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.

SHIN SPLINTS: Can They Be Prevented?

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If you are a runner and have experienced SHIN SPLINTS, you know how painful they can be and how much they can inhibit your running. The good news is that they can be prevented, and it is actually much easier than treating them once they occur.

How To Prevent Shin Splints:

1. Warm up well before running. This may include walking, stretching, and/or slow jogging.

2. Stretch your lower legs well before running. Stretch your calf muscle, soleus muscle (lower part of calf), and the front of your ankle (by pointing your toes downward/inward and downward/outward). Hold each stretch longer (30 seconds) if prior stretching routines have not been effective.

3. Avoid running on hard surfaces. Find trails, sand, grass, or a padded track to run on.

4. Be sure to wear proper shoes. Replace running shoes every 300 miles.

5. Consider using orthotics (over-the-counter or custom-made).

6. Slowly increase your training schedule, especially if you are new to running or returning after an extended time away.

7. Slowly progress to running on hills.

8. Do not run through shin splint pain!  

9. Do regular ankle Range of Motion and ankle strengthening exercises.

10. Cross train from the beginning of your jogging or running program.

Source: Brotzman SB, Wilk KE. Clinical Orthopaedic Rehabilitation, 2nd ed. 2003: Mosby. "Shin Splints in Runners" (Casillas MA, Jacobs M), pages 522-526.

The 4 Components Of Aerobic Exercise

There are 4 factors in aerobic training: Type of exercise, frequency (# of times weekly), duration (length of each workout), and intensity (how hard you work).

1. The type of exercise you select is important because it must be something you enjoy or at least tolerate regularly. The more you enjoy it, the more you will be motivated to do it! There are endless forms of aerobic exercise, including jogging, walking, cycling, aerobics, sports, cardio equipment, swimming, etc. If you are training for a sport or race, be sure to include sport-specific cardio workouts. It is good to include different types of exercise if possible (for example: walking and cycling).

2. The frequency of exercise depends on what you are training for. If you are starting an exercise program for the first time, you may not be training for any sport or race, but setting your frequency ahead will help you stick to your regimen. Perform your aerobic exercise at least 3-4x/week (or more). Take a rest day after a very difficult, long, or extra-challenging workout.

3. The duration of your aerobic exercise depends on the intensity (#4). If you exercise at a higher intensity, you can work out for less time per session (effective if you are super busy and have only 20-30 minutes/day to exercise). Likewise, a low-intensity workout means you need to exercise longer in each session.

4. The intensity of your exercise can be easily measured by checking your exercise heart rate (in beats per minute). Pending your doctor's recommendation, you should exercise at ~60-80% of your maximum heart rate (220 minus your age). If your intensity is too low, you will not get the most benefit from your aerobic workouts. Be sure to increase your intensity as your aerobic endurance increases (for example, increase average pace from 3.0 miles per hour during week 1 to 3.5 miles per hour during week 2).



Reference:
Baechle TR, Earle, RW (editors). Essentials of Strength Training and Conditioning, 2nd ed. 2000: Human Kinetics. Pages 498-501 (Chapter 21: Potteiger, Jeffrey A. Aerobic Endurance Exercise Training).

How To Prevent Overuse Injuries With Running

1. Cross train with other forms of cardio exercise, such as swimming, biking, etc.
2. Stretch your problem areas (hamstrings, IT band, Achilles, quads, etc). Spend extra time on these targets.
3. Avoid progressing too fast when training.
4. Correct biomechanical problems through bracing, taping and/or orthotics (make an appointment with your physician to determine if any of these are needed).
5. Replace good running shoes every 300 miles.
6. Talk to your physician about metabolic issues (obesity, nutrient deficiencies, eating disorders, etc).
7. Take periodic rest days from running. They can be replaced with strengthening or other exercise.
8. Decrease your amount of running if you are nursing an injury.
9. Change your running surface to grass or a soft track.
10. Increase your fitness, endurance and power by other workouts (intervals, plyometrics, weights, etc.)



Reference:
Brotzman, S. Brent, Wilk, Kevin E. Clinical Orthopaedic Rehabilitation, 2nd ed. Mosby: 2003. p. 522.