In this video, we're going to look at how to prevent knee pain from running. Things we'll
cover are warm-ups, why they are important, how they can prevent injuries, and also, I'll give
you an example of a program that works for easy runs. Then, I'm going to discuss training errors,
because those commonly can cause knee pain in runners. And lastly, we'll look at how strength
training can prevent knee pain. And there's a free program that you can download and use.
For those of you who don't know me, my name is Maryke. I'm one of the physiotherapists from
sports-injury-physio.com, where you can get online physiotherapy assessment as well as treatment for
your injuries. Have a look at the description of this video if you want the link to our website.
Warm-ups for runners are a little bit of a controversial issue because, let's face it,
if you’re a runner – myself included – you've probably … your warm-up for your easy runs is just
to jog really slowly at the start and then speed up a little bit. And yep, done that, been there,
no problem, most of the time. But you know what? If you're getting knee pain when you're running
or after you run, I want to make a case for you to consider doing a warm-up before you go out,
even before your easy runs. And I'll explain to you why this can help. Now, the most common thing
that we think about what a warm-up does is that it wakes up the muscles and it gets them nice
and warm. Yep, it does that; so, they can contract better, and there’s more blood supply to them, and
they're a little bit more pliable. Second thing that happens is, it warms up the joints and gets
your range of motion going, that you've got your full range of motion that you can work through,
so your hips can move as far back as they have to. And that can just help your whole kinetic chain
of your body move in an optimal fashion. But then thirdly, also, it actually stimulates the nervous
system and gets it firing at optimal levels. So, the body is brilliant. Whenever we don't use parts
of it at the moment, the brain just goes, “Well, we're going to downregulate the activity there,
because we want to save a bit of energy and rather send it to the other part that's doing the work at
the moment.” So to give you an example, if you're going to sit for hours on end and not really move,
when you get up, everything feels really stiff, because your joints have stiffened up.
Also, some of the muscles that have been low-level contracting, like your hip flexors, can feel quite
tight and not quite willing to let go easily, so your hip can't extend that far. But also,
you've sat on your bottom and your hamstrings, so they may not be fully alert at that point.
Now, for most people, this is not an issue, and they will wake up quite quickly. But if you're
finding that, “Hmm, I'm getting aches and pains when I go running, and my habits that I do before
I go out for a run may mean that my nervous system is not firing as properly as it should,” a simple
warm-up can help. Good news is, it really doesn't take a lot to wake things up and just get your
range of motion back. So, my favourite warm-up that I do before I go out for a run consists of:
Ten free squats. So, you're just going up and down in your comfortable range ten times. You don't
have to think about how you're doing it too much; you just do it with a nice, slow level, that you
get good control. Then I follow that up with some isometric bridges, so that I can really squeeze
my bottom and get my glutes firing. And then, just to get them properly firing, I'll do about
two sets of five single-leg bridges on each leg, because I find that really gets them going then.
I have to also say, these exercises are set for my level of strength. If you're not as strong
as I am, you may just continue doing double-leg bridges; they could do the trick just as well.
So then, I follow it up with another set of free squats. And then I'll do some lunges, where I just
dip into the lunge; so, I'm not lunging in-out, I just stand in a lunge position and just dip up
and down a few times. Spend a few seconds at the bottom of it; two, three, not too long. What
these do is, they open my hips for me. So, it's a nice, active stretch to get my hip flexors to
lengthen and realise that, "Ah, your leg can go back," other than you just sitting the whole day.
And then I usually end that with just doing some calf dips or calf pumps
to get them activated. You can do them over the side of a step, or you can just push against
the wall and just go up, down, up, down with your feet. But we're not hanging for ages at the bottom
of the step, because we're not looking to stretch them. We're just looking for them to lengthen a
bit, but also get activated while you're doing it. And then, you’re ready for an easy run. Now, this
warm-up will not be enough if you want to do a fast session that requires forceful contractions;
your warm-up has to fit with the type of running you're going to do. So, if you're doing that type
of running, you also have to follow this up with more energetic warm-ups and doing some
plyometrics and heavier things. But what you do there will depend on your specific case.
In my experience, one of the most common causes for runners to experience knee pain is due to
training errors. Now, a training error could be either that you ramp up your training too quickly
or you don't allow yourself enough recovery time between sessions. Or actually, it's just that
you're doing too many high-intensity sessions in a week. Now, to understand why this can cause knee
pain, let me first explain to you what happens to your knees and to the rest of your body when
you're doing exercise, like running. So, with any exercise we do, we … the body sustains a
bit of micro-damage. Now, micro-damage sounds quite hectic, but to be honest, it's normal;
it happens with everybody, and it is the way that our bodies grow stronger over time.
