If you’re a runner, chances are you have had a knee issue at some stage. Or at least been worried about it happening. We all tend to have this belief that running is inherently bad for our knees, but is it true? In the first part of this two-post series, we seek advice from the experts to help answer this question. They help us to understand the bigger picture of how running affects our knees, provide us with a simple test we can use to gauge how injury-prone we might be, and detail the different types of injuries, conditions or running technique that might cause knee pain.
In this post, we will explore what to do if you already have knee pain, and some stretches and exercises that might help runners’ knees! The information in these two posts have been researched and written wholly by the team at the Bowskill Clinic in London along with some medical experts they work with… specifically for you (us!), which is pretty awesome. Only minor edits (and a few cheeky comments) by me.
A gentle reminder from the experts before we start… While much of the information in this blog will help reduce the incidence of injury, unfortunately even with the best advice it is not possible to completely avoid any risk of injury when starting a running programme. But hey, we never said running would be easy, right?
If I have knee problems, should I avoid running?
There are many different things to take into consideration if you have knee pain and are a runner. Some kinds of aches and pains may simply come and go and can be ‘run though’, while others may need some rest and specific medical advice and treatment or a rehabilitation programme.
Below are listed some of the factors that mean you should stop running and see a doctor or physical therapist.
According to Dr Jonathan Rees,Consultant in Rheumatology and Sports Medicine, injuries commonly occur in the joints, bone or tendons. He explains that it is therefore important that you ‘listen to your body’. While there is also no substitute for a formal assessment by an experienced physiotherapist or sports doctor, the following are Dr Rees’s guidelines for when you should consult with a specialist:
- Pain. It is not normal to have pain (wait, what?). Not only that but pain will affect how you run. You need to know what is causing the pain and why.
- Any pain accompanied by swelling in a joint is of concern and you should not run on a swollen joint. It risks potential further damage to that joint.
- Pain at rest, at night or on gentle activity could indicate a stress fracture and it is essential that this is checked out medically.
- Pain that is worse initially, eases during a run and then recurs late that day or the following day is also a concern.
Another important factor in assessing knee injury in runners is understanding some of the implications of imaging findings. In other words, if you have x-rays, ultrasound or MRIs of your injury, it is important that they are interpreted by the radiologist with a full understanding of your sporting background, level of competition and history of training.
Dr Simon Blease, Consultant Musculoskeletal Radiologist and elite fell runner explains:
As radiologists we have to be aware of the additional changes that occur in the body in response to exercise. We call this phenomenon ‘Adaptive Change’ and it is important to realise just how much a knee may adapt to exercise compared to a sedentary person. For example, the knee cartilage will change its appearance in a way that would indicate disease in a sedentary person but can be, in fact, quite normal for an active runner. In addition to this, an elite athlete can tolerate pathological damage to the joint that would stop an ordinary person in their tracks. Training, conditioning, mental approach and determination all alter the individual response to joint damage and a radiological report must be take this into account in order to be meaningful for further management.
So, in my experience, if you get MRI results back that seem rather scary, get a second opinion, particularly from someone who is used to working with athletes! I’ve experienced this with scans, but also with ECGs of my heart. My ECGs always come out strange, causing doctors initial alarm, because of my enlarged heart and slow heart beat. It’s apparently called ‘Athletic Heart Syndrome’, and while perfectly normal for an endurance athlete, it can look like heart disease in someone more sedentary. (Read “Six Reasons Your Doctor Needs To Know You’re a Runner” in Runner’s World).
Returning to running after knee pain
If you’ve had knee pain in the past and are returning to running, it is important to concentrate on a) stretching appropriately and b) strengthening your legs. A graded return to activity that gradually increases volume and is created with cross training also in mind will help to reduce the chances of re-irritation.
a) Five stretches to help runners’ knees
Here are five stretches to help to maintain flexibility around the knee joint. However, as a reminder, if you have a particular issue you should always consult with a medical professional.
Hold each stretch for 30 seconds gradually and gently progressing the stretch as you feel able.
- The three plane hamstring stretch
- Sit on the edge of a bench with one leg straight and then other bent.
- Bring the arms straight in front of you pointing downwards.
- Lift the chest and fold from the hips to feel the stretch.
- Perform with toes up and turned in and out to vary the different heads of the hamstrings
2. The 90/90 glute
- Sit with both knees at 90 degrees
- Fold forwards from the trunk keeping a straight back.
- Perform to the knee, half way down the shin and outside the knee.
3. The triple angled calf stretch
- Place your arms against a wall with the back leg straight.
