Much KNEEded Advice: Avoiding common knee issues and mechanical issues while running!

Charge Running · December 16, 2019

Avoiding common knee issues while running + Avoiding the common mechanical issue in people with knee pain!

I regularly tell my patients that the knee is the worst designed joint in the body. The knee is a hinge joint working in the sagittal plane. It straightens and it bends. That is it. 

The knee’s problem is that it’s stuck between the hip and the ankle joints. These joints function like ball and socket joints and have infinitely greater degrees of movement, often pulling the knee in directions a hinge joint was not designed to handle (imagine trying to rotate a door that only opens or closes). These competing forces are a common source of knee pain in runners. 

The runner’s knee: a poor design? 

The motion of the knee while running is pretty simple—it extends and flexes between 40 to 60 degrees while your foot is on the ground. However, during this phase of the running cycle there are other forces that work to medially collapse the knee across the coronal plane (i.e. push the knee to rotate or glide inward toward the center). This medial force causes many runners’ knee pain. Whether you are prone to PFPS (Patella-Femoral Pain Syndrome), MCL (medial collateral ligament) sprains, ITB (Iltiotibial band) friction pain or meniscus issues, it is often due to this force caused by the hip and ankle. 

Common treatment options such as squats and wall sits (these exercises were found after googling “knee exercises for runners”) target mostly the quads and glutes (gluteus maximus to be specific—this is an important differentiation. You’ll see it’ll be important later!). While fair enough, these are muscles that are heavily used in running. The problem is that these muscles also only work in the sagittal plane and thus cannot combat that dreaded medial force. 

So how do you ACTUALLY work on avoiding common knee issues while running???

How hip exercises can treat your knee pain 

So—what’s the solution? Exercising the muscles that have control in the coronal plane, counteracting that medial force. Which muscles are those? The hip stability muscles! Yes, it is suggested that you exercise the hip to combat knee pain! 

More specifically, strengthen the gluteus medius and gluteus minimus muscles. These muscles combined work to abduct the leg—moving the leg out to the side. But when your foot is planted on the ground standing (and as with the stance phase of running), these muscles instead work to PREVENT medial collapse of the knee. 

3×10 is not enough for stability muscles 

Most people are used to hearing and then completing “3 sets of 10” or some iteration. That makes sense for some muscles, but 3×10 is not enough for the gluteus medius and minimus. These muscles are stability muscles that require endurance as they are nearly always engaged. So completing 3 sets of 10 will not even make a dent in the endurance of these muscles. 

The best prescription of exercises targeting stability muscles is completing just one set, but as many repetitions until form fatigue*. This means doing as many as you can of that exercise until you cannot do another one correctly anymore (or until the onset of pain—presumably this would not cause one’s knee pain since we are actually targeting the hip). Depending on the time of day you complete these exercises that can mean a wide range of repetitions. But it does not matter. Just as long as you achieve fatigue, you have accomplished your goal. 

With this prescription of exercises specifically targeting stability muscles, it is expected that you would apply a very low load—often, just the weight of your own body. So I am not suggesting you complete 100# Romanian deadlift until form fatigue, but in that specific case, you’re also not targeting stability muscles. 

The following are the two exercises I prescribe first and most often to my patients. It’s probably a movement you’ve done before but had never considered completing so many of them. 

Exercises targeting gluteus medius/minimus: 

Sidelying hip abduction 

1) Lie on your side with your hip joints lined up on top of each other. Make sure your top leg is straight with the rest of your body. Our body tends to cheat by bringing the top leg a little forward. Make sure your leg stays in line with your body if not even a little behind you. 

2) When you lift the leg up, you do not need to go further than 45 degrees. 

3) SLOWLY lower down and try not to lower all the way to the ground. 

4) Complete until form fatigue is reached. 

Sidelying clamshells 

1) Same set up as above, but with your knees bent one of the top of the other. 

2) The bottom of your feet should be in line with your buttocks (this may be a more forward position than you have previously done in the past with this exercise). 

3) Rotate the top leg up and SLOWLY lower down. 

4) Do not allow your trunk rotate. If done correctly, you should not be rotating more than 45 degrees. If you are, you are potentially cheating by allowing your trunk or pelvis to rotate. 

5) Complete until form fatigue is reached. 

We need to rethink how we typically view the role of our hip stability muscles when it comes to running and shift the focus away from the quads and hamstrings. That, combined with the proper knowledge of how to target these kinds of muscles, should help alleviate the pain caused by the dreaded .::medial force::. 

*Form Fatigue: The research on this topic is often contradictory. I’ve referenced a few articles as examples if you are interested, but in my professional experience working with patients, form fatigue seems to work best for primary stability muscles. Here are examples of the state of the research: an article here, here, and here.

Laya Griffith, PT, DPT, CSCS 
Doctor of Physical Therapy 
Certified Strength and Conditioning Specialist 
Running Enthusiast! 

The information and views expressed in this article are not intended to substitute in-person professional medical advice, diagnosis or treatment. All content, including text, graphics, images, and information contained in this article is for general information purposes only. If you are experiencing any form of pain or injury, please either consult your physical therapist immediately or go to your nearest emergency room.

Improve your mechanics, avoiding common knee issues while running, and jumpstart your training with any of Charge Running’s live, virtual runs, workouts or races!

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