Knee Pain From Jogging

IT Band and Knee Pain:

If your pain is in the lateral or outer part of the knee (not the front nor within the joint) and feels muscular, then it may be coming from your IT Band. In this case, here are your guidelines for jogging.

1. Warm up for 5 minutes (fast walk, bike, etc).

2. Stretch for 5 minutes, including a lot of IT Band stretches. Hold each stretch for 20-30 seconds and repeat 3-4x for each leg.

3. Start jogging on a flat surface and at a slow-moderate pace. 

4. If you feel IT Band pain while jogging, you may need to stop and stretch.

5. Do not increase your pace, distance or frequency until you can do so without increased pain.
6. Stretch the IT Band after workouts and throughout each day.

For example, you may be able to jog 20 minutes, 3x/week without increased pain. Try to increase by 3-5 minute increments to see if you can tolerate more. Do not push through pain in order to maintain a certain pace or distance. In that case, you would continue to worsen the problem instead of giving it a chance to heal completely. The goal with jogging is to slowly progress in order to do so without pain. 

Pain in Knee Joint: Book for Self-Treatment:

If your pain is within the knee joint, I recommend a book called Treat Your Own Knee by Robin McKenzie. It will teach you which knee movements may treat your pain and which movements to avoid.

Knee Strengthening to Prevent Knee Pain:

Joggers need to do leg strengthening in addition to jogging. You should spend at least 1-2x/week doing strength training for the lower body including all major muscle groups. One of the single best exercises to stabilize the muscles surrounding the knee is Straight Leg Raise. Lie on your back with unaffected knee bent. Straighten your knee (of painful leg) and slowly lift the entire leg ~10 inches and slowly lower (keep knee straight the whole time). Repeat 3 sets of 8-15 reps. Once you can do 3 sets of 15 easily without weight, increase resistance by using an ankle weight. Progress slowly in 1-lb. increments.

Photo: celiajohnsononline.com

Cross Training To Prevent Knee Pain:

Frequently, knee pain can be prevented by cross training. If your goal is cardio exercise, replace 1-2 jogs per week with another form of cardio. I highly recommend biking, swimming, or cardio workout machines. Of course, there are various other forms of cross training such as strength training, plyometrics, flexibility, interval training or various sports.

Jogging Modifications To Decrease Knee Pain:

1. Jog on grass instead of roads/sidewalks.

2. Decrease distance. For example, instead of 3-4 miles each on 2 consecutive days, do 2 miles every other day.

3. Modify shoes using inserts, orthotics or a new type of shoe.

4. Decrease speed. Lower your pace and see if it changes your pain.

5. Try interval training in order to increase your power without having to do as long distances in order to achieve an excellent cardio workout.

Postpartum Jogging and Knee Pain:

After pregnancy, it may be challenging to get back into jogging, especially if you are having knee pain. Your knees may not be ready yet to return to 3-4 miles, as the ligaments are still lax from pregnancy/childbirth. Progress very slowly as your body tolerates. If you are first returning to jog since having a baby, try 1/2 or 1 mile of walking/jogging. Jog for a bit but stop and walk as needed (keep a moderate to fast walking pace). Once you work up to jogging for a mile with no walking needed, increase to 1.5 or 2 miles of walking/jogging. If it is painful, decrease your jogging intervals. Slowly, as your knees tolerate, you should be able to jog more and walk less. But do not push through moderate or severe pain in order to jog a certain distance or speed. 

Always consider why you are jogging. If for weight loss, there are alternate exercises that you can do, so find one that is not painful. If for exercise outdoors, try biking instead. If for alone time/mom's sanity, join a gym with good childcare. If for specific race preparations, take a longer time to train. If you continue to injure your knee, you may have to stop jogging completely, so it is better to treat and prevent the pain than to jog through it.

Best Book for Self-Treatment of Painful Joints

Do you have joint pain that you cannot afford much medical treatment for? Robin McKenzie, a world-famous Physical Therapist and bestselling author, wrote a series of books about self-treating pain in various joints. I would highly recommend any of these if you have pain but cannot afford much therapy or other treatments.

