9 Benefits of Running For Knee Health

RUNNERS WORRIED ABOUT KNEE PAIN 💥

.

It’s a no brainer - Running is without doubt THE best thing you can do for your knee 💪

.

Here’s 9 reasons, off the top of my head…

.

There are many more…feel free to add to the list in the comments below…

.

And when someone asks, tell them👇

Running is like the the UV from the sun, it’s the DOSE that matters.

Excess UV sunlight contributes to skin cancer, BUT too little causes Vitamin D deficiency.

.

So listen to your body, but don’t fear running as it’s THE best form of exercise to support your knee joint.

.

If you need a little help getting your individual dose right, get in contact with a physio who also has a passion for running and knee health 😎

9 Benefits of Running For Knee Health

1. increases bone density - increases resilience of joint

2. Increases tendon capacity (eg Achilles calf spring that acts like a shock absorber for knee joint)

3. Cartilage health - loading stimulates growth of new cartilage

4. Eccentric muscle length and strength reduces knee joint compression

5. Low loads on knee cap (flat ground running) vs squats and lunges high knee cap loads causing accelerated joint wear

6. Improves metabolic health - leading to optimized weight (strength training increases muscle size so more load and weight for the joint)

7. Increased circulation through body - stimulating endorphins, optimize lymphatic drainage and flow

8. Natural and varied open environment with fresh air and sunshine

9. Able to train more consistently eg- when traveling

Is it worth foam rolling your ITB?

If you walk into any gym, you may see someone sadistically foam rolling their ITB, making all sorts of interesting faces.

The ITB, if you are unsure, stands for Ilio-Tibial Band - that is the long fibrous tissue that runs from the hip down to the knee along the outside of your thigh (see pic below).

An irritated ITB can lead to pain and inflammation in the outside of the knee, especially in runners and cyclists. If not addressed early, this can lead to ongoing pain and can be tricky to manage.

To roll or not to roll?

Recently there has been a lot of noise being made about the fact that regular foam rolling and stretching doesn’t physically change the ITB at all.

Some researchers point out that it is impossible to ‘release’ your ITB with a foam roller because it takes thousands of kilograms of pressure to change it.

Proponents for the foam roller say that it helps keep the tightness under control and prevents runner’s knee.

Who is right?

Well yes the ITB is made from very tense connective tissue are it probably doesn’t change all that much. And I’d definitely agree you can easily stir things up if you are constantly and aggressively rolling.

And you don’t want to have super loose ITB’s either - having strong and resilient ITB’s are an important part strong and efficient running form.

Ideally, you want to have them ‘in-tune’ like a musical instrument - not too tight or too loose.

What is really happening when you roll?

While it is hard to say for sure, I suspect most of the benefits from foam rolling are coming from what lies directly under the ITB. Here you’ll find one of the quad muscles called the Vastus Lateralis (see diagram below).

When you look at the above picture, you could easily believe that the ITB is the main player on the outside of the thigh.

However, on closer inspection, the diagram below gives a much more accurate picture, showing the relative density of the ITB compared with the huge Vastus Lateralis (VL) on the left of the picture.

Cross section area: ITB vs VL (Vastus Lateralis)

As you can see, while the ITB gets all the attention, the vastus lateralis has a huge cross sectional area and is the real workhorse of the leg.

The vastus lateralis muscles tend to become overloaded with lots of downhill running, squats and lunges.

Some muscles in the body due to their anatomy and location, are impossible to stretch effectively. The vastus lateralis is one of them.

Over time, one of the most common causes of pain on the outer side of the knee is from a build-up of tightness in the vastus lateralis (see trigger point referral patterns below).

So learning how to maintain flexibility by foam rolling in this area is hugely important to keep your knee and hip joints moving well.

How to foam roll the Vastus Lateralis:

Benefits to foam rolling the ITB/vastus lateralis:

• improved short term flexibility and blood flow

• releasing the muscles under the ITB (Vastus lateralis)

• stimulate the para-sympathetic system to activate the healing and recovery process

• connecting with your body and bringing awareness to any overly sensitive or tight areas
  

Things to keep in mind:

• avoid rolling directly over the outside of the knee and hip joints

• should never feel more then 5/10 pain. Regulate the pressure by using your upper body and core if needed. In the words of John Rusin, “Stop mindlessly foam roll like a jackass.”

