Expert advice: Stretches and Exercises for your Knees!

5-stretches

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:

  1. 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.
  2. 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.
  3. Pain at rest, at night or on gentle activity could indicate a stress fracture and it is essential that this is checked out medically.
  4. 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.

  1. 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

quadriceps

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.

sling-lean

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. 

A huge thanks to the Bowskill Clinic and their team of experts for providing us with all of this information. It’s no easy task to pull this all together. These guys are top notch, so I’m really stoked they agreed to do this! They have the UltraRunnerGirl stamp of approval (they helped me overcome injuries in 2010 and again last year in 2016 before Tor des Geants).

Contributors

The Bowskill Clinic is an interdisciplinary centre specializing in rehabilitation of orthopaedic and sports injuries.

jon-bowskill-portrait-photoJon BowskillCorrective 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-physiotherapist-london-w1Andrew JacksonMusculoskeletal 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-bowskill-clinicJayesh 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 jon@bowskillclinic.com or see more of our physiotherapy and biomechanical gait assessments at www.bowskillclinic.com

dr-reesDr. Jonathan Rees, Consultant in Sports and Exercise Medicine and Rheumatology at the Fortius Clinic

Website         www.drjrees.com
Email              info@drjrees.com

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.


simon-bleaseDr. Simon Blease, Consultant Musculoskeletal Radiologist

Website         www.advancedskeletalimaging.com
Email              info@advancedskeletalimaging.com

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.

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Weekend escape to Portugal

Now that I live in Geneva with the Alps at my doorstep, you wouldn’t think I would need to travel anywhere to train… But I can’t deny that sometimes I just feel an innate need to get away. Sometimes my brain just gets blocked and I need to find a way to hit the reset button. I don’t know if it is about escaping (itchy feet?) as much as it is about searching for a new environment to help clear the cobwebs, but either way, this weekend provided the perfect excuse to hop on a plane. It’s too cold in Geneva to comfortably do a run over 2 or 3 hours (for my thin blood anyway) and the snow conditions still aren’t great for skiing. But I’ve been desperate for some long-ish days of training. So, after a quick google search for ‘direct flights from Geneva to Europe’, cross-referenced with google earth to see where there were large amounts of green spaces, I wound up on a solo mission to Sintra, Portugal, less than 24 hours later.

Sintra is a little piece of Portuguese heaven. Just 20 miles west of Lisbon, it is accessible by train from Lisbon city center or directly from the airport via a 60 EUR cab ride (which is the lazy option that I took – I’ll admit it that on a three-day trip, I don’t waste time mucking around with public transport). A UNESCO world heritage site, Sintra looks like it was created out of the imagination of an eight-year old girl. Brightly-coloured buildings line the streets with ice cream shops on every corner. Christmas carols blast from speakers installed in the trees, synchronized throughout the entire town. A castle in fisherprice reds and yellows beams down on the city, viewed high above in the distance through a cacophony of vines and overgrown trees.

 

When I arrived here on Thursday night, I immediately set out into town to find some food. Outside of tourist season, and outside of Lisbon, Sintra is dead to say the least… but it didn’t take too long before I found myself stepping into a local haunt down a deserted side street. Everything about it felt right: not a tourist in sight (except for me) and no burgers, fries or caesar salads on the menu. Just local dishes served in clay bowls, wine available by the mini gallon, and what appeared to be the Portuguese mafia dining on the second floor. Perfect. Two octopus salads and one cheese board later, and I was ready for bed.

On Friday morning, I set out with no real plan in mind – I wanted to reach the ocean, but img_6222didn’t really know the best way to get there, so I just headed West and gave my feet the freedom to choose the exact path. I wound up on some busy roads, but also on some interesting detours through small ‘mountain’ villages and along narrow cobblestoned pedestrian paths in various states of disrepair. When I finally reached the ocean, it was pouring rain – one of those epic downpours where the raindrops seem to penetrate straight through to your bones – but it didn’t seem to detract too much from the day. I was in exploring mode, and a little bit of rain wasn’t going to stop me.

Saturday was more successful. I found my way deeper into the ‘dark green’ splotches on google earth, enjoying getting lost on the dirt roads and trails through the Serra de Sintra (Sintra ‘mountains’). (Side note: yes, like a new Swiss snob, I put any ‘mountain’ under 1000m in quotation marks, and this one only reaches 529m at its highest). The Sintra mountains contain a castle and palace at every turn it seems, with the Moorish Castle, the Pena Palace, the Sintra National Palace, the Palace of Monserrate and the Quinta da Regaleira all inside. Another time I will come back to actually spend time visiting these places… on this trip, I was happy to take in blurry versions of the historical sites as I ran past.

As I finish my third – THIRD – post-run meal inside yet another Portuguese local restaurant, I am pondering heading out for a night run to experience the magical silence of this place in the dark. But then again, with the generous sizes of the wine pours here, I’m probably just going to head to bed early… one more run ahead tomorrow before I jet back to the ‘bustle’ of Geneva.

