Tag Archives: advice

Ask the Osteopath: Runner’s Knee

As an Osteopath especially working in a sports clinic at a Running shop, I see runners come in with knee pain a lot. The most common cause of the knee pain is often Runner’s Knee or Patellofemoral pain.

What is Runner’s Knee?

Runners knee is also called Patellofemoral Pain and is the most common running injury and twice as common than any other running related injury. It is particularly common in runners under the age of 25 as well as in women, Beiser et al (2011). Unfortunately it is often a chronic condition with patients still reporting it 4 years later!Patellofemoral pain is also linked to an overuse injury and more common in marathon or ultra marathon runners, Nielson et al (2013).

What are the symptoms of Runner’s knee?

The pain is normally felt round the front of the knee either underneath or around the kneecap or Patella. The pain is normally when you are weight baring and is often from squatting, going up stairs and of course running. The kneecap is seen as a lever and helps in the movement of the patellofemoral joint, quadriceps and patella tendon, which are all attached to the kneecap, Dixit et al (2007).

What element contribute to getting Runner’s Knee?

There are several different elements that can contribute to developing runners knee these include the balance and strengths of your quadriceps, foot placement and running pattern.

Your quadriceps’ are a group of four muscles at the front of your thigh and the balance and strength of them individually is very important in their function. If one of the muscles say the one at the outside of your thigh is stronger it could cause you knee cap to be pull more towards the outside of your thigh rather than straight down when tense your quadriceps.

The effect of this can increase the pressure and decrease the amount of space in the knee as well as the force at which you foot strikes the ground. These can all contribute to why you experience the pain, Fulkerson & Shea (1990). Research by Cowan et al (2002) points to the outside quad actually starting to work before in the most inner quad muscle when you have this type of knee pain. Furthermore if your inner quad is weak you are more likely to dislocate or have an unstable kneecap, Sakai et al (2000).

You running pattern or gait could be predisposing you to this injury. For more information check out my blog post on the biomechanics of running. It is important to identify, if this is the case as you may need to see a podiatrist or Orthotist for orthotics to help correct this. If you say have flat feet or a low arch it can cause your knee to roll in when you take a step which can cause the outside muscle of your quads to have to work harder to bring the knee back into a neutral position. Furthermore it has also be shown in paper by Kulmala et al (2013) that by changing from landing on the ball of your feet than your heel can also reduce the pain by 15%. Similar studies and results have also been shown from have a smaller stride when you run both affecting the mechanical pull from the quadriceps that can contribute to the pain, Wilson et al (2015).

So I have Runner’s knee, What can I do to reduce the symptoms?

An exercise program is vital to the recovery of runner’s knee or patellofemoral pain. It may be necessary to reduce or stop the activities that are aggravating the pain including running and squat based exercises. This doesn’t mean you have to avoid doing exercise altogether depending on your situation it maybe possible to substitute with swimming or cycling through cross training as an alternative to keep your fitness up while you recovery from the injury. A majority of patients find ice being helpful in reducing symptoms and can be placed on the knee for 4 minutes wrapped up in a kitchen cloth.

An exercise program is vital to the recovery and rehabilitation of runner’s knee or patellofemoral pain. It may be necessary to reduce or stop the activities that are aggravating the pain including running and squat based exercises. This doesn’t mean you have to avoid doing exercise altogether depending on your situation it maybe possible to substitute with swimming or cycling as an alternative to keep your fitness up while you recovery from the injury. A majority of patients find ice being helpful in reducing symptoms and can be placed on the knee for 4 minutes wrapped up in a kitchen towel.

The exercises found in this document are generic for the typical patient with patella femoral pain and may not be suited to every patient’s circumstances.

Exercises for Runner’s knee:

Squat with medicine ball rotation

Squats with Rotation:

Place a ball or foam roller between your legs and as you drop down to a squat position rotation your knee over to the other side. This can be done to both sides or to one depending on your situation

Wall Squat

Wall Squat against a swiss ball:

Place the ball at the curve of your lower back with your hands outreached. Drop down so your knees are at right angles with your knees over your toes and hold for 10 seconds before returning to standing.

Single leg glue bridge

One leg hip lifts:

Lie on the floor with your knees bent. Slowly lift up your hips so it is in a diagonal plane with your knees. Once in this position lift up one leg straight into the air and hold for 7 seconds before returning to the floor.  You can repeat this 5 times and then switch to the other leg and do the same thing.

wobble board proprioception

Standing on one leg on a wobble board:

This exercise to work on your proprioception and balance of your ankle. It would be ideal to stand on a wobble board on one leg. However any uneven surface would be suitable you can start with a pillow and work your way up as you find it easier.

single leg Lunge

One leg lunge:

Start standing and move one leg forwards so your knee is over your toes then step forward and return to neutral. You can do this exercise 10 times on one leg before switching over to the other side.


Squats with changing angles:

Start with a normal squat with you feet pointed straight in front of you, then start to alter the angle of you feet each time so that you target slightly different parts of the quadriceps muscle. This will help to strengthen the imbalance between the individual quads.