Treat Your Own Back
Treat Your Own Neck
Treat Your Own Knee
Treat Your Own Shoulder

There may be various editions of these. I would recommend looking at Amazon or other websites to find the best prices, but you should be able to purchase one for $10-$15.

For more of McKenzie's exclusively-designed products such as lumbar rolls and pillows, check out OPTP.com.

Of course, if you have serious joint pain that is not resolving, please see your physician and request a prescription for Physical Therapy.

Do High Heels Affect Knee Pain?

Photo: State Library of New South Wales

Yesterday I took advantage of the perfect, Spring weather to play in the backyard with my daughter, and we ended up pulling weeds. So much for playtime, but for a 2-year-old it counted as fun. I was careful, of course, about my body mechanics for back safety. But in the process, my knee started hurting (I do not have any knee problems). As a PT, my first thought was: "what exercise can decrease my pain?" I sat on the floor with my leg extended in front of me, and I gently pushed down on my knee (into a straight position; AKA knee extension) and repeated ten times. Unfortunately, it did not help.

Afterward, I decided to wear 3-inch wedge heel flip flops because they felt better on my knee than my flat ones. Without time to explore further exercises, I continued my busy day, of which the next activity was to take my kids to Monkey Joe's for a birthday fiesta. Monkey Joe's is the ideal playhouse for kids over age 3-4, but most of the bounce houses and slides are too big for my daughter, so I had to accompany her on all of them. By the way, if you ever do so, be sure to wear socks (I regret being barefoot on the slides)!

Amazingly, at the end of the day, my knee no longer hurt! There are two possible explanations: my heels or my activity level at Monkey Joe's. Please understand that I would not usually recommend someone to do that much climbing when experiencing knee pain because it usually aggravates the knees. But one of those factors or the combined effect was surprising for my condition. Remember that my heels were not excessively high nor thin but a wedge. Also, my knee pain was mild and new. Chronic or recurrent knee pain likely would not respond the same way.

What is your experience with wearing heels and knee pain? Please share in the comments section for everyone's benefit!

The Best Single Exercise For Knee Pain

If you have knee pain of almost any type, one of the first exercises you would learn in Physical Therapy is a Straight Leg Raise (SLR). This exercise is done to strengthen the quadriceps muscle (quads) of the thigh and to provide stability for the knee joint. An added benefit is that it also strengthens the hip flexors (muscles on the front of hip). 

The following link (~30 second video) shows a modification of the Straight Leg Raise. It is performed with the leg rotated outward, which emphasizes the medial or inner part of the quads muscle (VMO). 

http://www.youtube.com/watch?v=OmB1ck20IfA

With a basic Straight Leg Raise, you first bend the knee of the good leg to keep your back safe and comfortable. On the affected or painful side, straighten the leg completely and lock the knee. This is an isometric contraction for the quads muscle (quad set). With the knee straight, slowly raise the leg up about 10 inches, hold it for a few seconds, then slowly lower it back down to the surface. Repeat at least 10 times and work up to 30 repetitions by practicing a few times daily. Once you can do 30 reps, add a 1-pound ankle weight and practice with that resistance until you can do ~30 reps without stopping. Then progress similarly, 1 pound at a time, until you get to 10 lbs (it should take you 2-4 weeks if you do it 2-3x daily).

This can cause fatigue or strain to the front of the hip, so do not progress too fast if you are getting pain or discomfort there. It is important to do the exercise slowly in order to use muscle control and not momentum. Also, do not raise the leg too high, which would draw in other muscle groups. Do not forget to keep the knee locked the entire time. 

For resistance ideas, you can use adjustable ankle weights, which range from 1-5 or 1-10 lbs and have removeable 1-lb weights. You could also use resistance bands, starting with light resistance and slowly progressing to harder ones. However, I recommend ankle weights more than therabands for this exercise so that you can keep your good knee bent. 

The time I needed PT

I knew I wanted to be a PT since high school. But in college I actually needed Physical Therapy for knee pain. Every time I ran, the back of my knees would hurt during the run and afterward. I actually had to stop running because the knee pain made it hard for me to climb stairs. I lived on campus at King College (a small school in Bristol, TN), where I had to walk and climb stairs a lot.

