Every day millions of people suffer from knee pain.
Some know the cause of their pain, and others do not. I was recently afflicted with knee pain that seemingly came out of nowhere. I was able to identify and address this pain through some select methods, and the purpose of this article is to recount my experience and share how I was able to treat my knee pain. I’m a Certified Strength and Conditioning Specialist and a USA Weightlifting Level 1 coach, but I’m not a physician or a doctor. While the methods I utilized are generally considered safe, I’m not a medical professional. With that in mind, here’s how I was able to combat my runner’s knee pain, in hopes that my story my help you.
What is Patellofemoral Pain Syndrome?
According to the Mayo Clinic, Patellofemoral Pain Syndrome is pain in the front of your knee, around the kneecap. It’s also referred to as runner’s knee. The pain usually increases when you run, walk up or down stairs, sit for long periods, or squat. I did not suffer any trauma or have anything acute happen to my knee, so my pain was either coming from overuse or a muscle imbalance/weakness.
“Patellofemoral pain can occur when the muscles around your hip and knee don’t keep your kneecap properly aligned. Inward movement of the knee during a squat has been found to be associated with patellofemoral pain,” the Mayo Clinic writes.
After resting and staying away from exercises or activities that seemed to cause pain in my knee for a week or so, I went back to training as usual. The pain returned. That helped me deduce that overuse was not the cause, as rest was not helping the issue. Like many people, my knee pain was the result of muscle imbalance or weakness. Once I zeroed in on the cause, I drew up a plan of attack that included self-myofascial release, stretching, muscle activation and a re-designed training routine.
Self-Myofascial Release (SMR) is often used to improve mobility or work out aches and pains one may be feeling on a muscular level. It is often provided by using a foam roller, PVC pipe, baseball/lacrosse ball/tennis ball, or even a barbell. The areas I targeted were the calf, outer side of calf, quadriceps, IT Band and groin. By rolling these areas and working out some of the knots, you can relieve some stress that may be pulling on the tendons associated with the knee.
An important thing to remember is that you should not only SMR on the side with pain, but also on the opposite side as well to keep your body balanced.
My order was as follows:
- Calf, 20-30 seconds on each knot
- Outer Calf, 20-30 seconds on each knot
- Quadricep, 20-30 seconds on each knot
- IT Band, 20-30 seconds on each knot
- Adductors (Groin), 20-30 seconds on each knot
I would typically stretch after training sessions or dedicate a portion of my day to the activity. But before I would stretch, I would perform some form of SMR. That is your choice, but I found that to be most beneficial for myself. The same muscles I did SMR on, I would stretch, as well. I also added general mobility to spots like the glutes, hip flexors, hamstrings, back, front of calf and feet. My order was as follows:
- Foot stretch, 20-30 seconds each
- Front of calf stretch, 20-30 seconds each
- Achilles stretch, 20-30 seconds each
- Calf stretch, 20-30 seconds each
- Hamstring stretch, 20-30 seconds each
- Glute stretch, 20-30 seconds each
- Quadriceps stretch, 20-30 seconds each
- Hip flexor stretch, 20-30 seconds each
- Adductors (groin) stretch, 20-30 seconds each
- IT band stretch, 20-30 seconds each
I also decided that focusing on activating certain muscles could be helpful in addressing my pain. Certain movements can often be painful because we are not using the appropriate muscles to initiate the action. Many people live a sedentary lifestyle, meaning they are seated and do not move much for most of the day, which can create muscle activation issues. Namely, anterior dominance.
I would use this muscle activation technique as part of my warm-up prior to a lift or directly after one of my separate stretching sessions. My main goal was to activate my groin, hamstrings, and glutes. My body had begun to rely too heavily on the quadriceps for lower body movements, such as squatting, and that was putting additional stress on my knees. My muscle activation series went as follows:
- Glute Thrusts x 10 reps (Single-leg variation if you’re advanced)
- Fire Hydrants x 6 each leg
- Bird Dogs x 6 each leg
- Med Ball Groin squeeze x 8 reps
- Lateral tubing x 10 yards each way
- Front/Back Tubing x 10 yards each
Re-Designing My Routine
The final way I decided to try to decrease/alleviate my knee pain was adjusting the exercise order I utilized during my workouts.
As I mentioned previously, my quadriceps were doing the majority of the work on my Squats while my posterior chain (glutes/hamstrings) were doing very little. So my idea, which was formulated with help from colleagues in the profession, was to start my workout with two to four sets of a posterior-focused movement. After my warm-up, I would do two of the following four exercises: Romanian-Deadlift (RDL), Cable Pull-Through, Hamstring Curl, Banded Hip Thrusts. By activating my posterior chain and getting those muscles primed and ready to work, it took pressure off of my quadriceps, which helped relieve my knee pain. The additional posterior work also helped me strengthen my posterior chain muscles and become less quad-dominant, which should help prevent pain moving forward.
In conclusion, the combination of all of these methods ultimately helped me alleviate my runner’s knee pain. I have since been successful in my training, both on the field and inside the weight room. I hope my story helps at least one other person solve or improve their runner’s knee pain. We must often look at muscles either further up or further down the leg to solve our knee pain.