

If you fail to have relief after resting from any overuse and incorporating a simple strengthening and stretching program, I would recommend seeing a sports medicine physician or sports physical therapist for further evaluation. Good luck!

Anna Monroe, M.D.

Dr. Monroe completed a primary care sports medicine fellowship at Wake Forest University. She has worked in orthopedics and in university student health. She is currently pursuing her Master’s in Public Health degree, and she hopes to promote health on a population basis.

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date: June 23, 2017