Ugh, runner’s knee. It’s one of the most common ailments to strike down pavement pounders — almost always at the most inopportune time (think: the middle of race training).
“Runner’s knee happens when the patella — that’s the small bone at the front of your knee joint, or your kneecap— is tracking in an abnormal direction, causing pain on the front and outside of the knee,” says Abby Bales, physical therapist, running coach, and a certified strength and conditioning specialist. “You’ll feel the pain when you stand up after sitting for a long time, and during repetitive movements like running and cycling.”
What Is Runner’s Knee, Really?
The condition can afflict anyone from beginners to marathoners, and it turns out the cause doesn’t actually have much to do with your knee. It’s more about the muscle imbalances around it (think hips, glutes, IT bands and quads), Bales says. Oh, and major bummer: It doesn’t get better with rest.
So, if the go-to arsenal of RICE (rest, ice, compression and elevation) won’t work in this situation, what’s a runner to do? The answer: strengthen, strengthen, strengthen — and work on your flexibility like you’ve never done before. “Most commonly, runner’s knee happens because the hip lacks motion,” says Bales. (You can thank your desk job for that). “You could do all the hip strengthening exercises you want, but if your hips also can’t move, you’ll never be able to activate those glutes when you run and the problem will just keep on coming back.”
To prevent that, Bales developed a stretch-and-strengthen program designed to help fend off runner’s knee for good. Do the three stretches (moves 1 through 3) both before and after exercise. “Before, to open up the hips and prepare them for a tough workout, and after to increase the range of motion your joint can reach after it’s been ‘warmed-up’ through activity,” Bales says. Then, practice the four strength exercises (moves 4 through 7) two times a week during training, or three to four times per week during your off-season to build and maintain muscle.
7 Key Lower-Body Moves to Add to Your Routine
1. Hip Flexor Stretch
This move opens the front of your hip to allow for increased mobility, Bales says. Most people sit all day and their hip flexors become extremely short. In order to engage your glutes (the major muscle that propels your hips), you need to loosen up your hip flexors.
How to: Start with left knee on the ground, right foot planted and leg bent at 90 degrees, hands on hips (a). Squeezing your glutes, drive your hips forward toward your right knee (b). Slowly move forward and back 15 to 20 times. Switch legs and repeat.
2. Lateral Hip Stretch
Lengthening the lateral compartment of the hip will prevent tightness from causing abnormal motion of the patella (which can lead to runner’s knee), Bales says.
How to: Start with your left knee on the ground, and your right knee bent at 90 degrees, so your legs form two right angles (a). Place your right hand on your right hip and reach your left arm straight overhead (b). Keeping your arm raised and legs stationary, lean your upper body to the right (you may feel this in your obliques, which are attached to your hips) (c). Hold for 15 to 20 seconds, switch legs and repeat on opposite side.
3. Rotation Stretch
With this movement, you can help improve the natural rotation in your hips, abdominals and back muscles — all key to proper running technique.
How to: Start with your left knee on the ground, right leg bent at 90 degrees so your legs form two right angles (a). Raise left arm straight in front of you, right hand resting gently on hip (b). Squeeze your glutes and slowly rotate your upper body, until your left arm is pointing towards your right knee (c). Hold for a few seconds, return to start. Repeat 15 to 20 times, then switch legs and repeat on opposite side.
4. Single-Leg Squat
Hello, strength training! This squat targets your gluteus maximus, the primary muscle that helps your hip extend.
How to: Start with legs hip-width apart (a). Rest your weight on your right leg, lifting the left foot slightly above the ground, so you’re balancing on one leg (b). Push your hips back and bend your right knee, keeping knees over toes and slowly lowering toward the ground as if you’re trying to sit in a chair (c). Return to standing. Do two to three sets of 8 to 12 reps on each leg.
5. Low Lunge
You’ll engage all of the muscles in your hips and legs at various points during this exercise, which also forces your body to get accustomed to moving through a wide range of motion.
How to: Start standing with legs hip-width apart (a). Bring your weight to rest on your left leg, with right foot raised slightly above the ground (b). Step your left foot behind you, keeping the left leg straight, while you bend your right knee to 90 degrees to form a lunge (c). Lean forward so your hands are on either side of your right foot, fingertips touching the ground, hold for a few seconds (d). Push forward with both feet to return to starting position. Do two to three sets of 8 to 12 reps on each leg.
6. Side Lunge
Often tight and weak in runners, the gluteus medius will engage every time you do this lunge. You’ll also work on stabilizing your knee and lengthening your adductors (a muscle in your thigh).
How to: Start with feet together, with weight resting on your left leg, right foot slightly above the ground, so you’re balancing on one leg (a). Raise arms overhead (b). Step your right leg out to the side, bending your knee as you land, driving hips back and keeping the left leg straight (c). Immediately use your right foot to push back to starting position. Do two to three sets of 8 to 12 reps on each leg.
7. Walking Curtsy Lunge
This exercise increases hip mobility, challenges your balance and directly engages your adductors, which can help stabilize your hips.
How to: Start with feet hip-width apart, weight resting on your left leg while the right is slightly above the ground, so you’re balancing on one leg (a). Gently rest hands on hips and engage abs for balance (b). Step your right foot forward and across your left leg, bending both knees toward the ground to lower into a lunge (c). Place your weight in front leg (without leaning forward) (d). Use your right foot to push forward and up, and bring the left leg off the ground and into a regular forward lunge (e). Cross the right foot again and continue, walking across the room on a diagonal. Do two to three sets of 8 to 12 reps on each leg.