So I saw a PT here in Columbia on one of my breaks from school. He showed me several exercises, and as I did them for the next weeks-months, my pain progressively decreased. However, I was afraid of the pain returning, so I stopped running completely. At the gym I did the elliptical machine instead, which did not bother my knees.

I went through the rest of college and grad school without returning to running. I did other forms of cardio but stayed off the treadmill. Several years later, I finally decided to try jogging again. Everything I learned in PT school kept me from having knee pain. I learned how to warm up, do the right stretches and avoid hurting my knees again. So now I can jog regularly without pain! I actually do the treadmill now much more than the elliptical.

All this is to say that PT works! If you have an injury or frequently painful area, find a good PT near you! But ideally, you can learn how to think like a PT now to prevent future pain.

Gym workouts and PAIN risks

It is January, so of course the gym is maxed out with new members. So whether you are new to the wellness center world or a veteran, here are some INJURY RISKS I have seen.

1. Doing squats/wall squats with wrong technique. This can cause knee pain if your knee position is wrong consistently. When you are in the squat, be sure that your knees are behind your toes. Imagine a vertical line from your toes upwards. Your knees should remain behind that line the whole time you squat.

2. Using the treadmill if you have a limp. I love working out on the treadmill, but it is not for everyone. If you have a leg or back problem which causes you to limp, a different cardio exercise would be more appropriate for you, to keep you from further injury (especially to your back).

3. Pushing through injury pain in order to complete your workouts. You can safely push through the discomfort of muscles being challenged in new ways. Just be sure you know which muscles are being strengthened with each exercise. However, some pain is not your usual workout discomfort. It is actually an injury or the start of one. In that case, you could end up needing PT.

4. Doing inappropriate exercises for your age. For example, I recently saw a fifty-something-year-old doing single leg plyometrics (jumping drills) toward the end of the workout. Plyometrics are meant to be sports-specific and age-appropriate, and they should be done at the beginning of a workout.


Keep up your hard work, and be wise in your workouts! God bless you!

Why is KNEE PAIN so common? Part 2

Knee trauma can be prevented with increased caution in these areas.

1. When you are standing up from a low surface, do so slowly. 

2. Avoid standing up and turning at the same time. 

3. Add leg stretching and strengthening to your exercise routine. 

4. Be very careful getting on/off the floor. 

5. Avoid leaning forward excessively if your knees are straight (example: reaching into the back seat of your car). 

6. Do all that you can to prevent falling! Stairs and bathrooms are higher risk areas. 

7. Be more cautious when you stand on step stools, chairs and ladders. Be cautious as you get up and down from those as well.

8. Do not stand on any surface that is questionable (ex: standing on a book shelf in order to install a curtain).

9. If you play sports, do specific exercises to prepare yourself. Warm up well before you start practicing or playing. Stay warm during your breaks (ex: baseball, football).

10. Listen to your body. If your knees start hurting when you are exercising, take a break from the painful exercise. Do not exercise through an injury because it will get worse.

Why is KNEE PAIN so common?

There are many causes of knee pain, which I will not go into because they are very technical and somewhat boring to talk about. But here are some things to watch out for.

1. Twisting your knee. This can be even more risky if you twist it quickly (sports).
2. Wearing unsupportive shoes. You need shoes with arch support! This is especially true when you will be walking a lot. Do not go cheap on shoes because your body will suffer for it.
3. Not wearing orthotics. Not everyone needs orthotics, but those who do should wear them all the time. If you have one or more of these, you may need orthotics:  flat feet, high arches, knock-knees, bow-legged, pigeon-toes, scoliosis (this list is not comprehensive).
4. Single knee trauma (car accident, fall, sports injury, etc). High risk sports are soccer, tennis, football, etc.
5. Thigh muscle weakness. Here is a simple exercise to get started with strengthening: straighten your leg in front of you (heel of foot can be on the floor). Lock your knee by squeezing/contracting your thigh muscles for 5-10 seconds. Repeat at least 10x.

To be continued!