Get Back to Running: How Physical Therapy Can Help with Runner's Knee
What is Runner's Knee?
Runner's Knee, also known as patellofemoral pain syndrome, is a condition that affects the knee joint and is characterized by pain around the patella (knee cap), swelling, and limited mobility. It is among the most common injuries seen in runners, with a prevalence rate of 15.6% compared to other injuries [1]. Runner's Knee not only affects runners but can occur in other high-impact sports as well.
Getting treatment for Runner's Knee is crucial for runners and other athletes who undergo high impact and stress on their knee joints during training and/or competition. Ignoring the symptoms of Runner's Knee can lead to other injuries and may even force an athlete to miss extended time. Physical therapy is one of the most effective ways of treating Runner's Knee symptoms, restoring normal knee function, and returning to sport. This article will explore the causes of Runner’s Knee and how physical therapy can help.
What Are The Causes of Runner's Knee?
The exact cause of Runner's Knee is not well understood, but it is believed to result from a combination of factors, including overuse, improper training techniques, muscle weakness, and a history of previous injuries.
Overuse: Running too much, too fast, or increased high-impact activities without proper preparation
Improper Training Techniques: Running form, wrong shoes, or lack of recovery
Muscle Weakness: There is strong evidence demonstrating a significant association between Runner's Knee and hip muscle weakness, specifically the hip external rotator and hip abductor muscles. This can cause excessive hip adduction and internal rotation during running, which could lead to lateral patella tracking and increased contact pressure in the lateral aspect of the patella [2]
Previous Injury: A history of prior injuries can increase the risk of developing Runner's Knee [3]
There are many factors that can lead to the development of Runner’s knee, so it is important to identify and address these triggers. Early detection and treatment of Runner's Knee can help prevent the development of chronic pain, forced time off, and occurrence of other injuries.
How Does Physical Therapy Help Runner's Knee?
Physical therapy plays a crucial role in the treatment of Runner's Knee. At Resilience Physical Therapy, we can help individuals with Runner's Knee develop a recovery plan that addresses the underlying cause of their pain, help to restore normal knee function and provide a plan to return to sport.
Treatment for Runner’s Knee typically includes a combination of techniques, including:
Strengthening and Mobility Exercises: We will identify areas of weakness and immobility to recommend specific exercises which can help improve knee stability and reduce pain [Click here for some exercise examples]
Manual Therapy: We will implement soft tissue release, joint mobilization, taping techniques etc., to help reduce pain and improve knee mobility
Coaching: We will perform a running form analysis, make recommendations on appropriate footwear, and create a training plan to help prevent further injury and provide a safe transition back to sport
Our mission is to help support athletes through rehab by providing the latest techniques and evidence-based practices to achieve their goals and get back to doing what they love. Our physical therapists are dedicated to providing personalized, one-on-one care and developing individualized treatment plans to meet each athlete's specific needs. If you are experiencing knee pain due to running or other sports, our team would love to help. Schedule a discovery call to see if we are the right fit for you!
References:
Lopes AD, Hespanhol Júnior LC, Yeung SS, Costa LO. What are the main running-related musculoskeletal injuries? A Systematic Review. Sports Med. 2012 Oct 1;42(10):891-905. doi: 10.1007/BF03262301. PMID: 22827721; PMCID: PMC4269925.
Xie P, István B, Liang M. The Relationship between Patellofemoral Pain Syndrome and Hip Biomechanics: A Systematic Review with Meta-Analysis. Healthcare (Basel). 2022 Dec 28;11(1):99. doi: 10.3390/healthcare11010099. PMID: 36611559; PMCID: PMC9818693.
van Gent RN, Siem D, van Middelkoop M, van Os AG, Bierma-Zeinstra SM, Koes BW. Incidence and determinants of lower extremity running injuries in long distance runners: a systematic review. Br J Sports Med. 2007 Aug;41(8):469-80; discussion 480. doi: 10.1136/bjsm.2006.033548. Epub 2007 May 1. PMID: 17473005; PMCID: PMC2465455.
Kakouris N, Yener N, Fong DTP. A systematic review of running-related musculoskeletal injuries in runners. J Sport Health Sci. 2021 Sep;10(5):513-522. doi: 10.1016/j.jshs.2021.04.001. Epub 2021 Apr 20. PMID: 33862272; PMCID: PMC8500811.
