Knee pain when running. Part two. What to do.

Welcome back to Madison Square Gardens for the fight of the century.  The bell has just sounded to signal the boxers back to the ring.  I can tell you now, it will need to ring a little louder to wake up The Tendon Tornado after the pounding he took in the last round!  Ground Force Frederick is commanding this fight.  The Tendon Tornado’s corner team should listen to the following advice to have any chance back into this fight.

So what then tends to be the main causes of injury in runners?

  • Lack of leg strength
  • Lack of conditioning
  • Loss of range of motion
  • Increased mileage too quickly
  • Increased speed
  • Adding too many variables at the same time (speed/hills/volume/frequency i.e Load)
  • Poor mechanics

Let’s look at leg strength and conditioning first.  This should be up there on all runner’s to-do lists in order to reduce the risk of overload injuries.  A large study in 2013 found that strength and conditioning reduced the risk of overuse injury by almost 50%.  What’s more, most running-related injuries can be treated with a progressive strength and conditioning program.

We talked last week about the forces through the body with running and how tendons transfer these forces from the muscle to the bone.  In that case, it would seem logical to improve the strength and condition of your leg muscles so that your body can absorb these forces more effectively.  That is, improve The Tendon Tornado’s ability to block punches from his opponent.

Here are the essential strength and conditioning exercises for runners:

Single Leg Squat:

Aim for 10-12 reps x 2 sets.  Increase to 3 sets once able.  3 – 4 sessions per week for all exercises.

Goal:  Perform 15-20 slow controlled knee bends with good technique, left leg = right leg.

Single Leg dipTaken from

Balance on one leg, then slowly bend one knee to roughly 30-40 degrees, then straighten up again.  Don’t let your knee drift inwards towards your other leg.  If this starts to happen, reduce the depth of the squat and hold onto something for support.  When it becomes easier, you can increase the depth of the squat and also hold onto some hand weights.

Single leg sit-to-stand exercise:  Aim for 10-12 reps x 2 sets.  Increase to 3 sets.

sit-to-standSourced from

Goal: To be able to push up into standing from a seated position, keeping hip in line with knee and in line with middle toe.  Ideally, aim to be able to push 125% of your body weight, from a seated position into a standing position with one leg.

If too difficult at the beginning, then rest your non-exercising heel onto the floor to provide support for the sit to stand.  You can also raise the height of the surface that you are standing up from.

Calf Raises: Aim for 12-15 reps x 2 sets, then 3 sets.

SLHRSourced from

Balance on one leg with some support, push up onto your toes keeping your knee straight, then lower slowly.  If too difficult, start with two legs together.  When it becomes easier, hold onto a hand weight on the same side as the heel raising leg.

Goal: To be able to perform 30 single-leg heel raises with good technique, left = right.

Lastly, an exercise termed ‘100 Up’ & it’s bigger brother ‘100 up Major’ have a role to play in conditioning the body for running.  Have a look at this youtube video and include it in your repertoire. This is an effective exercise in that it improves your running technique and muscle endurance.

Running distance and intensity

Increasing your training volume, that is, the amount of kilometres/miles that you cover in a week, is one of the most common causes of injury in runners, all you need is a log book or strava to help you keep on top of this.

Keep a record of your total weekly distance and try to not increase it by more than 10% per week.

This is what is called the 10% rule in the running world, however this rule can be broken under certain circumstances.  If you have started running recently, and have cleverly decided to begin with a low weekly volume of let’s say, 2-3 miles or 5km.  Sticking strictly to the 10% rule would mean waiting a long time to increase your running weekly distance.  So take the liberty to increase it more than 10% whilst listening to your body at all times.  It speaks our language you know!

Still on the topic of volume, it is a good idea to introduce a step down week in your gradual weekly build up.  Most training schedules that you will find online will include this in order to allow effective recovery.  This usually involves building up by 10% per week for 3-4 weeks prior to your step down week, reducing the distances by 10-20%, before progressing again.

WEEK 1 2 3 4 5
TOTAL KM 5 6 7 5 8

The intensity of running:

For anybody out there who is about to embark on a running buzz, please remember this.  Time spent running is more beneficial than intensity of running.  Easy running will still improve heart muscle, increase stroke volume (stroke volume is the volume of blood pumped out of the heart in one contraction or beat of the heart) and reduce resting heart rate, whilst at the same time greatly reducing your risk of picking up an injury.   It is because of these findings from research into running injuries that the following guidelines have become known.

  • Easy Running – up to 75% of maximum heart rate

This should make up to 80-85% of your weekly total distance.

  • Threshold runs – 90% of max heart rate

Comfortably hard.  Improves lactate threshold.  (This is the point at which the lactic acid in your blood starts to increase thus causing the body to stop exercising at that intensity level)  To improve your lactate threshold means that you can operate at a higher intensity before the lactic acid in your blood begins to rise)

  • Interval runs – 98% of max heart rate.

No longer than 5 min intervals.  Not all out.

The following practical tips should help to defend yourself against Frederick!

  1. Start a training log. Monitor your progress and keep an eye on volume.
  2. Have a plan. Whether it’s just a basic training structure or a progressive 3 month plan, have something to guide you.
  3. Listen to your body. Persistent aches and tiredness could be signs that you are over-training.  Remember to rest.

Let’s go back to Madison Square Gardens to re-join the fight.  Round 7 and the Tornado is blocking everything thrown at him/her/it! Ground-force Frederick can no longer force his way through the holes in the Tornado’s defence, looks to me like the tables have turned in favour of Team Tendon.  This fight could go on forever.  Wow, where did that come from, big right out of nowhere and Frederick is seeing stars.  Just how the Tendon Tornado predicted it, knock-out in the 7th round.  “Tornado, your prediction came true, what have you got to say”.  “I just wanna thank John Phelan and his almighty blog, everything I needed to know was in there.  I wanna thank my momma too!”

Thanks for reading folks,
Happy Running.

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