So, what happens is, you do a bout of exercise, then you need a period of recovery afterwards,
where you rest, and you don't do such intense work with your body. And the body then uses
that period to repair what you've done and repairs you stronger than before, because all of this is
now a signal to the body that you're not as strong as you want to be, and that's how you eventually
grow stronger. But, if you train hard again or train too quickly again before you've gone through
the full repair cycle, the micro-damage can accumulate, and that can cause overuse injuries
like Achilles tendinopathy, for instance. Now, it can be a bit tricky to get your recovery right,
because what you've got to look at is not just our day-to-day recovery; you've also got to look
at recovery on a longer basis. So for instance, if we think of a training week: You'll have high-load
days, so for runners, that will be fast running sessions or hill running sessions, anything that
really gets you out of breath is a high-load day. Now, high-load days cause more strain on the body,
so you usually require more time after a training a session to recover from those. Usually,
high-intensity training sessions take about 48 hours to fully recover from.
Low-intensity training sessions, so, where your heart rate doesn't go really hard or high,
and you're able to hold a full conversation while you're running, you only need about 24 hours,
usually, to recover from those. This time varies depending on your own fitness level as well,
so this is just a rough guide. But then, if we look at training weeks … So,
often runners will try to improve the times they do or the number of repetitions they do of
runs week-on-week. So then, every week the full training load is actually a bit higher for the
body, so that full load becomes more. Now, what we see is that you can get cumulative overload,
where there's only a tiny bit of recovery you're not getting, but that accumulates.
What they've now found is that it can work really well to have a deload week every third or fourth
week, where you train hard and you increase your intensity for two or three weeks, and then,
that deload week, you bring it all back down. You don't rest completely; you just bring your volume
down or your intensity down or both of them. And what that does is, it allows the body to catch up,
that it doesn't end up getting these overuse injuries. There's strong evidence to suggest
that this works in strength training, and that's where the original research was done. And there's
more and more evidence coming out that it can also be useful, especially in endurance running
and fast-running sessions. So, that's something to look at. If your knees are hurting after your
runs and you've – especially you've been running for a while – just look at, “Have I been trying to
increase my running volume too quickly?” Usually, a 10 to 15% increase week-on-week is okay. Second,
“Am I doing too many high-intensity sessions, too close together?” So, if you’re really fit,
you can usually get away with two high-intensity training sessions for running. If you're not that
fit and you're new to it, it's safer to stick with one per week. But again, it will depend on your
whole volume of things you're doing in a week. And then lastly, also, are you allowing enough
recovery days, even between your low-intensity sessions? So again, if you're new to running,
usually, if you're going to try and run every single day, you're going to end up in trouble.
If you're an elite athlete who's got … Well, elite athletes also have superior recovery
ability usually, through genetics, but they also have loads of loads of years of training, so their
body is better at recovering. They can usually train every day, but that's the difference.
So, have a look at your training schedule and just check if there's anything there that you need to
be changing to get rid of your knee pain. How do things like strength training prevent knee pain
in runners? There are a few ways. The first is, the stronger your muscles are, the more they can
absorb the forces when you run, so there's less force actually going through your knee joint.
Second is, strength training exercises help to improve your control and your coordination,
so you're getting better movements and quality of movement as you're running.
And then lastly, they've also actually been shown to improve your range of motion, so you're getting
a better range of motion as you're running. So, strength training for knees is a brilliant way,
if your knees are having a bit of a grumble, it's a brilliant way to help offload them. So,
it's important to not just look at the muscles that surround the knee, so, the quads and the
hamstrings and the calves, but also further away, because your core muscles and the stability around
your hips can impact your knees. For instance, there's some research that suggests if you've
got weak gluteal muscles, it can allow your knee to turn in too much. And that can lead to
things like medial collateral ligament sprains, meniscus injuries, and even IT band syndrome,
runners knee; there's lots of injuries that's been linked to that. So, it's important to
look at the full body when you look at strength training. Now, if you're not sure where to start,
what exercises to do, how many to do of them, I'm really happy to announce that we've included an
injury prevention plan for runners in the Exakt Health app. And this plan comes in three stages,
so you can … Doesn't matter what your level of strength training is or your skill level.
If you've never done strength training exercises, Level 1 will be perfect for you,
because it teaches you all the control and it really takes up the intensity very slowly.
But if you're quite experienced with strength training and exercises in general, Level 3 may be
more appropriate for you, because that requires a lot more skill and also has higher-load exercises
in there. But the other thing is that the app doesn't just include strength training exercises;
we've also included exercises for flexibility as well as coordination. So it's a nice, well-rounded
plan. And after each session that you do, the app asks you about how difficult the session
was and gives you the suggestions of, either keep this at the same level for a bit longer,
or actually, you can go up a level next time that you do this, because even within a stage,
you've got different levels of difficulty, so that you can keep on progressing. And then also,
it sets you specific targets after each stage so that you know when you're ready and ticking all
the boxes to move on to the next stage. The other thing that I really like is that you can choose
when to train in the week. So, you can say, “Well, I've got time on Tuesday, Wednesday, and Saturday,
and I can allocate this much time to it.” So, the app then works out what are the most important
exercises for you to do and how to fit them into that programme. So, if you're interested in that,
have a look. It's free to download from the App Store. It's called the Exakt Health app,
and I've also included a link in the description of this video that will take you directly to the
app to download it. Brilliant! Let me know if you've got any questions. And remember,
if you need more help with an injury, you're welcome to consult one of the team at Sports
Injury Physio – the link to the website is also in the description of this video. Take care!