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Brought to your knees by pain? (2/2)


As is often the case, the rule of thumb for preventing runner's knee is: act, don't react. This is because various preventive measures can be taken to circumvent incorrect and excessive strain on the knee.
Training material
- Buy running shoes only with professional advice: The choice of the right running shoe does not depend directly on its price, but above all on its fit. A detailed consultation in a specialist store should therefore precede the purchase of the shoe. Even with the right shoe or appropriate insoles, minor anatomical misalignments can be compensated and thus knee problems can be avoided in advance.
- Consider the service life of running shoes: A maximum of 500 to 1000 kilometers, depending on the model and body weight, a pair of running shoes should be worn according to experts. After that, the heavy wear of the sole threatens to put undue stress on the joints.

Training design:

- Balancing training: runners must keep in mind that for an optimal, i.e. healthy fitness condition, not only specific running training is mandatory, but so is strengthening and stretching all muscles, tendons and ligaments involved in running. In order to specifically prevent iliotibial band syndrome, one should primarily train the outer sides of the legs, without neglecting other areas, which would create a new imbalance. (See suitable exercises under point 7)
- Fascia training: Elastic, functional fasciae are a prerequisite for proper motor function and relief of the joints. In order to prevent the tissue structures from hardening or sticking together, sufficient exercise as well as the avoidance of permanent stress is obligatory. In addition, the fasciae should be stimulated by regular and specific training. Especially in case of knee problems, the following exercise is often helpful:
The starting position is lateral support, with the upper leg in front of the body for support. With the outer thigh of the lower leg, roll over a massage roller (e.g. Blackroll) a few times. If you feel pain at a certain point, you should remain in this position and wait until the quality of the pain changes. Only then continue the rolling movement. Do this exercise for about 20 seconds before changing legs.
- Individual training: A common problem of recreational athletes is the lack of experience or self-assessment. Too rapid an increase in training intensity, both temporally and practically, can lead to continuous overloading of the knee joints. Therefore, you should always train according to your current training and fitness level and make sure you have enough recovery periods between training sessions.
- Optimization of running style: A correct running style is essential for relieving the knee joints. In this context, one also speaks of a hip runner. This means that when running, through controlled hip extension, the thigh muscles and the buttocks absorb a significant part of the forces and thus relieve the knees. For this purpose, it often proves useful to perfect one's own running style through a professional running style consultation via treadmill analysis.

Exercises for therapy and prevention - stretching and strengthening relevant muscles

The knee occupies a central position in the musculoskeletal system, coordinating numerous muscles, fascia, ligaments, tendons and cartilage. Even the smallest imbalances in the system can lead to knee discomfort and a tractus iliotibialis. Therefore, it is important, both preventively and, with the orthopedist's permission, therapeutically, to exercise the various elements involved. A selection of exercises for stretching and strengthening relevant muscles and tendons is presented below. For optimal effect, correct execution is fundamental, so in case of doubt, the exercises should be performed independently only after or under the guidance of a trained therapist or trainer.

Stretching exercises

1 Middle gluteal muscle (Musculus gluteus medius)


1.1 For the first exercise, stand on an elevation with the affected leg hanging freely. As a stabilizing support, one should position oneself near a wall or railing. Then, with knees extended, slowly lower the pelvic side of the free-hanging leg about 15 cm, then raise it again. Repeat the exercise about 15 times and several times a day.


1.2 The starting position is the long seat. One leg is now bent over the knee of the extended leg and the upper body is turned towards the standing leg until the elbow is behind the bent knee. Now press with the elbow against the knee and at the same time create a counter-pressure with it. Hold the tension for about 20 seconds, then switch legs. Stretch both sides twice each.

2 Anterior thigh muscles (quadriceps femoris muscle and sartorius muscle).


2.1 First, get into a hip-width and straight stance. One leg is bent, its foot or ankle is grasped and carefully pulled upward toward the buttocks as far as possible. While doing this, the hip can be slightly hyperextended, but care should be taken that no evasive movement interferes with the stretch. To avoid this, you can also perform the exercise in the prone position. Hold the tension for 20 seconds, then switch legs. Repeat the stretching process twice for each leg.


2.2 For the next exercise, first step into a lunge position with the front foot and the back knee and leg firmly planted or lying on the floor. The arm on the side of the prone leg then reaches back and slowly pulls it by the ankle or foot toward the buttocks until the stretch is felt.  Hold the tension for 20 seconds, then switch legs. Repeat the stretching process twice for each leg.


2.3 The starting position is the step position, the back leg is extended and only the tips of the feet are on the floor. The knee of the front leg is bent, the whole foot is on the floor, the upper body is straight. Now slowly lower the thigh of the back leg to the floor and push the hip forward. Hold the tension for about 20 seconds, then switch legs. Stretch both sides twice each.

3 Thigh Band Tensioner (Musculus tensor fasciae latae)


3.1 To begin, stand with your back straight to a wall, legs crossed, with the leg to be stretched standing behind and extended. As a stabilization aid, you can lean slightly against the wall with your buttocks. Then tilt the upper body to the side of the leg being exercised until you feel a stretch above the hip. Stretching the arm of the side to be exercised above the head, the tension increases. Hold this position for 20 seconds, then switch sides. Stretch both sides twice each.


3.2 In the starting position, go into a lunge with the front foot being stretched and the entire back leg firmly planted on the floor. Then, cross the front foot in front of the back foot, shift the pelvis toward the exercised leg and tilt the upper body to the opposite side. For better stability, you can rest on the front knee. Hold the tension for about 20 seconds, then switch legs. Stretch both sides twice each.

4 Large Lumbar Muscle (Musculus iliopsoas)


4.1 For the first exercise you need a knee-high support. Place one foot on it, the other leg should be almost extended. Now gently push the hip of the extended leg forward. Hold the tension for about 20 seconds, then switch legs. Stretch both sides twice each.


4.2 In the starting position, lie on your back on a table with your sacrum at the edge. With both hands, pull one knee toward the chest while the second leg hangs freely over the edge and is pulled down by gravity. Hold the position for about 20 seconds, then switch legs. Stretch both sides twice each. If you want to increase the tension, a workout partner can gently increase the pressure on the hanging leg.

5 Back thigh muscles (ischiocrural muscles)

5.1 The starting position for the first exercise is a hip-width straight stance. Then carefully tilt the upper body as far forward as possible with the legs extended. Hold the tension for 20 seconds, then repeat the stretching process two more times.


5.2 For the following exercise, start in the supine position with both legs extended. Then, using both hands, gently pull one leg as far as possible toward the body while the other remains straight on the floor. Hold the tension for 20 seconds, then switch legs. Repeat the stretching process twice for each leg.