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Runner’s knee (clinically called patellofemoral pain syndrome, or PFPS) is extremely common in all types of runners, particularly those who are new to running or ramping up their training schedule.
Runner’s knee is characterized by pain at the front of the knee, near or under the kneecap and it is typically chronic in nature as opposed to an acute injury such as a fracture or sprain. That is, it comes on for no clear reason, sometimes gradually, and persists for weeks, months or even longer.
Typically, with chronic, non-acute pain, the site of the pain isn’t the site of the problem. As shown in this 2009 study, athletes with PFPS often present with weak hip muscles, specifically hip abductors and external rotators, which are part of the gluteal complex.
Weak hip muscles make for poor movement control of the femur. This compromised movement makes it difficult to effectively manage the impact of running, especially when fatigued. In this case, the knee pays the price for the hip’s faulty mechanics.
Patellar tendon pain is often part of PFPS. Research from 2015 and 2017 has shown that isometric exercises in which muscles contract with no movement occurring reduces pain and increases muscle contraction ability in those with PFPS.
The following exercises target the gluteus maximus, medius and minimus, all of which help to control the femur. The Loaded March and the 1-Leg Squat work the lower leg and foot as well. The Bench Hip Lift is a hamstring, calf and glute exercise. The final exercise, the Wall Sit, targets the quadriceps muscles and the patellar tendon.
Typically, with chronic, non-acute pain, the site of the pain isn’t the site of the problem.
Perform the following routine twice per week. Ideally, allow 48 hours between sessions. Wall Sits can be done daily for pain relief. Mild discomfort at the knee (no higher than a 3 on a 10-scale with 10 being most painful) is allowed both during and after the exercises.
Don’t rush this exercise. Control is crucial. Left one leg as if you were going to stomp hard on the ground. Lift the knee high and pull the foot toward the shin. You should feel a moment of balance when standing on one leg. Repeat on the other leg. You don’t need to stay on one leg for long, but you should attain a definite sense of controlled balance. Perform 10-20 reps for 2-5 sets. If you’re in the gym, you may hold dumbbells or kettlebells, wear a weight vest or put a barbell on your back.
Offset 1-Leg Squat
Similar to the March, the 1-Leg Squat demands precise control. Start with no weight. Lift one leg as if about to stomp hard on the ground: with a high knee and high foot. Your stance leg is the working leg. Perform a squat with your stance leg. Go as low as you’re able then stand fully up with a straight knee. If you can perform 10 good reps, you can add weight. Hold a dumbbell or kettlebell in the hand opposite your working leg. By holding the weight opposite the working leg, you load the hip muscles that are critical to fixing and avoiding PFPS. Perform 10 or fewer reps for 2-5 sets.
Bench Hip Lift
Done correctly, you’ll feel this in your hamstrings and glutes. Don’t rush. Lie on your back with your feet elevated on a bench, table, chair or plyometric step. Drive your hips into the air and return to the ground in control. Don’t plop down. If you can perform 10 good reps with two feet then it’s time to advance to the 1-leg version. For the 1-leg version, pull the non-working knee to your chest with your hands and hold it there while doing the exercise.
Experiment with the amount you bend the knee(s) of the working leg(s). You may lock them out fully, bend them 90 degrees or bend them any amount in between. You’ll get a different effect depending on the knee angle. Perform 10-20 reps for 2-5 sets.
Sit with your back against a wall with your knees bent to about 90 degrees. Hold for 30-45 seconds or until your quads burn. Perform 2-5 sets. You may perform this exercise throughout the day for pain relief.
—Kyle Norman, MS, is a Denver, Colorado-based personal trainer, strength coach and running coach with 20 years of experience. He specializes in helping people move well, get strong and get out of pain. You can follow his blog at www.DenverFitnessJournal.com