So you’ve been trying to get back into shape and just when you caught stride your knees started to hurt, now what!? There are a few key elements in handling this issue that include optimal exercise selection, smart programming, and activity modification. Here is a comprehensive approach on how to stay active and manage your knee pain regarding different physical activities including running and hiking.

 

Stay Active With Knee Pain: Runner’s Knee

Running is one of the most popular physical activities in the world, and knee pain tends to be something every single runner experiences in their running career. Running can be performed anywhere and doesn’t require any equipment, thus it is a cheap way to exercise and burn calories! However, a common mistake people make is they try running to get back into shape. You should be fit to run, not run to get fit. Trying to stay active and manage knee pain with running can be a challenge.

READ: RUNNER’S KNEE CAUSES, REHAB, AND TREATMENT

 

Accessory Exercises For Runners

Did you know the knee has been documented as the most common site for an injury in runners (1)? The knee-cap joint (patellofemoral pain syndrome) and IT Band (iliotibial band friction syndrome) specifically  are the most common. Whats important to understand is the patellofemoral joint and the IT Band are influenced by the hips. The glutes play a key role in controlling the position of knee because they control motion of the hips. The position of the knee and hip can also be influenced by the position of the upper body (often referred to as the trunk).

Whether you are a recreational/casual runner or an elite cross country athlete, it is essential to implement a cross-training strengthening and conditioning program that incorporates glute, quadriceps, and core training. Below are a few exercises that every runner could benefit from. This can really help to stay active and manage knee pain.

 

Having Knee Pain But Want To Continue Staying Active? You Can!

Don’t let your knee pain stop you from doing what you love! You still are able to stay active, you just need the RIGHT program, which is what we have for you! Learn more HERE! 

 

Stay Active With Knee Pain: Glute Strengthening Exercises

 

Running Storks

Sample Running [P]rehab Program Exercise Video

Get set-up near a wall, while standing on one leg (further away from the wall), hold a ball against the wall with the outside of your thigh/knee on the side that is closer to the wall. While maintaining this, let your hip/pelvis sink on the side further away from the wall followed by lifting your hip back up to push harder into the wall. Repeat. You will feel your hip muscles on both sides working, especially the one that is performing hip drop/hikes. You may also feel your quads and calves working. Do not drop the ball, try to keep your knee relatively straight on the side that is on the ground. Try to maintain a lean towards the wall. If you want to learn more about stork variations, read this article!

 

Try These Knee Rehab Hacks From Home!

 

Stay Active With Knee Pain: Core Training Exercises

Here are some core training exercises that you can implement into your programming!

 

Knee Pain With Hiking

We surveyed our followers and one of the most popular requests was how to stay active and manage knee pain that is in the front of the knee with hiking. Anterior knee pain with going downhill is not uncommon, especially for someone that is not used to doing this activity and ends up doing a lot in a short period of time. Also there is the chance that their performance and fitness level is sub-par.

Before we go any further there is something we should review – active vs. passive shock absorption. Simply put, every time you take a step with walking there are forces that are imposed on your knee. There are two ways your knee absorbs these forces (1) actively via eccentric muscle contraction, or (2) passively via bone and cartilage. Below are two videos in slow motion to appreciate the differences.

 

More Passive Shock Absorption

 

More Active Shock Absorption

As you would imagine, active shock absorption is optimal in efforts to promote the longevity of our passive structures. However, active shock absorption for a long hike with a lot of elevation change requires significant muscular strength and endurance. Whether it is poor fitness, fatigue, or a poor strategy – some individuals may demonstrate more of a passive shock absorption strategy, which may lead to anterior knee pain due to passive structure irritation including bone, cartilage, joints, ligaments, or fat pads. On the other end of the spectrum, performing a significant amount of acute active shock absorption that a person’s body may not be used to could also lead to anterior knee pain if the quadriceps/patellar tendon is overloaded.

 

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Sample Patellar Tendon Rehab Programming

Below are some videos sampling a progression through patellar tendon rehab! Ultimately you will want to load the patellar tendon with quad-dominant movements to increase its tolerance to load when progressing someone back to a sport or general activity.

