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.

Diastasis Recti: Treatment and Exercises

Photo: miraclephysicaltherapy.com

Diastasis Recti is a condition that many pregnant women experience, including me, being pregnant three times in the past four years. So here are some exercises to treat Diastasis Recti. You may begin these exercises after pregnancy, once your OB advises. They go in order from easiest to hardest. Only perform #1 and #2 if your separation is >2 cm. Once it decreases below 2 cm, you can progress to #3 and beyond, progressively. Technique is everything, so follow all instructions carefully.

1. Mini Abdominal Crunches: Lie on your back with your knees bent. Cross your hands over your abdomen so your hands can push your rectus abdominus inwards toward the belly button. Exhale and slowly lift only your head, but not so far to see a bulge (diastasis recti). As you perform the head lift, gently push the hands inwards. Then slowly release the head down and rest. Repeat 5-10 times. Then progress to 15-20 repetitions over the next few days. Finally, progress to 25-40 repetitions. Do this for several days, and check the amount of separation of your Diastasis Recti. If the separation is improving, the exercise is getting easier, and you can perform 30-40 repetitions at once, you may be ready to progress to #2. The photo shows a towel being used to pull inward, which is an alternative to using your hands to pull.

Photo: getactive.com

2. Mini Crunch/Pelvic Tilt: Lie on your back with your knees bent. Cross your hands over the abdomen as in #1. The mini abdominal crunch with arms pulling inward is the same as in #1. But this time add a pelvic tilt concurrently. To do so, tilt your pelvis backward so your abdomen is drawn in and your back is flattened out (likely you recognize this from early pregnancy exercises). Exhale as you do the pelvic tilt. Then lower your head slowly, and finally release the pelvic tilt. Repeat 5-10 times. Progress to 20, then 30+ repetitions. Only progress to #3 if your separation is <2 cm and has been improving as you have done #1 and #2.

Photo: http://www2.nau.edu

3. Pelvic Tilt/Heel Slide: Lie on your back with knees bent. Perform a pelvic tilt (flatten out your back) and maintain it. Slowly slide one foot forward (making the knee straighter) as far as you can while keeping the pelvis tilted backward, then slowly return the leg to the starting position (still keeping the pelvic tilt), and repeat with the alternate leg. Every time you extend one of your legs, exhale. Repeat 3-5 reps on each leg. Progress to 5-10 reps on each side. Increasingly do 5-10 additional reps until you can do a total of 30-40 reps on each leg with full range of motion (knee becoming fully straight) and, of course, a proper pelvic tilt throughout.

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4. Pelvic Tilt/Double Heel Slide. This is the same as #3 but performed with both legs sliding forward together. It is significantly harder than #3, so only progress to this exercise if it can be done with a maintained pelvic tilt throughout. Hold the pelvic tilt and slide both feet forwards, but not so far as to lose the tilt. As you get stronger, your range of heel slide will progressively increase. Practice slowly and exhale as you extend the legs. Then slowly return both legs to the starting position. Repeat 5-10 reps. Progress to 10-20 reps, then 20-30 reps.


Reference: Kisner C, Colby LA. Therapeutic Exercise; Foundations and Techniques, 4th ed. Philadelphia: F.A. Davis Company. 2002. Page 695.