4 Rehab Exercises For Shin Splints
Medial Tibial Stress Syndrome or shin splints is an overuse injury characterized by pain or tenderness on the inner side of the shin bone (tibia) closer to the ankle. This pain is caused by repetitive stress from the muscles/connective tissues surrounding the shin bone (tibia), leading to inflammation around the bone. This is one of the most frequent injuries occurring in runners with a rate of 13.2-17.3%
Here are four exercises that I like to incorporate into an athlete’s treatment plan:
1️⃣Ankle Dorsiflexion Mobilization
2️⃣Wall Supported Banded Single-leg Fire Hydrants
3️⃣Single-leg Hip Airplanes
4️⃣Single-leg Bridge Holds
If you are currently dealing with shin splints or experiencing pain when running, we can help!
Improving Rotator Cuff Stability: Shoulder Taps
The shoulder tap exercise targets the rotator cuff muscles and other muscles around the shoulder isometrically. This makes it an excellent entry point to improve shoulder stability, especially if dealing with an injury such as shoulder impingement or rotator cuff strain/tendinopathy
When performing shoulder taps, ensure your chest is positioned over your hands, keep elbows fully extended, and neutral spine. Make sure to keep body sway to a minimum
Here is a shoulder tap exercise progression:
🔸Perform 3 sets of 10-12 reps on each arm
1️⃣Shoulder Taps on Knees
2️⃣Shoulder Taps on Elevated Surface
3️⃣Shoulder Taps in Push-up Position
4️⃣Shoulder Taps in Bear Crawl Position
If you are experiencing shoulder pain or currently dealing with an injury, we can help!
Plyometric Exercise Progressions For Running Speed and Efficiency
Why should you start doing plyometric exercises?
Plyometric exercises are a great way to improve your rate of force development and energy storage through your tendons. This translates into faster and more efficient running by increasing your maximal force output when your foot hits the ground.
Here is a plyometric exercise progression starting from easiest to hardest:
Jump Lunges w/o Switch
Jump Lunges w/ Switch
Single Leg Sprint Jumps
If you are interested in working with us, schedule a free discovery call!
When Is It Not Okay To Run With Pain?
Every runner wants to be able to run pain-free but in reality that is often not the case. Sometimes you can have aches/soreness from yesterday's strength workout or interval run. Maybe you overdid it on your last long run and now you have some knee pain. A question that comes up a lot is "is it okay to run with pain?", especially now that marathon training is underway and you don't want to fall behind on your training plan.
Here are some guidelines for when you shouldn't push through pain during your runs:
❌Pain that alters your running mechanics
❌Pain that gets worst during running
❌Pain that persists more than 24 hours after running
❌Having to take anti-inflammatory medications for your pain
*These guidelines work for most runners but not all. Many factors can cause pain while running and this needs to be evaluated case by case. The last thing you want to do is run on a bone stress injury.
If you are experiencing pain and unsure if you should continue running or you're currently dealing with an injury, schedule a free call!
3 Core Exercises To Improve Your Running Form
Maintaining trunk stability throughout your run is crucial for efficient form.
Here are some exercises that will not only work on your core but also challenge coordination and motor control between your arms, legs, and trunk:
Perform 3 Rounds
1️⃣ Pallof Press with Marching - 15x each leg
2️⃣Push-up Position with Hip Marches - 20x each leg
3️⃣Thread The Needle into 90/90 Leg Position - 8x on each side
Pallof Press with Marching - 15x each leg
Push-up Position with Hip Marches - 20x each leg
Thread The Needle into 90/90 Leg Position - 8x on each side
If you are interested in working with us, schedule a free discovery call!
3 Dynamic Warm-Up Exercises For Your Pre-Run Routine
Why Should You Perform Dynamic Warm-ups Pre-Run?
Performing dynamic warm-up exercises before your run is important especially if you've been sitting at a desk, carrying a heavy bag, standing with bad posture, or walking in heels the whole day.
These exercises can help reset your muscles, improve your motor control, and prepare your nervous system for running.
1️⃣ Hamstring Scoops - 15x
2️⃣ Lunge + Thoracic Rotation - 15x
3️⃣ A-Skips - 20x
If you're not moving well, you definitely won't be running well. Give these a try before your next run!
Rearfoot Strike versus Forefoot Strike, Which one is better?
This is a common question that I come across with many runners, which foot strike pattern should I choose to help me run better?
There is little scientific evidence showing that one-foot strike is more beneficial than the other. A rear-foot strike is more commonly seen in recreational runners and transitioning to a forefoot strike does not mean improvements in running economy or reduced risk of injuries.
However, there are certain situations where transitioning to a different strike pattern can help. This is based on many factors such as injury history, running analysis findings, movement assessment, footwear etc.