• if you’re getting ongoing tightness, you need to get to the root cause! Consider contributing factors such as shoe wear (time for a new pair?), training habits, too many hills, inadequate glute strength and capacity, inadequate carbohydrates before and during your run, inadequate protein for recovery

• don’t bother trying to actually stretch the ITB - it’s anatomy is too complex to get an effective stretch

When to roll:

• if you have extremely tight leg muscles, you can roll gently before you exercise (30-60 secs max)

• the best time to roll is after you have finished exercising, when the muscles are warmed up

Conclusion:

• above all listen to your own body - if it feels good to you, then keep foam rolling your ITB and outer quads

• don’t spend too long foam rolling (2-3 mins total time to roll the major muscle groups) after you exercise is enough, with perhaps one longer stretching session per week

• an even more effective approach, target the vastus lateralis with the foam roller by rotating 45 degrees onto your front, and slowly bend and straighten your knee as you roll

• if you’re getting ongoing tightness and pain in the ITB, seek professional help with a Physiotherapist to help identify contributing factors

Questions?

Please leave a comment below…

More from the blog:

Managing My Patellofemoral Pain - Free Education Leaflet

Thanks to Christian Barton, an expert knee Physiotherapist in Melbourne, for putting this useful leaflet together.

This freely downloadable PDF explains:

• what exactly is patellofemoral pain and how it develops

• contributing factors

• key treatment options

• how physiotherapy can help

Pain on Inside of Knee? Get To Know Your VMO

The Resilient Knee Project is an innovative solution for people with chronic knee pain that empowers individuals to self-manage their pain and most importantly, get them back to enjoy the physical and mental benefits of running.

Founded by Daniel O’Grady, dedicated professional with first hand experience of overcoming knee pain and running the NYC Marathon, the project aims to be a world leader in restoring people’s confidence in their knees and get back to doing what they love.

Is The Resilient Knee Program right for you?

Take the free quiz here

Get to your know your VMO

If you’ve ever had a nagging pain on the inside of your knee or a knee that seems to buckle or give way, there is a fair chance you’ve had some dysfunction in the VMO muscle.

VMO dysfunction is very common in runners, hikers, cyclists, athletes involved in jumping sports and after any knee injury.

In this short blog, we’ll find out more about how issues develop in the VMO and what you can do to help.

WHAT IS THE VMO MUSCLE?

VMO stands for Vastus Medialis Oblique and this is part of the quads, running along the inside of the thigh, with the bulk of the muscle sitting directly above the inside of the knee.

FUNCTION:

The role of the VMO is to assist with extending your knee and arguably the most responsible muscle for knee stability, as it helps control the alignment of the knee-cap.

When the VMO isn’t functionally optimally, the knee cap tends to shift slightly out of place during movements such as squats and lunges, causing pain and inflammation behind the knee-cap.

SYMPTOMS:

When the quads get overloaded (suddenly or over time), tightness in the muscle fibres (called trigger points) can refer a toothache-like pain deep in the knee joint (see Figure 1 below).

This pain from the overloaded VMO muscle can often be confused with joint pain such osteo-arthritis or a meniscus tear, as the location and type of pain are often similar.

Figure 1

The initial knee pain then may disappear after a few weeks, only to be replaced by a sudden weakness in the knee (a condition called “buckling knee”) that causes a person to unexpectedly fall while walking.

HOW THE VMO BECOMES OVERLOADED:

The VMO can be activated as a protective response to knee injury such as to the ligaments, meniscus or post-surgery.

The VMO is also commonly overloaded with repeated use in the following situations:

• suddenly increasing your volume of running or cycling (running places around 6 x body weight through the quads)

• a new (or sudden increase) in an exercise program involving repetitive squats, lunges, leg extensions or wall sits

• jumping sports e.g. basketball

• cycling - poor bike fit

• walking downhill or stairs

• being over-zealous in rehabbing the VMO - too much strengthening too soon

TREATMENT:

Physiotherapy assessment will involve a comprehensive movement assessment to determine the cause of your VMO issue.

“Short term treatment such as soft tissue massage and dry needling is very helpful, while long term building capacity in the quads, glutes and core is critical to prevent a relapse.

TRIGGER POINT DRY NEEDLING:

Tightness and contraction of the VMO responds very well to dry needling, which can de-activate the trigger points (knots in the muscle).

The benefit of dry needling is that it can reach the deep fibers of the muscle and lead to a quicker resolution of symptoms. 

Treatment of the VMO is generally very responsive to treatment, provided the contributing factors are addressed.

