Knee injuries are commonplace among runners but they don’t have to be. By building the right foundations, you can run free from knee pain – so long as you know what’s causing it. 

The most common issues that runners come to osteopath Nadia Alibhai for help with are knee injuries. That won’t come as a surprise to most of us – we’ve all seen people hobbling along with their knees strapped up. It’s also the reason why many people don’t run in the first place, despite the fact that good running is known to improve knee strength and has the capacity to actually reduce knee pain. 

But clearly, there is a link between painful knees and ‘poor’ running. A former runner herself, Alibhai points first to the fact that many of us have spent the past couple of years sitting for longer than usual. “After hours of sitting down, your hip flexors get tight. Then, these desk workers head out for a run after sitting down all day, they haven’t warmed up enough and all of a sudden, they have anterior knee pain.”

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Of course, lots of people would argue that they had painful knees when running way before working from home was a thing – and that, Alibhai says, is probably because of muscular imbalances.

If you run with your knees slightly tilted inwards, getting shoes with the right arch support won’t stop you from being in pain. To really work towards pain-free running, you need to start working on strengthening your gluteus medius and maximus. Strengthen those, and you’ll find that your knees will start to open back out.

“If you’re finding that you get anterior (front) knee pain when you run or the morning after a run, it’s time to focus on rehab. When I work with runners who have sore knees, we focus on isometric muscle strengthening – really basic stuff like where you’re lying in bed, just lifting your leg up and down without moving the whole body.

“The knees take so much impact during a run, so we need to make sure that the stability is there.”

You see, that frontal knee pain isn’t about the knee itself – it’s about all the other stuff on that side of the body being underactive. To correct and get rid of pain in your knees, you don’t actually have to work on the knee joint at all; you need to work on the stability and strength in your hips, glutes, quads, hamstrings and core. “If you work on those four areas away from your runs, you’ll start to float through the miles!” Alibhai says.

It’s not just strength training that can make a difference; stretching is also important. “I find that a lot of people, when they’re riding on that endorphin rush at the end of a run, think, ‘Oh, I feel great, I’ll just crack on with my day.’ They never stretch!”

Stretching after a run might seem pointless – you’ve already done the impact stuff – but you want to balance out strengthening with stretching so you can go from what Alibhai calls ‘thud, thud, thudding’ to soundless, easy strides.

Running, she says, can be “amazing” – if you strengthen the right areas. “But if you don’t, it can be one of the most damaging sports.”

When we run (particularly if you run in a town or city), we don’t just go forwards; we have to nip around buggies and couples, tiny dogs and bends in the pavement. Your knee needs to be able to go with all of those dynamics, changes and shock. It’s not enough to be able to go up and down – it’s about getting different angles involved. That might mean doing some pre-run drills as part of your warm-up – lateral lunges, sideway swings, cossack squats.

Running can be amazing if you strengthen the right areas but if you don’t, ‘it can be one of the most dangerous sports’

Let’s go back to Alibhai’s key point: all runners need to focus on strengthening their glutes.

“I watch runners and walkers, and I see a lot of women who run with very poor glute activation. And that’s when you can see the pelvis has kind of tilted forward. I know they must be in some serious pain and the fact that they’ve often got their knees taped up with support aids suggests that they’re willing to go through that pain just to get the incredible endorphins that running provides. My main concern, however, is the damage they’re doing to themselves and their joints.”

To run well, she says you need to: “Keep yourself supple – move. Increase your mobility, increase your stretching and increase the surface area of the muscle; when the surface area of the muscle is increased, so is the power of that muscle.”

She uses the example of bodybuilders. They may look huge but when it comes to throwing a punch, they might not have as much power as you’d expect. Martial artists, on the other hand, tend to be much smaller but they have a lot more force going through every punch. “It’s the same concept with running – you want to increase the service area and then strengthen it.”

Nadia Alibhai’s knee pain plan for runners

Dynamic stretching pre-run:

Knee-to-chest stretching

1. Standing on one leg, hugging one knee into the chest.
2. Switch to the other side

Leg swings facing forward

1. Standing on one leg, swing the other to the front and back
2. Switch to the other side

Leg swings facing sideways

1. Standing on one leg, swing the other sideways – out to the side and across the front of your standing leg
2. Switch to the other side

Dynamic stretching post-run

Cobra 

1. Lying on your front, place your hands underneath your armpits
2. Extend the arms to push your upper body and pelvis away from the floor
3. Keep the shoulders relaxed and look straight ahead
4. Slowly bend the elbows to lower back down

Sphinx

1. This time, lie on your front and raise your chest to place your forearms on the ground with elbows bent to make a right angle between your upper and lower arms.
2. Retract the shoulders and look up – this time the pelvis stays on the mat
3. Slowly lower the chest and head down

Supine twist

1. Lie on your back with your legs straight out in front of you
2. Bring your right knee into your chest and slowly guide it to drop over to your left – keeping the left leg on the ground
3. Look over to the right and feel the twist in your lower back and glutes
4. Hold for a few seconds and repeat on the other side

Strengthening exercises

You don’t have to do these all at once but try adding three or four to your strength and conditioning sessions. Wall sits are something you could do while brushing your teeth – you don’t have to be in the gym to get stronger. It’s the same with clamshells; why not try to do a minute on each leg while lying in bed in the morning?

Split squats

1. Holding your dumbbells, stand with feet hip-width apart. 
2. Take a step forward with your right leg, pause, and then bend both legs so that the left knee touches the mat
3. Repeat eight times with the right leg in front, then swap to repeat on the left

Ankle hops

1. Stand with your feet shoulder-width apart and come up onto your toes
2. Jump a couple of inches off the ground without pausing when you come back down 
3. Maintain a very small bend in the knees while jumping and don’t let your heels touch the ground all the time you jump
4. Go for 20 reps, rest for a minute and repeat

Single leg press

This is the one move that requires you to go to a gym and use the leg press. If you’ve never used one before, ask one of the trainers on the gym floor.

Lateral lunge with weight

1. Holding your weight and standing with feet hip-width apart, take a big step out to your right
2. As you do so, bend that right knee while keeping the left leg straight
3. Push your butt out as you come down, as if you’re going to sit in a chair (you’ll know you’re doing it right if your knee doesn’t come over your toes)
4. Push back up to standing
5. Repeat eight times on the right, then swap to the other side

Wall sits

1. Start by standing against a wall
2. Take a step forward, keeping the spine and head on the wall
3. With your arms down by the sides, bend the knees to make a 90° angle and reach the arms forward
4. You should now be ‘sitting’ against the wall
5. For an extra challenge, try to lift one leg out, then repeat the other side

Clamshells

1. Lie on your left side with your hips and knees bent at 45°
2. Stack your right leg on top of your left leg, heels together
3. Keeping your feet together and left leg on the floor, raise your right knee as high as you can without your heels coming apart
4. Pause, then return to the starting position
5. Go for 10 reps on that side, then switch 

Tall kneeling to standing

1. Holding the dumbbell in your right hand, come onto your knees
2. Lift that weight into the arm, keeping the arm straight 
3. Engaging the core, bend your left knee to begin to stand – keeping that weight in the air
4. Once standing, return to the starting position – leading with the left leg
5. Repeat eight times on that side before switching, this time leading with the right and holding the weight in the left arm

Build stronger glutes with the Strong Women Training Club four-week Strength Training for Runners plan.

Images: Getty

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