Strength Exercises For Runner’s Knee Pain: New Physio Research

Strength exercises are crucial in managing runner’s knee pain, also known as patellofemoral pain syndrome. This condition is often caused by muscle imbalances, poor flexibility, and over-training, for example a rapid increase in running volume or intensity. By targeting specific muscles around the knee and hip to increase their strength, exercise can not only alleviate the pain but also enhance knee stability, reduce your risk of future problems, and improve running performance.

Incorporating strength training into your routine can significantly reduce knee pain due to running, and reduce your risk of future injuries. Exercises such as lunges, step-ups, and single-leg squat variations are highly effective in strengthening the muscles surrounding your hip and knee. Additionally, improving flexibility and mobility through stretching or using a mobility aid, for example a foam roller, trigger-point ball or massage gun, can improve your running mechanics.

Combining strength exercises with proper running technique and following the right running training program provides a comprehensive and effective approach to managing and preventing patellofemoral pain syndrome. Implementing these changes into your running training will keep you running pain-free for longer and enable you to minimise your risk of runner’s knee while improving your running performance.

Treatment For Runner’s Knee – Key Takeaways

Strengthening exercises are essential for managing runner’s knee pain, and increasing the strength in both the knee and the hip muscles is more effective than knee strengthening alone
Incorporate flexibility and mobility exercises as needed to allow improved biomechanics
Proper running technique, following an appropriate running training program, and allowing adequate rest and recovery are also important for effective long-term management of runner’s knee pain

Anatomy of Runner’s Knee

Runner’s knee, or patellofemoral pain, is a common injury affecting many athletes. Understanding the key structures involved and how they function can help you understand and manage your pain, and help minimise your risk of future problems.

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The knee joint consists of the kneecap, or patella, which rests on the front of the femur (thigh bone). The femur sits on top of the tibia, the shin bone, forming the main knee joint. The patella functions to protect the knee and improve the leverage of the quadriceps, the muscles in the front of the thigh, helping them to act more strongly across the knee joint.

The gluteal muscles, i.e. your butt muscles, also play a vital role in lower limb biomechanics, including knee mechanics and alignment. These muscles help stabilise the hip and pelvis during movement, for example when running they help stabilise your pelvis as you land on one leg and swing the other leg through. Weakness in the glutes can lead to poor movement control in the knee, increasing your risk of knee pain as well as many other common running injuries.

Research Into Strength Exercises For Runner’s Knee Pain

Recent research suggests that combining hip and knee strengthening is the most effective in reducing pain and improving activity levels in individuals with patellofemoral pain (runner’s knee). Strengthening both the hip and knee muscles is more effective than strengthening the knee muscles alone. Strengthening the hips helps in maintaining proper overall lower limb alignment and movement control during activities, including running, and this is helps improve overall knee and patellofemoral joint mechanics and function.

Identifying and Addressing Muscle Imbalances

Recognising and correcting muscle imbalances is key for runners dealing with knee/patellofemoral pain. These imbalances may include strength imbalances as well as length and mobility issues. Identifying these imbalances is a critical first step in the process of developing an effective management plan, because it allows targeted exercises to be prescribed to restore correct muscles strength and length.

Role of Muscle Strength In Runner’s Knee Pain

Strong muscles support joints, provide stability and maintain correct movement mechanics. Key muscles for runner’s knee pain include the glutes, quads, hamstrings, and hip flexors. When these muscles are not equally strong, it can cause imbalances. It is worth noting that the calf muscles are also a critically important muscle group for distance runners in general. So, although they are not directly linked to runner’s knee pain, runners should always include calf strength in their program to help their running performance as well as reduce their risk of many running injuries.

Weak glutes can lead to overcompensation by other muscles, such as the hamstrings or TFL (tensor fascia lata, a muscle on the outside of your hip that attaches to your ITB). Weak glutes are also common in people who have tight hip flexors. These imbalances and compensations, over time, can lead to abnormal lower limb mechanics and mal-tracking of the patella, resulting in runner’s knee pain.

The patella (kneecap) is actually located within the tendon of the quadriceps (quads) muscles at the front of the thigh. This means that quads weakness or imbalance can significantly affect patella tracking and lead to patellofemoral/runner’s knee pain. We used to think that strengthening the quads muscles alone was the main focus of strength exercise for runner’s knee pain however, we now know that it is important to also target the hip and pelvis muscles for the most effective management.