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I meant to take a photo of my food. But it disappeared a bit too quickly 🙂

To see my runs on Strava, click here! I am delighted to announce that I was selected by Strava to represent them in the 2017 Western States Endurance Run… follow me as I ramp up my training to get ready for the adventure of a lifetime!

How to Get the Most Out of Your Treadmill Workouts

*This post originally appeared as ‘expert advice’ on RacingThePlanet’s website

No one actually likes using the treadmill. It’s a machine that was designed for lab rats, not human beings. Running in place next to a bunch of other sweaty robots in a gym? No thank you. I would much rather be outdoors exploring new landscapes with the wind at my back and the sun on my face. Unfortunately, in my line of work, the treadmill often provides my only source of exercise. As an international human rights lawyer I tend to live in unsafe places like Afghanistan, South Sudan or my current home, Gaza. They are not exactly the best places to run around outside in my spandex (I am still waiting for Salomon to come out with a full body ninja running costume). I have come to accept the treadmill as a necessary evil in order to keep up my fitness.

While you may not live in a war zone like I do, if you are a busy person who likes to run, the treadmill is usually unavoidable. They might be boring but they do offer a convenient way to get a run done in a controlled environment. In order to help ease the pain, here are a few tips for getting the most out of your treadmill workouts:

1. Work on your technique

Admit it – when you’re running on the street and you pass by a row of store windows you check yourself out in the reflection, right? Don’t be embarrassed – your vanity can actually help you out in the gym. Being surrounded by mirrors throughout your entire run can allow you to pick out quirks in your technique that you might not have seen otherwise. Do you run with duck feet? Swing one arm out to the side? Bounce up and down too much? Try to evaluate your technique critically and work on changing one bad habit at a time.

Bonus tip: try to watch your technique from the front and also from the side so that you can see your form from different angles. If your gym or home treadmill is not set up with mirrors, ask a friend to film you from the front, from the side, as well as a close up on your feet from both angles. Videotaping yourself on a treadmill can give you or your physiotherapist some valuable feedback on your biomechanics.

2. Challenge yourself

Treadmills are also great for doing speed work. By setting the machine at high speeds for discrete periods, you can push yourself to run at a pace you might not otherwise have tried. I find doing pyramid workouts to be a fantastic way to rev my heart rate and boost my cardio. For example, after a ten-minute warm-up, start with 5 minutes at a marathon pace, then 4 minutes at a half-marathon pace, 3 minutes at a 10 km pace, 2 minutes at a 5 km pace, and 1 minute at max speed before repeating this in reverse, ending with 5 minutes at marathon pace again.

Bonus tip: for my fellow adventurous travellers, if you are in a place with poor electricity, make sure to cover the front console of the machine with a pillow. Countless times I have run at full speed on a treadmill only to experience a power cut, prompting me to impale myself on the front of the machine. I have learned to protect myself (and my ribs) with proper padding using camping pillows or sleeping pads.

3. Come prepared

To make my treadmill workouts go by as quickly and smoothly as possible, there are a few key items that I make sure to bring with me:

An iPad loaded with mindless television shows or a magazine to keep me entertained.

• A quick-dry towel to avoid sweating all over the machine (and my peers). The Sea-to-Summit Dry Lite towel is a great option.

A water bottle.

A dry sac to put my sweaty gym clothes in after my workout. This is a much better eco-friendly alternative than using the plastic bags that gyms often hand out!

A duffle bag to keep all of my clothes, shoes and other gear together. I love The North Face Base Camp Duffel Bag. It’s sturdy, waterproof and great for outdoor adventures, too.

Bonus tip: Treadmills also allow you to test out new gear easily and conveniently. As someone who tends to chafe quite easily, I always like to test out a new running shirt or sports bra in the gym first before wearing it on a trail run. If my clothes start to bother me early on, I simply change to my old clothes in the locker room and hop back on the machine.

4. Bring a buddy

Why torture yourself alone? Bring a friend. Not only can a friend help to pass the time, but he or she can also provide a bit of healthy competition. Our Romanian UN bodyguards just love it when I try to outrun them on the treadmill.

Bonus tip: if you cannot bring a friend with you, you can still help to motivate each other. Agree to do the same workout ahead of time – for instance, a 5 km run at your fastest speed or fastest 1 km run at 10% incline – and record your results at your convenience. This works best with a group of runners as you can have fun comparing stats over a period of time.

5. Mix it up

There are a few creative ways to use the treadmill to engage different muscles groups. Here are some of my favorite fun treadmill exercises:

Backwards: start off facing backwards on the treadmill and set the speed on low. Increase slowly to a backwards jog. I like to do this on an incline, which is the closest I can get to mimicking running downhill indoors. It helps to engage the calves and hamstrings more than usual.

Sidestep: face the side of the treadmill, grab onto the handrail for balance if needed, and set the speed on low. Side shuffle as the belt moves underneath you, bringing your feet together and apart. Do not try to cross your outside foot in front or behind your inside foot as you side step – there is likely not enough room on the belt.

Power off: use the treadmill to help you do some dynamic stretching at the end of your workout. With the power off, grab the front of the machine or the side handrails and try to move the belt using your legs while taking big strides to stretch your calves. This can also be used to do some resistance training.