- Bend the arms to feel the calf stretch.
- Place the toes in and out to change the stretch
- Bend the front knee at the same time to stretch the lower calf of the front leg at the same time.
4. Quadriceps stretch
- Hold one leg behind you bringing the heel towards the glute.
- As you pull the heel back tighten the abdominals to try to posteriorly tilt the pelvis
5. The lateral sling lean
- Straighten your back leg with the front leg bent.
- Reach over your head towards the wall.
- Lean away from the wall to feel the stretch.
b) Five strengthening exercises to help with knees
These general exercises can help to develop strength around the pelvis, knee and hip joints, but again (you guessed it) if you have a particular issue you should always consult with a medical professional.
1. The belt and ball squats
This exercise improves strength of the muscles that control inward and outward movement of the upper leg.
- These squats should be performed over 4-6 seconds lowering and lifting but maintain pressure on the ball or against the belt.
- Feet should be parallel or slightly turned out if more comfortable for this version.
- Hips and knees should bend with the same relative timing.
Lower for 4-5 seconds pause for one and rise over 4-5 seconds. Repeat 12-15 times for 1-3 sets with 45 seconds of recover between sets.
2. The toe touch drill
This exercise improves tracking of the knee and balance and proprioception.
- Stand on one foot and reach the other foot forwards.
- Reach out as far as you can maintaining balance and keeping the knee over the region of the second toe.
- Perform this slowly 3 times to 45 degrees, 90 degrees, 135 degrees and 180 degrees.
Reach out over two seconds and back over two seconds for three repetitions at each position. Repeat one full circuit before repeating on the other side. Rest for 45 seconds and repeat for 1-3 sets.
3. The hip thruster
This exercise improves strength of the muscles that extend the hip.
- Lie back on a ball or bench with your arms cross your chest. You may use a weight on your hips as your progress.
- Drop your hips to the floor and then push upwards clenching your glutes together as you drive upwards.
- Slowly lower and repeat
Push up over three seconds, pause for one at the top, and then lower down over three seconds. Perform 12-15 repetitions, resting for 45 seconds between sets for 1 -3 sets.
4. The swiss ball leg curl
This exercise improves strength of the muscles that control the back of the leg.
- Lie on the floor with your feet on the ball.
- Push up through the hips and at the same time bring your heels to your backside.
- Aim to keep the knees, hips and shoulders in line at the top of the movement before lowering to the floor.
Push up over 2 seconds and back over 2 seconds. Perform over 12-15 repetitions rest for 45 seconds between sets and complete 1-3 sets.
5. The forward ball roll
This exercise improves core control and hip and trunk dissociation.
- Make a box with your trunk, arms and hips.
- Hold a straight position of the back and then roll the ball forward from the hands and the hips.
- You should only roll as far as you can hold the spine still.
- Hold for 3 seconds and then slowly roll back again.
Roll out over 3 seconds, hold for three seconds and return for three seconds. Perform 12-15 repetitions rest for 45 seconds and then repeat for 1-3 sets.
The Bowskill Clinic is an interdisciplinary centre specializing in rehabilitation of orthopaedic and sports injuries.
Jon Bowskill, Corrective exercise specialist / performance strategist, founder at Bowskill Clinic
Jon is an exercise specialist with a particular interest in creating bespoke strategies for rehabilitation and performance. He works with his team to bring together the right specialists to help resolve a range of different sports injuries.
Andrew Jackson, Musculoskeletal Physiotherapist at the Bowskill Clinic
Andrew is a specialist in physiotherapy and movement mechanics. He works closely with Jayesh to develop treatment and exercise prescription for runners.
Jayesh Thakrar, Musculoskeletal podiatrist at the Bowskill Clinic
Jay is a specialist in running biomechanics and uses the very latest VICON motion capture system along with in shoe pressure analysis to precisely understand runners’ needs.
To find out more of what our runners rehabilitation and management programmes involve contact firstname.lastname@example.org or see more of our physiotherapy and biomechanical gait assessments at www.bowskillclinic.com
Dr. Jonathan Rees, Consultant in Sports and Exercise Medicine and Rheumatology at the Fortius Clinic
Dr Rees is a specialist in sports medicine with a particular interest in running and tendon injuries. He was physician to the 2012 London Olympics and 2008 Team GB paralympic team.
Dr. Simon Blease, Consultant Musculoskeletal Radiologist
Dr Blease is a specialist in musculoskeletal imaging especially relating to sports injuries. He provides second opinions on scans for complex or non resolving issues.