SELF-CARE TIPS:

• apply heat to the VMO muscle 10 minutes each day to increase blood flow and reduce tension

• if you’re a runner or hiker, avoid the hills (in the short-term)

• ensure your shoes are not overly worn

• when running - avoid over-striding, ensure proper warm up and cool down and take walking breaks frequently to avoid overloading the VMO

• avoid prolonged kneeling on the floor e.g. gardening, washing floors - use a low bench or stool to sit on instead

• foam roll the VMO daily for a few minutes (see below). It’s also a good idea to roll out the adductors which are also commonly tight
  

Foam Roller for the VMO:

Foam rolling the inner quad and adductor - fun times!

Let’s get you back to doing what you love…

If you’d like to get your knee on the fast track straight away, please use the button below to schedule an appointment:

Dan O'Grady is a results driven qualified Physiotherapist and member of the Australian Physiotherapy Association.  Dan has a special interest in treating knee pain.  He has been working in private practice for 15 years. He is passionate about helping people to move better, feel better and get back to doing what they love.

---

Download the The Healthy Knees E-Book - now on special !!

Building A Resilient Knee For Running

Building A Resilient Knee For Running

Important Note: This blog post is very general in nature. Some or all of the advice may not be appropriate for you. Please check with your Physiotherapist for specific advice on your condition.

---

If you’re fairly new to running - and tell your friends and family you’re planning or running a marathon or half-marathon, very often you get this well intentioned question:

While we can easily shake off the comment at the time, it’s often not until a few months down the track, when your training volume starts to increase, you may in fact start getting some twinges in the knee, that the comment can come back to haunt you.

An element of doubt can sit in the back of your mind, making you question:

“Is running actually harming my knees”?

“Were they right after all”?

So what does the research say?

There’s a common view in the community that running isn’t good for your knees, and may cause early wear and tear and possibly lead to arthritis.

So what does the research actually show?

A very high quality study recently came out that followed over 100,000 people to see how their lifestyle and exercise habits related to their risk of developing knee arthritis.

The study showed that recreational runners had a risk of developing knee arthritis that was around 3.5%, compared with non-runners whose risk was 10.2%.

Knee arthritis risk: Runners vs Non-Runners

In other words the non-runners had a three times greater chance of developing knee arthritis that runners.

Amazing.

Rather then their joints ‘wearing out’, runners had increased muscle bulk around the knee, providing a protective effect on the joint.

This study allows you to be confident that recreational running will not harm, and may actually improve, your hip or knee joint health.

Biggest Risk Factor

So if running doesn’t cause arthritis in the knee, then what is the biggest risk factor?

If we look at the research again - the biggest risk factor for knee arthritis was being over weight.

So in terms of knee arthritis, the risk of being inactive and becoming overweight is much greater than being active and running regularly.

Knee pain and running

So… we know running doesn’t cause arthritis - (it actually might prevent it).

However, the knee is still a very common area of pain and injury for runners (in fact 50% of all running injuries are in the knee).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

Patello-femoral Syndrome

The most common running related injury is what we call Patello-femoral Syndrome (also known as Runner’s Knee).

Patellofemoral pain (PFP) is a condition where pain is felt on the front of the knee, either around or behind the patella.

It is caused by an increased load and force going through the knee-cap that, resulting in inflammation and swelling around the knee.

The main symptom of Patello-Femoral Syndrome is pain with loading and a general vague ache in the front of the knee.

The pain generally gets worse with:

• running especially downhill

• climbing stairs

• kneeling and deep squatting

• sitting with knee bent up for prolonged periods e.g. sitting on a plane or movie theatre

Key Point:

A key point here is that knee pain from running is most likely related to inflammation around the knee cap rather than any structural joint damage.

The confusing thing is that the aching pain from patello-femoral syndrome can mimic the pain you may feel in the early stages of knee arthritis.

No doubt this can be a little disconcerting.

But you definitely don’t need to freak out about developing knee arthritis.

2 choices:

When you develop knee pain as a runner - you have 2 options:

1. Keep running and push through the pain barrier.

   Sometimes this can help and the pain goes away. But sometimes the pain doesn’t get better and things just get worse. Runners traditionally have very good pain thresholds - but the jury is still out if this is a good thing or not!

2. Stop running altogether.

   As runners, we know when you stop running, you tend to lose your fitness really quickly. Your capacity decreases rapidly and your muscles become de-conditioned and so just resting doesn’t really solve anything. When you get back to running, the pain and inflammation is just as bad as before.

