Runner’s Knee Injury Prevention Training Plan

Runners’s knee is another one of those general terms that are used to refer to a group of symptoms rather than one specific injury. When you hear the term, runner’s knee, you’re probably alluding to a knee injury that is characterized by one or more of the following symptoms:

  • Pain under or around your kneecap
  • Gradual onset of symptoms
  • Crunching or cracking sensation in your knee
  • Knee weakness or tendency to collapse or give way
  • Slight swelling around your knee
  • Pain becomes worse when running
    Pain increased after running downhill
  • Pain worsens after sitting for long periods of time

If you are suffering from several of these symptoms you might have a case of runner’s knee or what is now more accurately called patellofemoral pain syndrome (PFPS).
In the past, PFPS has been called chondromalachia, anterior knee pain and good old runner’s knee. True chondromalachia is damage to the back surface of your knee cap. Chondromalacia has taken the brunt of the blame for PFPS in the past because it has been assumed that the pain of PFPS was caused by chondromalacia’s characteristic deterioration of the back surface of your knee cap. We now know that while chondromalachia is one potential cause of PFPS, most runners with PFPS don’t have any damage to the rear surface of their knee cap. There are several other more likely causes of PFPS that are related to abnormal kneecap tracking caused by anatomical problems, muscle weakness, muscle imbalance or poor flexibility.

The most common anatomical cause of PFPS is something called a “Q” angle. Your Q angle is the angle of your femur as it travels from your knee to your hipbone. Wider hips result in a larger Q angle which tends to cause your kneecap to mis-track to the outside. Since most women have genetically wider hips than men, this explains why PFPS strikes women more often than men.
There are four primary muscles that make up the quadriceps group on the front of your thigh. These muscles are responsible for extending your knee and flexing your hip. The four muscles are called rectus femoris, vastus lateralis, vastus medialis and vastus intermedius. Your vastus medialis attaches to the inside of your knee cap and places pull up and to the inside. Your vastus lateralis attaches to the outside of your knee cap and pulls up and to the outside. If both of these muscles are in balance you get a balanced, even pull on your knee cap and it tracks properly and smoothly. The problem is that many runners have a vastus medialis muscle that is relatively weak in relation to their vastus lateralis, which results in a stronger pull on your kneecap to the outside. This mis-tracking of your knee cap is a common cause of PFPS.

To help prevent PFPS you ideally want your knee cap to track smoothly and in line. That requires a balance in strength between your vastus medialis and vastus lateralis muscles. You can accomplish that by performing knee extension exercises, squats, lunges and step ups.

Excessive pronation can also cause or aggravate PFPS because your knee tends to rotate inward during excessive pronation. That inward rotation also causes your knee cap to become mis-aligned. So, it is also important to strengthen both your foot muscles and hip abductor muscles to help prevent over pronation.

This strength training plan includes knee extension, hip abduction and foot strengthening exercises that will help keep you away from the misery of PFPS. Don’t forget to consistently include both dynamic warm up drills and static cool down stretches to keep your flexibility up to par.

The Runner’s Knee Injury Prevention Plan

While there are several related causes of runner’s knee, they all come down to two primary issues – a mistracking kneecap and excessive stress on your patello-femoral joint. This runner’s knee prevention plan addresses both issues.

Mistracking Kneecap

A mistracking kneecap is caused by an excessive Q angle, imbalanced or weak quadriceps muscles, poor knee alignment or excessive pronation. While there is little you can do to decrease your Q angle, you can take some steps to minimize the effects of it. The same steps will help you correct muscle imbalances, muscle weakness, poor knee alignment and over pronation. The first step is to increase the strength of all four of your quadriceps muscles. Stronger more synergistic quads will pull more evenly on you kneecap and help avoid mistracking problems. Lower leg and foot exercises as well as hip abduction exercises will decrease your level of pronation, which will help keep your knees properly aligned and also decrease or prevent overpronation problems. Strong hamstring muscles will keep your upper leg strength in balance and help avoid a mistracking kneecap.

