by Dr. Michael Riccardi, DPT, FAFS, CSCS

Whether you’ve been running for years or just started last week, you should familiarize yourself with some common running injuries, so you know how to prevent and treat any reoccurring knee pain. The two most common running injuries to be aware of are Patellofemoral Pain Syndrome (Runner’s Knee) and Iliotibial Band Syndrome (ITBS).  The knee is, by far, the most commonly injured area, so it’s important to know what to do if you are experiencing some of these issues while running, and when it’s time to seek professional help.

Some common issues and their causes include the foot and ankle feeling too tight/stiff (too much supination), feeling too floppy and loose (too much pronation), having a lack of hip mobility in one or all three planes of motion, decreased hip strength, poor running form and body mechanics, or even just bad footwear.

What’s the Difference Between Them?

Runner’s knee is a vague pain, generally felt in the front of the knee. The pain usually worsens with increased running distance and may even linger for a few days after a run. Runner’s Knee, or PFPS, is generally felt right underneath or above the kneecap, whereas ITBS is more commonly felt on the outer lower portion of the knee.

ITBS feels more like a sharp pain and is often fairly ‘predictable’ in most cases; meaning that people will commonly describe something such as, “I can run the first 5 miles fine, then mile 6 comes around and it starts to hurt, every time in the same spot.” It is common for both Runner’s Knee and ITBS to hurt more going downhill compared to uphill (or when walking downstairs), though it is especially common with ITBS.

While there are many potential causes for both these injuries, there are some similarities in basic treatment strategies. Here are some mobility techniques and stretches to try before every run to help prevent any Runner’s knee or IRBS injuries from worsening. Usually, your knee injuries will stem from a combination of a few different things, so it is important to make sure you see a skilled physical therapist to figure out the cause of the pain and help come up with a treatment plan that’s right for you.

Download the full workout here.

Mobility Stretching 

Foam Roll Quads
The most important thing to remember while foam rolling is to move slowly up and down the muscle. Start above the knee and move directly up the front of the quads by moving up 2 inches and then back down 1 inch. Repeating all the way up. It’s important to remember to turn the body slightly to get the outer and inner quads. On tender spots, pause, wiggle your foot left to right like a windshield wiper, then bend and relax the knee a few times to really dig into the muscle.
Trigger Point TFL
The ITB isn’t a muscle and therefore can’t get ‘tight’. However, it does attach to a small muscle towards the front of the hip, called the Tensor Fascia Latae (TFL), which can get overworked/tight in a lot of runners, causing a pull on the ITB, creating a sensation of tightness. This tightness can be released with foam rolling to a degree, but since it is a small muscle, I find that digging in with a lacrosse ball is more effective. Find your hip bone, drop down an inch or so and slightly to the outside. Lay down, partially on your stomach and partially on your side with a lacrosse ball underneath. If it feels tender, you’re on the right spot! Try to hold for about 10 seconds then roll slightly to a new area and repeat 3-4 times.
Hip Flexor/Quad Stretch
Get into a half-kneeling position and put the back foot up on your couch or coffee table (place something under the knee to make sure you’re not grinding the knee into the ground). Then, squeeze your abs and tilt your pelvis back (hold this pose the entire time). You should already feel a stretch down your quads and in front of your hip. Next, drive your weight forward, towards the front foot, being careful not to arch your lower back too much. Hold for 1-2 seconds and then ease back. Repeat 10 times. For the second set, try digging a little deeper, as you drive your weight forward towards the front leg, also twist your chest towards the front leg.

 

Strengthening

Squats
Runners tend to have a similar trend of being really tight in their quads and really weak in their glutes and hamstrings. This muscle strength and length imbalance is one of the biggest reasons for pathology in runners, along with poor running form and mechanics. Squats are a great way to build a strong foundation for running. Varying the foot position is a good way to ensure you’re hitting all aspects of the muscles. There are also a few different variations that you could try. Start out with just body weight air squats, then try to progress to dumbbell Goblet squats, Barbell front squats, and back squats. Try starting with just a set or two and then building up to 3-4 sets of 10-20 repetitions.
Walking Lunges
Take a big step forward, try to keep the weight evenly throughout the foot while trying to prevent the knee from moving forward too much over your toes. Keep the back leg straight and your torso in line with your back leg. Shift as much weight as possible onto the front leg, reach forward right in front of the lunging legs knee with both hands. You should primarily feel this in the hamstrings and glutes. Do some lunges where you reach forward in front of the knee, and some where you lean forward but add in a twist towards the stepping. Think about how you walk/run, when you step with your right foot, your left arm goes forward, making you rotate to the right. Same thing with this: rotate towards the stepping leg to increase the amount of glute activation on that side Work up to 3 sets of 10 lunges on each leg.
Side Lunges
Running is a very linear motion, primarily just going forward, however, each joint does move in 3 planes of motion throughout the running stride and it’s important to be mobile throughout all planes. Runners often lack mobility in the frontal (side to side) and transverse (rotational) planes. Side lunges get you to move into the frontal plane and open up the hips, stretching the adductors slightly while also strengthening the glutes. Just like the walking lunge, reach forward in front of the knee so that you can sit back into your hip. Try to keep the foot, knee, and hip of the stepping leg all in one vertical line by not stepping too far. Work up to 3 sets of 10 on each leg.
Single Leg Deadlift
Stand on one leg with a slight bend in the knee. Simply tilt forward from the hips keeping the back leg relatively flat, and letting the opposite leg reach up as a counterbalance. Be careful not to rotate up when doing this. Focus on keeping the hip that is in the air down low when you are in the “down position”. Work up to 3 sets of 10.
Rear Foot Elevated (Bulgarian) Split Squats
You’ll need a box, bench, couch, etc. Stand in front of the ‘step’ facing away from it and place one foot behind you on top of the ‘step’. Stand far enough away so that you sink down, but the knee of the front foot doesn’t move forward much. Reach forward in front of the knee and then drive through the front foot/heel as you stand up fully. Work up to 3 sets of 10.

Now, let’s talk about physical therapy!
When foam rolling doesn’t quite cut it, seeing a physical therapist to dig into those tough spots is the best solution. They’ll be able to target the areas that you might be missing with the roller as well as analyze your running form to make suggestions. They’ll also be able to look for other impairments while analyzing your form, like tight feet or ankles, which may be affecting the knee as well. Physical therapists can make sure that your form for each exercise is correct and ensure you’re progressing to higher skill variations when necessary, also considrr a couple of free spins uk.


Dr. Michael Riccardi, DPT, FAFS, CSCS, has worked with Performance Physical Therapy since 2018 as a physical therapist at our Pawtucket location. He received both an undergraduate degree and a Doctorate of Physical Therapy from Springfield College. He is certified in Applied Functional Sciences through the Gray Institute and is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning. He’s completed courses at the Postural Restoration Institute in several topics, including myokinematics, the pelvis, postural respiration, and instability and impingement. Dr. Riccardi specializes in running assessments and gait analysis