Importance of Muscle Balance and Co-ordination For Runners

Muscle balance is about ensuring that different muscle groups have enough length and strength to allow them to work together and produce efficient and controlled movement. But that’s not the whole story! You also need to make correct use of the available length and strength of different muscles during movement. Put simply, it’s no good having enough length and strength in muscles if your brain doesn’t co-ordinate them together correctly.

Co-ordination or “motor control” is critical for correct movement, for example is achieving an efficient and economical running style. Think of it like a “movement habit”. If you’ve been running (or doing many other types of movement) in a certain way for years, your brain will have developed specific and very ingrained nerve firing patterns to recruit muscles to produce the movement in that way. So if you suddenly increase the length or strength of a muscle but don’t change the way your brain sends signals through your nerves to engage the muscles, there will often be little or no change in the way you move.

So, for the most effective management programs for runner’s knee (and many other running-related injuries), we need to restore muscle balance (length and strength) and also train your brain to use your muscles to produce more effective and economical movement. This means that as well as strengthening muscles in isolation, for example specific quads or glute strength exercises, we also need to be doing more functional or movement-specific drills. For runners this might include single-leg squat variations, which help co-ordinate muscles working together to keep stable with only one foot on the ground, and/or running coaching which improves your running gait economy and efficiency.

Essential Strength Exercises for Runner’s Knee Pain

For runners experiencing knee pain, focused strengthening exercises are effective in relieving pain, improving stability and helping you get back into training. Concentrating on the quadriceps, glutes, hamstring and calf muscles can make a significant difference in managing knee pain. These strength exercises are also effective in reducing your risk of future injury and improving your running performance. As well as strengthening specific muscle groups, your program should also include more functional exercises, for example squat variations and running-specific drills. This ensures that once you build strength you actually use that strength to improve your movement control and running gait.

There are way too many strength exercise options available to go through in this post. A few of the more common entry-level exercises that we use with runner’s knee pain are shown below. Generally start with 3 sets of 8-10 reps, performed 2-3 times per week. But remember that personalisation is the key, i.e. you need to get on the right program for you. This means your strength training should be based on an initial assessment that looks at your;

strength and flexibility
movement control and co-ordination
current injury and symptom level
injury history
strength training experience
running goals
access to weights and time able to be committed to your training

Calf Strengthening for Runners

Your calf muscles play a crucial role in middle and long distance running, for example marathons. We need to remember that we have two separate muscles that make up our “calf muscle” group – your gastroc and your soleus muscles. This is important because although they work closely together, we need to train them a little differently to ensure we improve strength in both muscles. Straight-knee and bent-knee single leg calf raises are usually a good place to start.

Questions & Answers

Frequently Asked Questions

What are the best knee strengthening exercises to perform at home for runners?

Some of the best early-stage exercises include squat and lunge variations, step-ups, bridges and clam shells. All exercises should be performed with correct form and at a slow controlled speed. Once you are feeling comfortable doing 3 sets of 8-10 reps of these you can progress by adding weights. However, these are only introductory exercises and you should also progress to more challenging exercises when you feel ready. Also, personalisation is key, so having a proper assessment with a running physio is really helpful to ensure you follow the correct strength program.

Which muscles should be targeted to prevent or manage runner’s knee?

Focusing on the quadriceps, glutes, calf muscles and hamstrings is usually important for runner’s knee pain. Strong hip and pelvis muscles help improve overall lower limb biomechanics, stability and movement control while running. Quads strength is vital for maintaining correct patella alignment (patella tracking), and strong calves have been shown to be important for many reasons in distance running.

Can strength training help relieve runner’s knee pain, and if so, how?

Yes, strength training is a major part of most programs used to manage knee pain in runners. Building strength helps by improving your biomechanics and running gait, supporting your knee and patellofemoral joint alignment/tracking, and helping stabilise your pelvis, hip and lower limb during your running gait.

Should I stop running if my knee hurts?

Reducing your running volume and/or intensity is often required early-on to allow runner’s knee pain to settle. However, we try not to stop clients running completely, although this is sometimes required in more advanced or severe cases. Generally, running with a small-moderate amount of pain is still ok, as long as it settles fairly quickly after your run and you don’t feel that it is changing your running gait or getting too sharp. As you improve you can gradually increase your running volume and intensity again.

How can I reduce the risk of getting runner’s knee pain?

Consistent strength training and following the right running training program, one that increases your running gradually at a pace that your body can adapt to, are the two most effective ways to reduce your risk of getting knee pain with running. Having your running gait assessed and improved can also be very helpful, especially for persistent or recurrent pain. Other things you can do may include mobility/flexibility exercises, doing proper warm-ups and cool-downs, maintain a healthy weight, get enough sleep and eat a healthy balanced diet.