You can download this guide at: The A State of Health Clinic’s Website.

Post Half Marathon Advice: What to do after

Congratulations you’ve finished a half marathon. Hopefully you have had a great experience not just with the physical running side but also the atmosphere which makes these events so special. Your recovery starts as soon as you get across the finish line so here is some tips on what to do post half marathon to help avoid the aches and pains over the next few days.

Zero – Five minutes post half marathon:

Don’t Stop!

You may feel exhausted, aching and needing a lie down however the best thing to do is keep moving for at least 10-15 minutes after you finish. Listen to you body but get a cool down in and keep moving even, go for a light jog or a walk. Just try not to sit down straight away, walk to the food or charity tent. Start your post race stretching and put some layers on as your body will loose heat very quickly.

Zero – twenty minutes post half marathon:


It’s vital to replace the fluid that you would have lost throughout your run as quickly as possible to help your body recover. For a half marathon distance try electrolyte sports drink, juice, water or the beloved runners favourite chocolate milk. You want to drink enough liquid so that your urine returns to a pale yellow, if its darker you are still dehydrated. Water is great but as you would have lost salt and mineral throughout your run try a combination.


In the first half an hour after you finish you want to eat some small, with main component being carbohydrate with a small amount of protein and fat. Good examples are a banana, fruit either fresh or dried, Nuts, bagels/baps, cereal bar/flapjack, yogurt or chocolate.

2 hours post half marathon:

After you finish your run try to have your main meal; half of the meal should be made up of carbs preferably whole grains with an equal amount of protein. Ginger and honey have also been proven to help and reduce muscle soreness.

Thirty mins – one hour post half marathon:

Stretching and Sports Massage

It wont be the first time you’ve been told about the importance of stretching after a race but there’s a reason way. After you have done your own stretches end the to the sports massage tent and get a massage. The therapist will often be able to detect muscles that you may not have notice being tight as well as getting deeper into the muscles. They will also be able to help you with dynamic stretches, which have been proved to be more effective than static stretches.

The evening post half marathon:

By the evening you should have refuelled and start to relax. Whether your staying in a hotel or you were lucky enough to be local and are able to chill at home make sure you keep moving. Just go for a evening stroll nothing strenuous something simple like a 10 minute walk with the dog at a very leisurely pace will be more than good enough. The most important thing is you get a good night sleep cause lets face it you deserve it!!

Three – five days post half marathon:

Get another sports massage to help with any aches and pains that you may have developed post race. You can read for about the benefits of Sports Massage here.

Four days post half marathon: 

When should you start running again?
The general rule is between 4 days after go for a 2-mile light run just to keep your muscles moving. You want to reverse taper and start to slowly build up the mileage you are doing.

You can download this guide at: The A State of Health Clinic’s Website.

For other articles on Half marathon’s check out what to in the week before and on raceday.

Half Marathon Advice: What to do in the week before the race

So you’ve signed up for a half marathon! Whether you have competed before or it’s your first half and taking on the challenge. Here are some of my tips of what to do in the week before the race:

1 week before the Race:

Use today as a full dress rehearsal, get up and have the same breakfast you plan to have on the day. This way you can test out everything and have some more confidence going into the race. Try to go for your run at the same time as you plan to do the race. Remember stay hydrated through the day and maintain through this week.

6 days before:

Either take today off or do a light cross training session. You could try the main meal your planning to have the night/lunch before your race. Make sure you get a good night sleep.

5 days before:

Do you last main training session before the race today and practice your routine including your diet, clothing. Try doing the run again at you’re planned  race pace.

4 days before:

Go for a fartlek or short high intensity interval work out to keep your legs moving and to get your heart racing. Fartlek means speed play in Swedish its just a term for interval training or run/walk training.

3 days before:

If you have a rest day planned for the day before and are not traveling aim for a light session no longer than 30 minutes. Start monitoring your fluid intake and make sure your staying hydrated. Make sure you get a good night sleep. Start to increase your carb percentage to 65?70%, but try to avoid beans and other food that may upset your stomach.

Get a good night sleep!!

3-5 days before

Get a sports massage preferably after an easy training session. Depending on how often you normally get a massage depends on how close you can leave it to the event. If you get them regularly you can have one closer to race day. You can find out more at the benefits of Sports Massage on my blog post.

Two days before:

If you have to travel to your race this would be the ideal day, go to pick your bib and other race day essentials including your food and drinks you may want on the day. Start increasing the percentage of carbs in your diet to around 70%. Avoid beans and other food that may cause bloating. If you’re not traveling to the race go for  a short walk or a light cross training session.

The day before:

Go for a very short run first thing to keep your legs moving no more than 20 mins! May attention to your diet with your main meals being breakfast and lunch to give your body enough to digest. Aim to eat easy to digest carbs like pasta with protein and not too much fibre or fat. Drink 2 glasses of water with dinner and then go for a short walk. Get everything laid out and packed for the morning so everything is ready. Set your alarm and try to get a good night sleep.
You can download this guide at: The A State of Health Clinic’s Website.

For more articles on Half Marathon running check out my race day and post half marathon guides.