Running Knee injuries

When you look at the statistics regarding running injuries, you might start to get to get a bit gun shy. The Bristish Journal of Sports Medicine reported that up to 50% of runners will have an injury during a calendar year which will cause them to either miss or alter training as a result. Pretty staggering statistics when you stop to think about it. So the question is, how do I continue to run, and stay injury free? This task is not as hard as you would think.

Of the most common injuries with running, 50% occur at the knees. Typically, runners get pain in the front of the knee, aka chondromalacia patellae, or lateral knee pain, aka iliotibial band syndrome. Sports medicine research has recently noted consistent trends with injured runners, especially female athletes. Even though a runner is symptomatic at the knee, the contributing deficits are typically found at the hip(http://www.drfisio.com.br/artigo12.pdf). The weakness at the runner's hip allows abnormal movement patterns to develop which strain the knee. The abnormal patterns of movement seen with squatting activity are that thigh bone and knee tend to drift excessively toward the midline of the body, as well as rotating inward(http://www.usc.edu/projects/rehab/private/docs/researchers/powers/8_powers_influence_of_altered.pdf). Instead of the knee staying stacked over the foot, it drifts into a knock knee position such that not only is the kne cap put under abnormal load, but the IT band is chafed by the thigh bone. Chris Powers, a PT at USC, used a real-time MRI to see what was happening at the knee with squatting activity and how it relates to these common injuries. In a nut shell, the weakness of the hip abductors and external rotators, allow for the abnormal movement to occur. Take home message on this is for minimal stress to occur at the knee you need a strong hip.

The emphasis of strength at the hip needs to be focused on the hip abductors and hip external rotators. If you stop to think about this for a moment, it makes perfect sense. It all goes back to specificity of training. What I mean by this is that runners tend to be strong in the muscles that are used with running. However, to prevent running injuries at the knees, a runner needs to do exercises which have them moving in other directions than straight ahead running, like out to the side or into leg rotation, for example.

To work on the hip abductors you can simply lie on your side with your back against a wall and raise the top leg towards the ceiling. Keep the stomach muscles tight and lift the leg only about 12 inches. Use the position against the wall to your advantage- make sure your heels stays in contact with the wall so that you are working the abductors, not substituting with another group of muscles.



A more advanced exercise would be using theraband. Tie theraband around your ankle in standing such that it is tight when your ankles are close together. Standing tall, you are going to side step in one direction keeping the torso 'quiet' so the hip muscles can do the work. If you are moving to the right, make sure you do not drag the left foot when it comes closer to the right. Also, control not only the step away with the right leg, but also the step closer with the left leg. Stepping back and forth multiple times is a great way to start. Remember to focus on your posture so the hips are doing the work, not the trunk muscles. Using a mirror tends to be very helpful.


To isolate the hip external rotators is just as easy as the hip abductors. Start against the wall as above. This time you should start by bending the hips and knees such that there is a 90 degree bend in each. Next step is to brace with the stomach muscles as you lift just the top knee up 10 inches. I call this one the 'clam ' exercise. Again, use the wall to your advantage- the wall will prevent you from rotating the pelvis back thereby using the trunk muscles versus just the hip. To make this exercise more challenging, you can wrap the theraband around the knees such that you now have a resisted 'clam' movement. Lift the top knee up, pause, then slowly lower down to the other knee.


Both exercises should be done to fatigue The focus needs to be on form and controlling the movements. I ask athletes to perform 2 sets of 15-20 repetitions. With the straight leg raise against the wall, an ankle weight can be added to increase the challenge. This is also the case with the clam exercise. Theraband, available at running stores like Pacers (http://www.runpacers.com/), can be used once a runner has developed proficiency with the basic level exercises. The theraband would be placed just above the knees for the clam exercise. Again, the focus is one good form with low level resistance and high repetitions.