Beating Runner’s Knee – by Dan Cartwright

Dan is a bit of a running legend! He's conquered ultramarathons through sweltering heat and leg sapping mud and written all about it on his fantastic website. But, like any runner, even he's prone to the odd injury or two. So when a nasty bout of knee pain stopped him in his tracks he kindly agreed to tell us how he overcame it to come back stronger than before!…

Before you read this ask yourself one question. How many of you have a recurring injury or niggle which affects your running?

I would bet that most runners have and they accept it as being a risk of the sport. I did, but that all changed for me. Let me explain why….

After four years of running a mixed bag of events, from trail ultras to track 5k's, adventure races to London Marathon, I felt like I'd pretty much found my feet as a runner (pun intended). Like all runners I'd had niggles and pains along the way, never a serious injury, more a series of issues which at times had reduced how much, how fast or how far I could run.

I've twisted ankles, suffered from the truly hideous plantar fasciitis, tweaked hamstrings and got bugs in my eyes, but perhaps the most persistent of these was Patellofemoral Pain Syndrome (PFPS) also known as runner's knee.

I will describe PFPS in the best way I can. After running for more than 8 miles, my left knee would start to feel like it was seizing up, like the joint was rusting somehow and it was painful to bend the knee. This soreness would remain well after the exercise stopped and be exacerbated by having my feet raised with my knee straight.

To be honest, bending my knee after a period of rest was agony and the discomfort would last days.

I've suffered from this before and with a little rest it has gone away, I've also gone through extended periods of running with no issues but this time was different. I have a 100km race in 10 weeks time and as well as rest I needed to come back stronger than before. My goal was to build legs that could take all the damage that running could throw at it and still keep going. If the issue flared up again I wouldn't have time to recuperate and complete the training necessary for the event.

So I turned to RunningPhysio aka @tomgoom. After a lengthy Twitter conversation, Tom made me realise that the trick with recovery isn't to rest and then make the same mistakes again, rather it is to identify the issue, rest the injury and recover with exercises that will strengthen and condition the affected area to prevent it happening again.

This may seem obvious when you're reading this, but so often in fitness or sport we train in the same way and expect a different result. There is a concept in exercise known as specificity, it refers to the fact that the body will adapt “specifically” to a repeatedly applied stress.

In bodybuilding, if you continually increase the weight you are moving, the body will adapt to match the increased demand, building muscle strength and size. In running, if you increase your pace, you body will adapt and allow you to run faster. Genetics being a limiting factor in this, if you train properly and with structure, you can see specific improvements in any given area.

Rather than repeat previous mistakes, I devised a plan which would allow rest, active recovery and (when appropriate) strengthen and condition the area to prevent it happening again. I won't go into the details here as the training plan was lengthy and cumbersome to read, but I identified the muscles and connective tissues that were presenting as the weakness and trained them specifically to reduce the risk of recurrence of the PFPS.

I chose a programme that increased flexibility and strength in my hips, particularly the gluteus medius (which was disproportionately weak compared to the other glutes) as well as quads, hamstrings and hip flexors. The programme started with reduced range of motion in the knee to start with so as not to aggravate the issue and steadily increased in resistance and range.

Rather than doing the same thing as before and expecting a different result, I did the following;

Identified the problem,

Rested the affected part,

Reconditioned it and the surrounding and postural muscles and

Came back stronger than before.

After two weeks I was able to run pain free. After a further two weeks I started a 20 day run streak with distances varying from 2 to 16 miles, with no issues at all. I genuinely felt stronger than ever and my running form was improved.

I'm now well into my training for the ultra marathon and keen to run more. You never know when an injury will occur, but you can do a lot to reduce the risk of injuries that can plague you as a runner.

Running is a great sport, it keeps you fit, it gets you outdoors and it opens you to a whole world of new experiences and people. But if running is your goal, my recommendation is this; train the rest of your body to support it.

Running alone does not a good runner make.

 

Follow Dan on Twitter via @DanRunning

 

 

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8 Responses to Beating Runner’s Knee – by Dan Cartwright

  1. Greg May 12, 2014 at 8:57 pm #

    Brilliant – I need to take this advice.

  2. Connor June 21, 2014 at 12:37 am #

    Thanks for the article Dan! I am in a very similar situation to the one you found yourself in. Is there any chance you could post or email the program you developed? My issue is the gluteus medius as well. If you do not have it in a digital format then don’t sweat it. Thanks!

  3. matt November 19, 2014 at 10:13 pm #

    Great advice Dan Im in similar situation and have rested kneed for 4 weeks so just doing cross trainer and bike with a bit of running. What was your programme so can give a try as I really love running and hate it when I cant run.

    Cheers

    Matt

  4. Nicole November 25, 2014 at 11:16 am #

    Hi Dan,
    I seem to ve experiencing similar difficulties in my right knee. I love running and can’t imagine not being able to run distance but at the moment I can’t make ot a few kms without it niggling and my knee hurts throughout the day as well. Would you be able to wnd me your training plab or could I purchase it. Or should I see a physio to tailor a plan for me?
    Thanks for your article, Nicole

  5. Ashley April 17, 2015 at 3:25 am #

    Hi Dan, I was wondering if you could share your plan to recovery with me. I was diagnosed with runners knee and the dr. told me to rest and go for PT. it has been over a month and I am not seeing much improvement. I was told recovery could take up to a year. I’m dying to get running again especially since the weather is getting nice. My hamstrings were very tight and I have been stretching them everyday. Any other advice on exercises you think worked best for you?

    You’re article is seriously the most inspiring and shows there is hope. Many others are very discouraging. Thank you for sharing your story.

    All the best,
    Ashley

  6. Alan August 11, 2015 at 10:46 am #

    Dan,
    I have decided to ‘tick the box’ and do an ultra – 56kms. I have done 6 marathons and currently do approx. 13 miles on our long run. However, I know I have a problem with runners knee and I want to do as much training as possible to a point where the knee will not be a problem. Would it be possible to get details of the exercises ( or guide me to where I could find them) you found beneficial so I could strengthen the area and hopefully avoid injury.
    Many thanks

  7. Chris Johnson October 26, 2015 at 10:14 pm #

    Good stuff Dan & Tom!

  8. Daniel Cortes November 18, 2015 at 4:01 am #

    Dan:im’ 51,i’ve been very active fiscally all my life,i wasn’t built to run,how ever i use to run recreationally combined with heavy pedaling in my indoor trainer ´cause i ran triathlons too.After running the Miami marathon jan/15 i was diagnosed with Condromalasia or better called the runners knee,my right knee cartiladge was ripped a little,level 3 and had arthroscopy.My other knee started to hurt right away and my hips too,my quads are gone and this recovery process has been hell.My running and cycling days are over,unfortunately.My knees hurt and i could become eligible to a partial or total knee replacement within some years.I want to avoid this situation in the future at all cost.After seven months of operation my knees range of motion is limited and doesn’t feel right.I just want to walk normally again and avoid future trouble.Can i have your advice´ Thanks Daniel

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