stay active with knee pain the prehab guys

How To Stay Active Around Knee Pain

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 with 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.


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Return to Running Progression And The Soreness Rules

Thinking about getting into running again after a knee injury? Check out this Return to Running Progression from the University of Delaware as well as the Soreness Rules. When it comes to getting back to running, it’s all about gradually applying the load and stresses to your body again – a term called graded exposure. By applying load/stress in a graded way, you not only give time for your body (and brain) to adapt to the demands, but you also allow yourself to objectively determine how much running you can actually handle.

If you’re injured, follow these guidelines to get back to running! Progress to the next level when you are able to perform the activity level for 2 miles without increased effusion or pain. Perform no more than 4 times in 1 week and no more frequently than every other day. Do not progress more than 2 levels in a 7-day period. Here is the link for the running protocol as well as the soreness rules


Having Knee Pain But Want To Continue Running? You Can!!

running program stay active with knee pain the prehab guys

Don’t let your knee pain stop you from doing what you love! You still are able to run, you just need to RIGHT program, which is what we have for you! A great expression we like to educate others on is, “You don’t run to get fit, you have to be fit to run.” Without proper training, education, and an understanding of healthy running hygiene habits, issues may arise that can keep you from running. The Running [P]Rehab Program will teach you the best cross-training routine for runners and education to help you maintain optimal running health. Learn more HERE! 


Stay Active Around Knee Pain With Glute Progressions!


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.


Stay Active With Knee Pain: Glute Strengthening Exercises

Standing Firehydrant

Sample Running [P]Rehab Program Exercise Video

  • HOW:  Start against a wall and put your back toes on it gentle, keeping the majority of weight on your front leg. Stand on the front leg leg with a slight bend in your hip and knee. Using a band above the knees, push your opposite knee out and back at a 45 deg angle and hold this position for a second. Then slowly bring your knee back to the starting position. The wall is only there for balance. Repeat.


  • FEEL:  You should feel both glutes working, but especially on the side that has the foot on the ground.


  • COMPENSATION:  Don’t let your hips rotate out, don’t arch your back, don’t let your knee cave in on the side you’re standing on, do not lean your torso side-to-side. Do not lean backwards into the wall! Your foot back there is just for balance


Split Stance Lunge – Rear Leg Emphasis

Begin by stepping one foot forward and the other back with your toes pointed forward in a split stance position. Bend both knees and lower yourself down but shift over half of your bodyweight to the back leg. Push into the ground returning to the starting position. We are going to try to use our back leg as much as possible to return to the standing position! You should feel your leg muscles working. Keep your chest upright. Make sure most of your bodyweight is on the back leg.


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!


Stay Active With Knee Pain: Core Training Exercises

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


Stay Active With Knee Pain: Flexibility For Runners

For anyone that has started running for the first time, or for the first time in a long time – you tend to feel pretty sore and stiff in your legs. Below are some of our favorite stretches for common areas that tend to tighten up and feel stiff from running. This can at least short term help to stay active and manage knee pain with running.

Couch Stretch

Begin in a half-kneeling position with your back foot resting on an elevated surface. Make you keep your pelvis tucked then shift forward towards the front leg. You will feel a stretch on the front of your thigh of the back leg. Avoid arching the back with this exercise.


Prone Hip Flexor Stretch

Lay down on an elevated surface like a bench, a couch, or a bed. Bring one leg off and march that leg up as far as you feel comfortable. The lower the surface the more aggressive the stretch will be.  You will feel the front of the hip that is on the elevated surface.


Calf Stretching

Standing with a wall in front of you, place the balls of your feet on the wall with one foot. Keep the knee straight as you lean forward to hold the stretch for as long as prescribed, and then relax. While keeping your knee straight, shift your weight to each side as well as forwards. The higher your foot is on the wall the harder the more you will feel the stretch. You should feel a stretch in your ankle and even the bottom of your foot. You should also feel your lower leg muscles working.  Keep the knee straight, don’t bend it.


What About ‘IT Band Stretching’?

Here is a video where we show you how to foam roll the TFL and IT Band. The key is to foam roll not the IT band itself, but the muscular attachments of the IT band, as the band itself is a non-contractile tissue!

Want to learn more about the IT band and a common knee issue in runners? Check out this podcast!


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.


Stay Active With Knee Pain: Improve Active Shock Absorption

Below are a few exercises to improve glute strength, quadriceps strength, and eccentric muscle control of the hips and knees. This can really help with how to stay active and manage knee pain.

Step Up & Step Down

If the step-up exercise is bothering your knee – then try the eccentric step down portion with a small range while keeping all of your weight on the box. Lower down to what feels comfortable and then return to the starting position.


Slant Board Eccentrics

A staple amongst patellar tendon rehab exercises. Positioning your foot angled down on the slant board is going to increase the demand on the quadriceps, thus increase loading of the patellar tendon.


Patellar Tendon Management

Below are exercises and programs that we have used with our patients/clients and have found success with managing patellar tendon issues to stay active and manage knee pain. Many people have reported significant success using our specialized knee program dedicated to managing this and other anterior knee structures!

Early Quadriceps/Patellar Tendon Loading


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


Patellar Tendon Management


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

acute chronic workload ratio the prehab guys

An easy way to measure acute : chronic training load is 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. Acute workload can be looked at the number of training units over a seven day period and chronic workload will be your weekly average over a four week span of time. The equation we will look at is acute/chronic work load 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.”


progressive overload acute chronic workload ratios the prehab guys


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.

Dealing With Knee Pain But Want To Continue Exercising?

stay active with knee pain patellofemoral pain program the prehab guys

Knee cap and anterior knee pain can be one of the most frustrating and self-limiting injuries to deal with. The common issue we see is most of these injuries are never addressed or rehabbed correctly in the first place and the same underlying issues remain, which can be a recipe for another vicious cycle of pain and setbacks in the future. We’ve designed a comprehensive solution for you to get back to normal life and simple things like squatting and going down stairs pain-free! For more information, click HERE.



  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?”


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

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