Last, but certainly not least, you need a substantial degree of elasticity and flexibility in your hamstring, quadriceps and hip muscles to avoid further muscle imbalance problems.

Excessive Knee Joint Stress

One of my pet peeves are those that say running is bad for your knees. That just isn’t true. It’s a fact that excessive stress during your running stride is bad for, not only your knees, but also your hips and back. But, that excessive stress is cause by stride inefficiencies, not running itself. Heel striking and over striding and the main culprits when it comes to excessive knee joint stress. You can avoid or fix those stride problems by tweaking your stride mechanics and improving the strength in your lower legs and hip abductors. Your hip extensor muscles also play an important role in decreasing stress on your knees because they both help absorb the stress of your foot strike and assist in the push off, or more accurately, your bounce off phase of your running stride. Strong core muscles help maintain stability in your stride and further decrease knee joint stress.

Exercises Included

Here is a list of the exercises and drills included in this plan.

  • Quadriceps Exercises
  • Single Straight Leg Lift
  • Two Leg Bench Knee Extension
  • One Leg Bench Knee Extension
  • Knee Extension Step Downs
  • Downhill Running
  • Hip Extensor/Hamstring Exercises
  • Lunges
  • Walking Lunges
  • Side Lunges
  • Reverse Lunges
  • Stride Lunges
  • Squats
  • Single Leg Bench Squat
  • Balance Squat
  • One Leg Squat to Stride Up
  • One Leg Squat to Power Up
  • Extended Leg Squat
  • Bench Step Ups
  • Bench Stride Ups
  • Lower Leg/Foot Exercises
  • Alphabet Drill
  • Towel Pull
  • Heel Walking
  • Lateral Foot Walk
  • Medial Foot Walk
  • Barefoot Strides
  • Hip Abduction Exercises
  • Fire Hydrants
  • Fire Hydrant Wrap Arounds
  • Hip Shrugs
  • Hip Rolls
  • Hip Roll Strides
  • Bench Hip Abduction
  • Core Exercises
  • Basic Plank
  • Intermediate Plank
  • Advanced Plank
  • Flexibility Exercises
  • Hamstring Stretch
  • Quadriceps Stretch
  • Piriformis Stretch
  • Pretzel Stretch

Stride Mechanics

There is no doubt that over striding is the most common running form flaw among distance runners. I have coached many hundreds of runners during my career and over 90% of my clients tended to over-stride when they came to me. Over-striding is caused by reaching out in front of your center of gravity and landing on your heel. Over-striding causes a number of problems related to both performance and injuries with runner’s knee and other knee injuries leading the list.

Over-striding causes you to land heavily on your heel. This places a lot of impact stress on your heel. That impact stress also affects your knees, hips and upper back. This is one of the primary causes of runner’s knee. A heel strike also promotes more foot pronation that knocks the alignment of your hips, knees and feet out of whack. That misalignment places excessive stress on your knee and causes significant knee cap mistracking.

To avoid or correct over-striding, concentrate on landing on the ball of your foot with your foot directly under your center of gravity. This will allow you to maintain most of your forward momentum. You should feel as if you gliding smoothly along the ground with little impact or vertical motion. Try to take quick shorter strides. You do want to maximize your stride length, but you want to do that by increasing your “air time” or time between foot strikes, not by reach out in front of your body. Try to take at least 90 full strides per minute. If you fall below that level you may be over-striding.

Before and after foot strike you should be dorsi-flexing your ankle. You are dorsi-flexing your ankle when you pick up your toes. This does two things to help you avoid over-striding. It prevents you from “toeing out” or pointing your toes towards the ground. Toeing out causes you to reach out in front of your body and over-stride. Dorsi-flexing your ankle also puts your feet, knees and hips in the proper position to take full advantage of their elastic energy potential.

*This injury prevention plan is adapted from “Bear Naked Strength Training for Distance Runners”, by Rick Morris

This runner’s knee injury prevention plan is presented to you below in PDF format. You can view the pages using your scroll bar or the PDF viewer controls at the bottom of each page.



Runner's Knee Prevention