By Jonny Stahl
As you learned in Part 1, it’s a bit more nuanced than just waking your glutes up from their 8-year nap.
If you improve one or two of the causes of Runner's Knee (see causes here), then you’ll likely clear up a few more. For example, if you improve the position of your pelvis, along with your ability to control the position and function of your pelvis during running, then you’ll very likely improve:
1. Hip mobility
2. The ability to control your Centre of Mass
3. Where you plant your foot on the ground
4. The coordination of your muscles throughout the running cycle.
Once you re-gain control of your pelvis, have the minimum required amount of mobility that you need in order to run as you’re designed to, and you hit the ground with your foot more or less underneath your body, then things will begin to improve drastically.
In other words, everything is related, and to think that things occur in an isolated fashion is reductionist in nature and simply inaccurate.
Now, how can we actually do this then?
Let’s go through some movements to add visuals to the above points.
When we’re running, we’ll have a light anterior pelvic tilt, which is the position and angle of the bottom line on the right picture. This, in nature, is necessary, as it allows us to produce force and perform as we’re designed to. Once that angle becomes excessive and/or when we’re unable to control and get out of that position, then we may run into issues.
An excessive anterior pelvic tilt during running will very likely shift our Centre of Mass forward, which may result in you hitting the ground with your foot further in front of your body than is necessary.
If you’re not sure what I mean, then just stand with feet shoulder width apart and push your pelvis forward. See how your body re-organises itself so that you don’t fall on your face?
That’s what I mean.
When all of this happens, the length of our muscles change, meaning that the way they interact with each other changes. And when this happens, our ability to coordinate our muscles together, to absorb force and then to produce force will likely be affected.
1. IMPROVE PELVIS POSITION AND MOBILITY
Most runners (and most people in the western world these days to be honest) are stuck in an anterior pelvic tilt and have limited pelvis range of motion. The following four exercises will improve the pelvis of your pelvis and improve your hip mobility, with a specific focus on hip internal rotation.
Breathing with Hip Internal Rotation:
90/90 Breathing with Hamstrings:
90/90 hip flip:
Standing Hip + Foot Rotations:
Note: most of these exercises are part of Your Daily Mobility Routine – a daily routine which I designed specifically for runners to focus on these exact areas. You can get that for free here.
2. IMPROVE INTERMUSCULAR COORDINATION:
As mentioned, in order to avoid the knee becoming overloaded during running, it’s essential that the muscles around the knee play their supporting role by actually functioning together, as they’re designed to.
When we run hit the ground, we want our muscles function rather isometrically. This means that they’re working against a force, but without any change in muscle length.
When we’re successfully able to do this, not only do we absorb forces better, but we’re also able to use some of those absorbed forces and be more elastic when we produce force.
Do you ever see some runners who just bounce around like a Springbok? Well that’s what I mean.
Here’s a video of a Springbok, just in case you’re not quite sure how they move 😉.
Here’s also three exercises that you can perform in order to improve your intermuscular strength and coordination. It’s worth noting that these exercises are designed to cater to the needs of running, which is something that is poorly understood when it comes to the long-term treatment and management of Runner’s Knee.
Wall Calf Strides:
Pro tip: lift your hips half way up and keep the glute of the working leg squeezed the whole time.
Foam Roller Hamstring Bridge:
If you’re unable to do this one-legged, then start with two legs and build up to a 60s hold before moving to the one-legged version.
Pro tip: push your forefoot down into the foam roller and lift your heel as high as you can at the same time. Enjoy the burn 😉
Door Frame Isometric for Runners:
Pro tip: push your foot hard into the ground with the knee slightly bent, whilst at the same time pushing hard upwards into the door frame. Ensure that your lower back is only lightly arched.
I want to make this point very clear: strength training for runners must cater to the needs and requirements, particularly when it comes to injury rehabilitation (e.g. strength training for Runner’s Knee or other running-related knee pain).
Otherwise you’re shooting in the dark and wasting precious time and energy.
3. IMPROVE PELVIC POSITION AND CONTROL DURING ACTIVE/EXPLOSIVE MOVEMENTS:
Dribbles
Pro tip: think about riding a bicycle here, starting from small pedal cycles and building up to larger ones.
High Knees with Overhead Hold (progression)
Pro tip: aim to be nice and explosive and minimize your time spent on the ground with each step/ground contact.
The aim of the game here is to improve your ability to control your pelvis throughout quick, active movements. Taking the arms out of the equation increases the requirement for the trunk, pelvis and lower limbs to stabilize in order to efficiently hit the ground.
The great thing about these exercises is that if you perform a poor step, then you’ll know about it straight away as your ability to absorb and produce force will be significantly less effective.
What’s awesome about that is that your brain and body learns from these poor steps (due to the fact that they do not achieve the desired goal of smooth, efficient movement), allowing you to develop and get better at being more explosive and elastic.
The statement of “learning from your mistakes” really rings true here.
SUMMARY:
Let’s bring it all together one more time.
The actual causes of Runner’s Knee can be many, as can the treatment options. At the end of the day though, the human body is designed to move in specific ways and therefore has certain requirements.
Far too few people truly ask why the front part of the knee is painful and being constantly overloaded. Runner’s Knee itself is a symptom and a glaring sign that your loading strategies need to be improved to ensure that that specific site is loaded, without getting overload.
To get rid of Runner’s Knee, focus on the following:
1. Improve pelvis position and pelvis/hip mobility
Improve position of centre of mass
Restore hip range of motion, particularly hip rotation
2. Improve strength/coordination to support your knees when running
Improve the way you move and load
3. Learn to control your pelvis during challenging, active movements
Improve the position of your foot strike on the ground, relative to your body
4. Improve the way you move, control your body, absorb forces and produce forces
Run pain-free and perform better as a result.
This article may seem like a lot to digest as it’s full of information, but I can assure you that if you follow the four steps immediately above, then you’ll begin to notice a difference in how you move, how you hit the ground and ultimately, how you feel.
It’s most often not the pain itself that hurts the most, but rather the inability to do what you want.
Don’t let Runner’s Knee or other injuries limit your ability to run. Be proactive and treat your body like a Maserati!
P.S When you're ready, here's three ways that I can help you to move, live and perform pain-free:
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