Thankfully there is a 3rd option - and the rest of this post will be talking about five very practical strategies you can use to help reduce your knee pain and get back to running.

5 Strategies to help with knee pain and get you back to running

Before we start, we need to get on the same page.

Unfortunately there are no quick fixes.

There are multiple factors (20-30!) that may all play a role in why you’ve developed knee pain.

Without doubt, the best results come with a personalised assessment with a Physio who has a special interest in running.

This will help identify the main issues and get you on the fast track to healing.

On average, it takes 8 - 12 weeks to reduce knee pain and get back to running properly again.

Getting healthy again will test your patience, and it is very often a case of 2 steps forward 1 step back.

1. Reduce Inflammation

If we go back to the original cause of the patello-femoral pain in the knee - it is inflammation that develops under the knee cap.

If you have knee pain, it means you have inflammation.

So the first and most important step is to reduce the inflammation in the knee.

The best way to do this is to use a good quality ice pack on your knee for 15 mins x 2 day (every day for 2 weeks).

The ice packs we sell in the clinic are the Sideline Ice and Wrap ($39)…they are a great option.

Using the velcro strap means you can get a solid compressive effect and still keep moving about, without having to stay seated the whole time.

Often the knee starts to feel better quite quickly when you decrease the inflammation, but it’s important to keep icing for 2 weeks so you completely break the inflammatory cycle.

If you start to feel better and then return to exercise too quickly, you will start the inflammatory process over again.

Another good option when you have knee pain is getting into a pool or standing in the cold water down at the beach. The buoyancy of the water can have a positive impact on decompressing the knee.

We don’t tend to use anti-inflammatory medication, unless the pain and inflammation is severe.

2. Reduce Load

Generally, activities with more knee bending increases stress to the Patella-femoral joint.

So to reduce irritating your knee further, you will need to:

• reduce heavy weights especially lunges and squats

• avoid stairs

• avoid kneeling

• avoid sitting with your knee bent up for prolonged periods

Sometimes you also need to avoid a quad stretch as this can also irritate the knee joint

Reducing Load When Running

If at all possible, we like to keep you running in the short-term, with a few alterations.

Some common modifications include:

• avoid downhill running and keeping to flat ground as much as possible

• reduce speed and include some more walking breaks (especially when you feel knee pain)

• do shorter, more frequent runs rather than longer runs

If running is still too sore you may need to take a complete break for 1-2 weeks.

In this time, you can generally keep walking and getting in the pool can be helpful too.

Some people like to get on the bike, which can be a good option to maintain your cardio-vascular fitness. However you need to be wary of developing muscles imbalances that cycling can often accelerate - most commonly increased hip flexor tightness and under-active gluteals.

3. Increase Tissue Capacity

If we look at which muscles are loaded when we run, the soleus muscle in your calf (takes up to x 8 body weight) and the quads (up to x 6 body weight).

Photo Credit: Rich Wily Running Symposium La Trobe 2018

They already work a lot so it probably doesn’t make a lot of sense to increase the strength of them, especially if you are running a lot and doing hills regularly.

But the accessory muscles such as the hamstrings, gastrocnemius, and the glutes have all got potential to improve their capacity and help off-load the knee.

Some common exercises you could include would be calf raises, bridges, clams, crab walks and hamstring curls on the ball.

Getting a Physio to develop a personalised program for you will provide many benefits in the long term and keep your knees from getting overloaded and inflamed.

4. Create Neuro-muscular balance

Many people think of the knee as a simple hinge joint.

While the joint does act like a hinge, there are around 20+ muscles that attach and need to be balanced around the knee.

If you are a musician - anyone who plays the guitar - you know that every time you play, you spend a couple of minutes ‘tuning’ up, before you play.

If your strings aren’t fine tuned properly then obviously your going to sound terrible!

The muscles are like the strings of the guitar, and tend to get overloaded and tight with running, leading to increased loads on the knee-cap.

Keeping your muscles in tune could include things like:

• foam rolling

• stretching

• deep tissue massage

If your muscles are having a bit of trouble releasing, then the next step would be to try dry needling.

Trigger point dry needling has the ability to reach deeper into the muscle, getting a more effective release.

You can find out more about dry needling here.

5. Modify Running Gait

There is some solid evidence showing that making some small modifications to your running gait can take pressure off your knee.

Returning to running after a knee injury can be a little scary.

