Overcoming that nagging knee pain as a devout ultrarunning maniac.
Running, for quite a long time, up and down many lumpy bumpy hills, aches and pains seem to be quite a normal part of ultrarunning, and of course, it kind of makes sense.
But you don’t need to completely accept it.
You know them things in-between your feet and your hips that just seem to always NAG.
You’ve tried all the shoes, adjusted your gait, your volume, your life — but still, there is a nagging pain?
Unless it’s due to a traumatic injury and you have a torn something or other, most knee pain in runners (/humans) is really quite a simple fix.
And I hope for you to get something out of this that is more than just realising that you have “weak glutes”. And I hope to use no nonsense words.
That nagging, general knee ache and pain you have is likely caused by a myraid of factors, but let’s keep it simple — for now.
When it comes to preventing and eliminating pain, start off simple. We can get so lost in endless analysis of foot pronation, femur length and all the rest before we go right to the basics.
It’s not that the above doesn’t matter (although I’m not sure there’s much you can do about the length of your femurs, aha — that big bone in your thigh), but it’s that it doesn’t matter if you don’t first address the other matterful stuff.
This is the simple guide. There are of course MANY more in depth causes.
The main factors/things I’ve seen in my work with clients time and time again, and in my own experience —
- Tight TFL
Oh this is always fun! When this pesky little thing gets tight, which is — quite common — it can create pain.
When this gets tight, it can pull on the IT band, which can create subsequent pain in the knee.
Blah blah blah. What to do about it?
1 — Get on a foam roller, and feel one of the most intense, sickening pains of your life.
If this is tight, you will know about it. It HURTS.
Roll it for 1–2 minutes, when you find the spot that is extra sickening, stay on it, and try and melt onto the foam roller.
Deep breaths through the nose into the belly. If you don’t relax, nothing will really happen.
I like nasal breathing, with a 4 sec inhale, pause, 4 sec exhale, pause. Something like that. Or whatever you need to do to make sure you’re not tensing like mad.
Now, the thing that gives you that knee pain/ache — do it, has it gone?
If yes — whoo! that’s great.
If not, then that’s ok too. If this felt super tight and painful, it’s a good idea to continue this painful endurance activity of foam rolling it.
2 — Stretch it
It’s a funky thing to stretch, as most end up stretching their hip flexors.
The key is to tuck your pelvis under. Squeeze your glutes, and bring your pelvis towards your face.
Other cues — imagine (or don’t), that you have a willy, and put it in your bellybutton.
Keep this position as a priority in the stretch.
2. Your knees are caving inwards
A lot of runners have this.
Go on one leg, and try and squat down onto a chair or something similar.
What happens to your knee?
For most, you’ll see it wobbling all over the place and eventually collapsing inwards.
If this happens, that’s a likely cause of knee pain, and there’s a few things you can do —
1 — Fire/activate your VMO muscle (the small, teardrop part of your quad near the medial/inside of your knee)
Few ways to do this, but an easy way is to tie a resistance band around the back of your knee, attach it to something 2–3 metres away.
(Please make sure this thing you’ve tied it to is sturdy, lol)
Bring the knee forward, letting it come over the foot/toes
Then, fighting the resistance of the band, fully lock your knee out.
Do this, lots. I’m talking 30–100 reps.
Get a burny burny feeling.
Now do the thing that creates pain in your knee, see what happens.
You could also retest the single leg squat thing, and see if it looks or feels different.
If this has created a difference, this is something good to add in to your training/prehab/rehab stuff. Do before running, or strength training, or even on days off.
Key — keep your heel on the floor and resist the resistance only with the knee that has the band on it.
2 — The likely cause also… “weak glutes”
I failed on my promise.
Specifically the glute medius, that plays a huge role in stabilisation of the knee and preventing the knee from caving inwards.
There are loads you can do for this.
A good and easy one though, is get a looped resistance band, place it above the knees, and do continuous sidesteps, leading with the knee. Keeping one foot off the floor at all times.
Back and forth, back and forth.
Aim for that burny burny feeling.
Do the thing that normally creates the pain, has it gone? Improved?
The glutes are, as I’m sure you know, a relatively neglected area for all runners, so for future progressions it’s good to train them properly.
And unfortunately, just doing banded walk abouts won’t quite build up too much muscle or strength, although it will do wonders for your neuromuscular coordination and all else.
Some great exercises to build up your glutes —
- Bulgarian Split Squats (horrible, but awesome)
Add resistance, too.
Most women can likely do 20KG+ (at a minimum), for a set of 10. Most men can likely do 30KG+ (at a minimum), for a set of 8–10.
It’s easy to think that because you’re a runner, you don’t need to load things. But strength training isn’t running (if you weren't aware), it requires a load hard enough to stimulate an adaptation..
(And that’s why we all train, right?)
2. Single leg hip thrusts
Again, making sure to work to a hard intensity. Leaving 0–2 reps left.
If you feel this mainly in your lower back, it’ll be because your moving with the back and not the pelvis, solution —
Fire up the glutes beforehand, do some banded glute work (so much on google), and focus on the movement of the pelvis — trying to tuck it.
Both the above are great as you’re getting 2 main things, you’re getting the shortening and lengthening of the muscle (like all exercises tend to give) — which stimulates muscle damage (good thing) and you’re also getting a lot of work from the isometric contraction of the leg you’re standing ON.
Aka, both glutes are having to work, one to move the body (the one that’s getting longer and shorter) and the other to keep standing on one leg.
And as runners, we tend to be on one leg quite a lot!
3. Where is your attention/awareness..
A lot of runners, myself included, tend to be quite hypersensitive and aware of pain..
Because we’re fearful of injury!
What this can result in, is a massively overdriven awareness to very minor and insignificant sensations.
I’m not saying it’s in your head — but I am inviting you to play with it.
Pain is pain, for sure — and you and I both know when pain is bad, and when pain is, hmm — am I just obsessing a little?
What we focus on grows, and quite often that hypersensitive and fearful of not being able to run being in us, keeps all of our focus on a small, minor ache..
And turns it into a catastrophe!
So just be aware of that too, and perhaps play around with where your attention is, and how this changes your experience of pain.
For the record, I am NOT saying to run with pain! But to be aware of the differentiation between pain, and a hyperaware alertness that is causing your internal stress.
I promised I’d keep it simple, so this is the end!
That above honestly tends to cover most cases of general knee pain.
Of course, there is so much more, but try the above first.
However, if you’ve gone from running 20 miles a week to 80 miles in a week, it’s probably why your knees hurt.
But equally, ultrarunning and overdoing the volume is a cool thing in a way.. because it magnifies your weak points
And we all have them.
I hope this was helpful..
For coaching enquiries, please contact me below— https://www.instagram.com/miaoldroydpt/
Happy knees!