If you are in the process of changing your foot-strike pattern, make sure to modify your running mileage/training accordingly and perform specific strength exercises to help your body transition smoothly.
If you are interested in working with us, schedule a free discovery call!
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Xu Y, Yuan P, Wang R, Wang D, Liu J, Zhou H. Effects of Foot Strike Techniques on Running Biomechanics: A Systematic Review and Meta-analysis. Sports Health. 2021 Jan/Feb;13(1):71-77. doi: 10.1177/1941738120934715. Epub 2020 Aug 19. PMID: 32813597; PMCID: PMC7734358.
Thompson, Missy et al. “The Coupling of Stride Length and Foot Strike in Running.” Frontiers in sports and active living vol. 4 768801. 12 Apr. 2022, doi:10.3389/fspor.2022.768801
✨3 things to check when you go back to the gym after labor✨
1️⃣ Heaviness/pressure-like feeling around your vulva area
🔸After labor, especially for breastfeeding moms, connective tissues that support your organs are not as stable as they were pre-pregnancy. When we start to lift heavy or challenge our core stability more than our tissues can handle, there is a risk of developing organ prolapse.
2️⃣ Conning at your central abdominal line can indicate diastasis recti
🔸During the third trimester, having conning is normal but after labor, if you are still seeing conning when you do any core exercises and/or weight lifting movements then you might have developed diastasis recti.
3️⃣ Leakage during high-impact activities
🔸When doing exercises such as box jumps, double unders, and running if there is leakage, this can indicate stress urine incontinence.
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If you notice these symptoms when you are at the gym, please reach out to a Pelvic Floor PT for an assessment to see whether you have a pelvic floor dysfunction
Runners: 3 Strength Exercises to Incorporate Into Your Training
Why you should add single-leg exercises into your workouts
Running is essentially jumping from one leg to the other repeatedly. That is why efficiently absorbing load through a single leg is crucial.
Here are 3 strength exercises incorporating single leg loading to help improve your running:
1️⃣ Loaded Marches - 3 x 30-40 seconds
2️⃣ Band Single Leg RDLs - 3 x 10
3️⃣ Front Rack Reverse Lunges - 3 x 10
Improve Your Running Mechanics: Hip Extension
Importance of Hip Extension During Running
During the toe-off phase of running, at least 10-15 degrees of hip extension range is crucial to set up for efficient propulsion. This is also known as triple extension when the trail leg is in full hip, knee, and ankle extension.
Issues That Can Occur When There Is a Lack of Hip Extension
When a runner lacks proper hip extension mobility, some common compensations that can occur include lumbar spine hyperextension, shortened running stride, and increased loading at the ankle joint. Inefficient running form can eventually lead to a repetitive stress injury.
Hip Flexor Weakness Can Be One of The Causes of Limited Hip Extension Mobility
If you have been stretching and continue to feel hip flexor tightness, the issue might not be a shortened muscle. Weakness can sometimes be perceived as muscle tightness. Try strengthening the muscle instead and see if that fixes the issue.
Here Are Some Exercises To Strengthen Your Hip Flexors:
1️⃣ Eccentric hip flexion contraction w/ Kettlebell
🔸Make sure to keep your back flat on the bench
🔸Bring both legs to your chest, hold onto the opposite leg and slowly lower the weighted leg down
2️⃣ End-Range hip flexion isometric holds
🔸Bring your knee up to your chest, release and hold the position
🔸Make sure to keep your core and glutes engaged
3️⃣ Resistant Band marches in Triple extension
🔸Raise your knee up towards your chest
🔸Make sure to keep your core and glutes engaged
Overhead Shoulder Warm-Up Exercises
I usually have issues with end-range shoulder flexion during overhead loading, these exercises help prepare my shoulders by increasing my range of motion and stability in those positions.
Here are some of my go-to warm up exercises that I use to prep my shoulders for overhead lifts. Use light to medium weights (this is just a warm-up)
1️⃣ Thoracic Extension + Unilateral Elbow Liftoff
🔸Find an elevated surface to rest your elbows on
🔸With both hands touching your shoulder drop your chest towards the floor while maintaining a neutral spine
🔸Lift one elbow off the surface and hold for 5 seconds
2️⃣ Landmine Shoulder Rotations
🔸Start at end-range shoulder flexion with neutral spine
🔸Lower the barbell to one side and bring it back up, make sure the motion is slow and controlled
3️⃣ Bottoms-up Kettlebell Presses
🔸Start at a 90/90 elbow/shoulder position
🔸Press dumbbell up into end range shoulder flexion and hold for 5 seconds