We find sometimes people can be a bit over-cautious and defensive and this leads to a very upright posture, almost running within yourself.

Counter-intuitively, this upright posture tends to increase the force on the knee…so switching to a forwards lean is a simple solution.

Some studies have shown that incorporating a forwards lean can improve your running efficiency by up to 30%, as you tap into the power of gravity.

It’s important to lean forwards from your ankle, rather than bending from your waist, that could lead to pressure on your lower back.

Over-striding

A common thing with knee pain in running is over-striding.

This can lead to increase peak forces going through the knee.

The solution is to modify your cadence (how many steps you take per minute).

Generally, increasing your cadence 5-10% can significantly decrease the peak load of force going through your leg.

For example, if you’re at 165 steps per minute - increasing to 175 - 180 may do the trick.

Many GPS watches track your cadence in real-time, or you could use a metronome app on your phone to help keep your rhythm.

Side note: Running with a faster cadence doesn’t mean you have to run at a faster speed. There is an art to learning to shorten your stride, but still run at a comfortable pace - it can take some practice.

Return to Running

Just a few final tips about returning to running from a knee injury:

• for the first 3-4 weeks, choose a flat surface to run on and gradually layer in the hills as your pain allows

• before you run - do a quick tune-up - foam rolling, gluteal engagement exercises

• try taping the knee. About 50% of the time, using a rigid tape can make a huge difference in stabilising the knee cap. The other half of the time it doesn’t make much difference, so it is worth trying out - and your Physio can show you how

• shoes - a new pair never goes astray after an injury and will help take the full shock absorption with less pressure on the knee

Pain as you return to running

As you return to running, your knee may still be twingy.

The following scale is useful to keep in mind and rates your pain level from 0 (no pain) and 10 (worst pain you could imagine).

Of course, ideally the pain would be 0, and that’s great if that’s the case.

In reality, you may still have some twinges and soreness as you’re getting back into it.

This is really common and is often more related to the knee getting used to the loads again, rather than more damage.

We rate a 0-5 pain score as an acceptable level.

You can still run, but just be mindful, if your pain increases to a 6 or greater, then you need to stop and walk / rest.

Take note of your pain levels at the time of exercise, and also the 24 hour response.

Pain that lasts until the next day means you’ve probably done too much, so next time reduce the amount so your body can handle it and gradually build up from there.

---

What about if you already injured your knee - is running still OK?

That is a great question, and it is very hard to say without a personalised assessment.

If you have previously torn a ligament or meniscus in your knee - some doctors would suggest you avoid running forever.

However, if we go back our research showing the biggest risk factor of knee arthritis is being over-weight, there is a case to be said for gradually re-introducing running (if it’s something you enjoy), as a means of maintaining effective weight control and creating a supportive muscular foundation for the joint.

Following the five strategies outlined above would most likely be a great help, but again please consult with a Physio to get a tailored plan set up for you.

Avoiding surgery

Some recent research has demonstrated that 65 per cent of people with knee arthritis and meniscus tears can avoid surgery by following a physiotherapy program (Katz et al. 2013).

The protocol involved an individualized physiotherapy treatment plan with a progressive home exercise program. 

The three-stage structured program was designed to:

• decrease inflammation

• improve range of motion

• optimise muscle strength

• improve aerobic conditioning (e.g., with the use of a bicycle, elliptical machine, or treadmill)

• proprioception and balance re-training

Conclusion

Running is safe - it definitely doesn’t cause arthritis and may even protect your knees.


Knee pain is common however and the most common cause is knee cap pain.

Listen to your body - respect it - get in touch with Physio who can guide you back to running safely.

Rather than pushing through the pain or stopping alltogether, try the 5 Strategies:

• decrease inflammation using an ice pack

• temporarily decrease load

• increase tissue capacity with some simple strengthening exercises

• create muscle balance

• modify your running gait

If you have any other questions about knee pain and running, I’d love to help you out.

You can send me email to dan@kinfolkwellness.com.au

If you’d like to get started on your journey back to running pain-free again, simply click on the link below to schedule an appointment.

Dan O'Grady is an experienced Running Physio in Adelaide who has worked with runners from around the world including ultra-marathoners and weekend warriors.

• Dan worked with Robert De Castella's Indigenous Marathon Project at the 2013 New York City Marathon.

• A keen runner himself, Dan ran the New York City marathon in 2015 & 2017 and is currently preparing to break his 5k PB before he turns 40!

• For running advice & inspiration, follow our Instagram

---