Patellar Tendon Rehab Phase 1

 

Patellar Tendon Rehab Phase 2

 

General Considerations To Stay Active With Knee Pain

As previously stated, eccentric muscle action is essential for active shock absorption, which can cause a lot of muscle damage and associated soreness via Delayed Onset Muscle Soreness (DOMS). Paying attention to your exercise programming, volume, and listening to your body are simple ways to mitigate the risk of dealing with knee pain. When you’re managing symptoms or there is a movement that causes a lot of pain – take a break! You don’t want to keep poking the bruise, tissue healing takes time, and modifying your activity for at least a short period of time can be beneficial.

Getting back into training and finding the perfect amount of volume can be tricky. A simple concept is the acute: chronic workload ratio. Simply put, we want to find the sweet spot when it comes to training volume. Too much training load in a short period of time compared to your long-term average can increase your risk of injury. This is probably the most important concept to consider with how to stay active and manage knee pain.

Acute:Chronic Workload Ratio

An easy way to measure acute: chronic training load is the Sessional Rate of Perceived Exertion (sRPE), which is session time X RPE. An example of this would be 30 minutes of training X 7/10 intensity = 210 units. The acute workload can be looked at as the number of training units over a seven-day period and the chronic workload will be your weekly average over a four-week span of time. The equation we will look at is acute/chronic workload with the sweet spot being 0.8-1.3.

Say that your weekly average is 840 units a week and one week you did 700 units. That ratio would be 700/840 = 0.83, which is in the sweet spot. However, if you bumped up to 1700 units in one week, that would be 1700/840 = 2.02, which would be in the danger zone. Think about how often you ramp up your training or slowly ramp up your hiking distance before a big hike? Consider this next time before you do a big hiking trip!

According to Tim Gabbett, “In terms of injury risk, acute: chronic workload ratios within the range of 0.8–1.3 could be considered the training ‘sweet spot’, while acute: chronic workload ratios ≥1.5 represent the ‘danger zone’. To minimize injury risk, practitioners should aim to maintain the acute: chronic workload ratio within a range of approximately 0.8–1.3. It is possible that different sports will have different training load–injury relationships; until more data is available, applying these recommendations to individual sport athletes should be performed with caution.”

LISTEN: ACUTE TO CHRONIC WORKLOAD RATIOS

 

Closing Thoughts

If you have any doubt about what you’re dealing with and you have been experiencing long-standing knee pain – please see a medical professional. This information is not intended to be medical advice specifically for you. You should not leave your body up to a guessing game on your own – do yourself a favor and seek a skilled healthcare clinician that can assess and evaluate your knee(s). This skilled healthcare clinician should be someone that is familiar with orthopedics and sports injuries as well as someone that sees knee injuries often. With a thorough in-person assessment, you will be able to benefit from an individualized program that will be designed just for you.

 

Learn How To Overcome Knee Pain and Take Control Today!

The knees are true hard-nosed blue-collar workers! They get the job done when the hips and ankles may be taking some extra rest breaks. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle. In this program, you will learn how to restore mobility, learn to get your powerful quadriceps cooperating with you, along with starting the journey to addressing the hip and ankle. Get started today. 

 

References

1. Tauton et al. 2002 “A retrospective case-control analysis of 2002 running injuries”
2. Gabbett TJ 2016 “The training-injury prevention paradox: should athletes be training smarter and harder?”

 

About The Author

Craig Lindell, PT, DPT, CSCS

[P]rehab Co-Founder & Chief Content Officer

Craig is a South Jersey native & Penn State Kinesiology Alumni. When the opportunity came, Craig packed his bags and drove to California to pursue his Doctorate in Physical Therapy from the University of Southern California. With [P]rehab, Craig oversees all digital content creation and multi-channel publication that reaches millions of people on a weekly basis. As a PT, Craig has a wide array of experience from working with various neurological conditions to working with collegiate & professional athletes across the Big Five in North American sports. Experiencing physical therapy first-hand as a soccer player in high school, Craig has a passion & special interest in adolescent athletic development working with young athletes to overcome injuries. In his spare time, Craig enjoys exercising, playing golfing, hiking, traveling, watching Philly sports, and spending quality time with his family.

 

 

 

 

 

Disclaimer – The content here is designed for information & education purposes only and is not intended for medical advice.