Front of Knee Pain From Long Runs: Causes, Exercises & How to Keep Training According to a Doctor of Physical Therapy
This is for my marathoner who swears THIS is the training cycle where your "front of knee" pain will NOT come roaring back with a vengeance.
And honestly, I love that for you.
But I heard you've been getting down on yourself
Because that vague, but spicy, sometimes sharp, sometimes just a deep aching discomfort in the front of your knee that occasionally grows in intensity, starts making a come back as your long runs start getting longer.
For some runners, it's around that 45-60 min mark.
Others: it's mile 10- 15+.
Often, it's loud and proud after your LONGEST long run sometimes throwing a check-engine light the next morning. (hello, random front of knee aches and pains)
Or if you're running a lot of hills (mostly the downhills).
Maybe one of the most frustrating parts: walking is fine.
You can even stop mid run, walk, have no problems (maybe just fatigue around your knee), start your run back up...
...and there it is again.
Leaving you with the biggest question: "How do I keep training?"
So let me show you some of my favorite exercises that I use to keep my own knee niggles away. (because yes, my right knee likes to be a drama queen, especially at that 10 mile mark.)
Let's hop in.
Patellofemoral Pain in Runners: Why Your Front of Knee Pain Keeps Coming Back
Before we jump into the exercises, you really need to know this stat.
Especially if you're a runner whose run multiple marathoners or just run long distances in general.
If you've experienced anterior (front) knee pain before that's been related to your running, there's a 50% chance it's patellofemoral knee pain. (meaning knee cap and knee joint related pain).
But the heavy hitter:
50-80% of runners who have had patellofemoral knee pain ONCE, will get it AGAIN. Even if they've done physical therapy for it.
This is NOT meant to be doom and gloom. This is a reality check.
This gives you a different, objective perspective.
Because a lot of runners will chalk up "repeated trashed training cycles because of my knee is all my fault..."
If you didn't recover, fuel, increase mileage in a smart way, or strength train...well, you've got some things to work on.
But if you've "done all the things":
This means you're not crazy.
It means you need to fine tune your strength exercises, which is why you're here, but it means this is a VERY common occurrence. And it's not just you.
So keep that in mind as we go through these exercises: patellofemoral pain is MANAGED. Not always "cured".
That being said, I've been hitting my knees hard with consistent HEAVY strength training and plyos for the past 3 years, and my right knee drama queen has barely made a peep.
So you're not broken. You just need to train smarter.
Front of Knee Pain in Runners: Exercises to Reduce Pain & Keep Running
Circuit:
Body weight - heavy weights
Hip Hike with 3-Way High Knee Isometric
3 x 10, hold for 3-5 secs
Hip Thruster
3X 8-12
Single Leg Squat to Box /Bench
3x 8
Bulgarian Split Squat with Tempo
3x6-10
tempo: 3 secs down, 2-3 secs up
Pain in the Front of Your Knee When Running? Start Here
Hip Hike with 3-Way High Knee Isometric
Not gonna lie: there's a lot going on with this exercise.
TOP TIP: before you worry about trying to push your knee into the wall to engage your glutes, focus on the hip hike motion first. But start with that hip elevated, you're already beginning to bias your glut med muscle. Then by pushing into the wall, we're further engaging it.
NOTE: the hip hike will be most difficult in the last position (where you leg is slightly behind you). That's ok. This exercise is primarily meant for the runner whose in more pain, who feels their knee is very cranky and irritated.
Isometric exercises like these are great for reducing pain and engaging near-by muscle "teammates" but we want to move on from these as soon as possible to begin actually loading the "problem area".
Hip Thruster
Basic? Yes. But with a purpose.
FUN FACT: a lot of social media will blame knee pain on weak glutes. And this gets perpetuated when you go to a physical therapist in person for your patellofemoral pain, they test your glutes, and proclaim "your glutes are weak!" However... we now know that knee pain result in your glutes presenting weak. Meaning, your glutes look and act weak because of pain. And it becomes a chicken or the egg problem.
So the reason for this exercise: It's always beneficial to target a "weak" muscle group, like your glutes in this case, in order to remind them how they work (neuromuscular reeducation). This position also does NOT irritate an already spicy patellofemoral joint.
Therefore: remind glutes to get strong. Strengthen the joint above the cranky joint. And help restore full lower extremity strength without pain. Viola.
Single Leg Squat to Box /Bench
Time to get Funky
PRO TIP: if you're knee is very spicy, do not jump into the exercise. It will only hurt more.
Disclaimer: there is a wide progression or variety of exercises a runner may go through while recovering from front of knee pain. So don't think you "have" to do this exercise immediatly. However, we do know quad strength (especially eccentric strength like this) is KING when recovering and preventing a return of "front of knee pain".
What I want you to focus on: find a bench or a kitchen chair that's a good height for you, meaning it's not so low you fall down into your squat. I want you focus on sitting down or descending into your rep, in a slow and controlled manner. No plopping! I'll often give runners a PVC pipe or a swiffer handle to hold on to for a little bit of balance assist. If you need a little oomph to help you with the ascent, you can have your non-working leg extended out in front of you, allowing your heel to gently, minimally, push into the ground like a kick stand.
But you got it: ideally, the squatting leg is doing all the work.
Bulgarian Split Squat with Tempo
More single leg? You know it ;)
CRASH COURSE: you can "adjust" your bulgarian split squat (BSS) to target more glute vs more quad. And this can be particularly handy if your knee is being crankier than normal, but you know you still need to strengthen so you can keep running.
In your normal BSS set up, play around with the trunk of your body being more upright vs hinging forward at your hips. Think of it this way: pretend theres a string attached to the top of your head and it's pulling you straight up towards the ceiling. Perform your BSS here: you'll notice it's probably a little ouchier AND your quad is working hella harder.
For your next rep, instead, tip your torso forward so your nose is towards the ground (anyone know what I mean when I say like the "drinking bird" toy?). This will place you more in a hip hinge position, targeting your glutes, and reducing load on your quads and patellofemoral joint. This position will allow you to actually do the exercise but with less pain.
WRAPPING UP
You may be thinking...
Exercises are great, but how do I keep running and training in the mean time?
For the spiciest and crankiest of knees: the treadmill will be your friend.
NOTE: these are examples of ways to adjust a treadmill to reduce pain and discomfort.
I AM NOT saying to run ALL your mileage at these inclines!
As part of your return to run program:
you may want to start the treadmill at a 7% incline as running uphill more evenly distributes load and force between your hips, knees, and ankles.
Gradually, decrease the grade to 3%.
Then level surface surface.
And lastly, adding in controlled, small amounts of down hill running.
We want these down hills added in slowly.
Running on a decline increases the amount of force experienced by our patellofemoral joint since our knee is responsible for controlling our center of mass as we run down hill.
But with the help of strength, appropriate use of plyos, and distributing forces evenly while running, it is possible to return to and keep training despite pesky front of knee pain.
Until next time running fit fam,
Dare to Train Differently,
Marie Whitt, PT, DPT //@dr.whitt.fit
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