BACK TO THE BASICS: REAL FITNESS RESULTS – Apr 19, 2016 – Jogging – Reasons for knee problems in runners and how to fix it By: Adam Neufeld, MSc, PTS Running has many physical and mental benefits. It produces large releases of “feel good” endorphins in the body, improves cardiovascular functioning and endurance, can help with weight loss; not to mention that having a strong aerobic base largely improves individual capacity when lifting weights. However, let’s face it… if you’re a runner, you’ve likely experienced issues with feet, ankles, knees, or hips. Due to running mechanics, the knees generally produce the most movement, compared to hips, in this upright form of exercise. When issues present at the level of the knee(s), it’s often a symptom of a problem originating somewhere else (foot, ankle, glutes, etc); not the cause. This article will focus on the “why” and the “how” of this issue. CORE First, running technique is paramount to proper mechanics and performance, and improper technique can lead to excess strain, or shear forces, on joints and working muscles. Since jogging is generally fairly low intensity (and can even be somewhat relaxing), there’s a common tendency to disengage the core muscles of the abdomen, through which we transmit energy to our peripheral muscles. In fact, most if not all joint issues that stem from cumulative bouts of running are due to improper core activation. “Core” refers to the abdominal muscles, obliques, lower back (spinal erectors) and to some extend our upper back (lats), and surrounding musculature. Since the core muscles’ function is primarily to transmit force (energy) from our lower body to our upper body, and vice versa, it stands to reason that a disengaged trunk will lead to faulty energy transmission, and excess torque on our major joints (hips, knees, ankles). Scientific data does, in fact, exist to support this theory, and suggests that improving core activation and abdominal strength, while practicing mindfulness and focusing on technique, when running, can help to fix some of these issues. “Flexing” the abdominal muscles while running can dramatically improve not only posture, but power generation, stride efficiency, and recruitment of the glutes, which are also key to proper knee stability. GLUTES The second most common reason runners have knee problems is due to inactive (and/or weak) glutes; specifically the glute medius. Glutes and hip abductors tend to go dormant during long bouts of sitting, and for many people, these muscles are often weak and overly tight. The glutes are such big, important muscles, in hip function, that without proper glute firing, proper running mechanics are significantly reduced. The quads are forced to work overtime to stabilize the knees, and since they can’t perform this task alone, they tighten up and pull on our iliotibial bands (IT bands), to reduce the strain. The result is chronically tight hip flexors, tight IT bands, and achy knees. Sound familiar? Now, interestingly, the glute max is basically asleep when walking, but is highly activated only when running. However, running in itself, is not enough to stimulate proper glute firing, since these muscles needs to be strengthened directly. SUMMARY Joint problems from running generally stem from improper core activation during running, weak or dysfunctional glute firing, and/or poor running mechanics, compounded by inflexibility and long hours of sitting. Since a lack of muscle activation, strength, and flexibility (length) can all lead to reduced joint mobility and movement quality, it shouldn’t be surprising that running also increases joint stress and can produce eventual dysfunction. This type of dysfunction may cause muscle injury through cumulative strain, or lead to aches and pains, and inflammation. Unlike the hips, which have more muscular support and stability, the knees take an extra beating, and have to support us through their connection downward from the trunk, and upward from the ankle. Whether it’s plantar fasciitis, shin splints, ankle or knee problems, or hip/low back pain, start working to correct, from the feet up! WHAT TO DO Do an inventory checklist (ankle function, Achilles tendon, hip tightness, glute activation, abdominal strength, etc.), and try and determine where you might have areas for improvement. 1. Technique When running, flex abdominals and drive “through” the glutes by driving knees upward on each foot strike, off the ball of foot. If you need practice, consider using a weight sled (see video here: https://www.youtube.com/watch?v=Ib9O1kD6bUI) 2. Flexibility If you’re chronically tight everywhere (stretching enough?), your body will eventually let you know. If calves and shins are tight, ankle function is reduced, and produces excess force on the knees. If hips and glutes are tight, again the knees usually take the extra stress. Stretch your hip flexors, calves, shins, and hips, regularly. If you’re already stretching and are still having issues, consider specific soft tissue work (SMR – self-­‐myofascial release), and do this regularly for the feet, calves, quads, and glutes. Try using a tennis ball, lacrosse ball, or foam roller, and focus on rolling tender areas to improve blood flow and movement quality. Just make sure your glutes and abs are strong, too, since SMR is a maintenance technique, not a quick fix! Simple YouTube searches for stretches can help elucidate technique. For increased flexibility and overall joint health, look at doing Joe DeFranco’s “Agile 8” or “Limber 11” routine, once to twice per day, and as your warm-­‐up, prior to running, or strength training. See these routines here https://www.youtube.com/watch?v=3B-­‐3Khbht5s and here https://www.youtube.com/watch?v=FSSDLDhbacc 3. Strength Work As mentioned, the glutes function primarily to extend the hips and stabilize the knees, and thus it makes perfect sense to work on activation and to strengthen the glutes. Often people struggle to “feel” or contract the glutes properly, so getting good at activating and flexing them is key. If you have a desk job, simply stand up every 30-­‐45min and give your hips a stretch, and glutes a hard squeeze. Try performing simple side lying leg-­‐raises (laterally). If the muscles in your upper outer glutes fatigue very quickly, you may be on the right path to helping your knees, since the glutes’ main function is hip extension and knee stabilization. Be careful not to let your hip flexors take over the movement, since they’ll want to kick in to reduce the discomfort or fatigue. Do this by keeping your feet pointed straight and slightly down. If these muscles fatigue quickly, consider doing 2-­‐3 sets of 12-­‐20 reps several times per week, especially before running, and you ought to notice an improvement in your knees. Since running involves triple extension (extension of ankles, knees, and hips), focusing on exercises that mimic hip and knee extension. Targeting the glutes, hamstrings, and lower back makes a lot of sense, toward this end. Generally speaking, runners are quad dominant, and activation of the posterior chain of muscles can go a long way to improving performance, and eliminating imbalances in the body, front to back, while reducing the incidence of muscles tears during running sports. Examples of these exercises include the back extension, deadlift, romanian deadlift, hamstring curl, hip thrust, and glute bridge (single and double leg). See proper glute exercise techniques here https://www.youtube.com/watch?v=Q7NiX692EBc and here https://www.youtube.com/watch?v=ikQ5Jrez9WQ&list=PL8FAA3928DE739DD4 Lastly, strengthen your anterior core muscles and abdominal muscles. Use exercises that promote neutral spine and abdominal activation, like the “supine dead bug” (https://www.youtube.com/watch?v=rbemelnkHag), and abdominal exercises that promote anti-­‐
extension – think planks, ab wheel or TRX fallout (https://www.youtube.com/watch?v=swi-­‐
lBfEBvU; https://www.youtube.com/watch?v=tVYg6qAntf4). *Note: squats are not included in this list, since they somewhat target quads, and these muscles are generally over-­‐developed in runners, in proportion to their hamstrings. However, proper low-­‐bar barbell squats are also very effective for posterior muscle recruitment and strengthening. Hope this helps, and thanks for reading!