Beat the Seven Body Breakdowns

Prevent and recover from the seven most common running injuries

by Christine Aschwanden

runner's knee, patellofemoral pain syndrome, PFPS, running injury
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1. Runner's Knee

Patellofemoral pain syndrome is even more annoying to get than to try to say during a fartlek session. Also known as PFPS or 'runner's knee', it is the irritation of the cartilage on the underside of the patella (kneecap).

About 40 per cent of running injuries are knee complaints and 13 per cent of runners have suffered knee pain in the past year, according to an RW survey.  

PFPS typically flares up during or after long runs, after extended periods of sitting down or while descending hills and stairs.

Are you at risk?
Anyone with biomechanical factors that put extra load on the knee is vulnerable to PFPS, according to Dr Bryan Heiderscheit, director of the University of Wisconsin Runners' Clinic, US. Those factors include overpronation (excessive inward foot rolling) and weak quads, hips or glutes.

Can you run through it?
Yes, but you need to take extra rest days and reduce your mileage. Run every other day and only as far as you can without pain. Some runners find inclines less painful, so Heiderscheit recommends simulating hills on a treadmill. Running uphill works your glutes: strong glutes help control hip and thigh movement, in turn preventing your knees from rolling inwards. Cycling may speed recovery by strengthening the quads, and elliptical training and swimming are also knee-friendly. Just avoid running downhill, which can exacerbate pain.

Rehab it
 Strengthen weak hip and glute muscles with lateral side-steps, says physiotherapist Charlie Merrill. Loop a resistance band just above your ankles or knees. Separate your feet and bend your knees to lower into a crouch. Now walk sideways for 10-15 steps, keeping your feet straight and upper body still.

Maintain band tension throughout, then reverse the direction. When this gets easy, try it on your toes. If there's an issue with the way your kneecap tracks, athletic tape may reduce pain.

You can watch Merrill demonstrating knee taping at Post-run icing helps in the early stages; heat works best as the injury is healing.

Prevent a relapse
Heiderscheit recommends shortening your stride length and landing with your knee slightly bent, which can take up to 30 per cent of the load off the joint. Count the number of steps you take per minute, then increase by five to 10 per cent. Keep your knee tracking correctly by strengthening its supporting muscles - your quads and glutes - by doing side-steps and squats.

Elite tip
Olympic marathon silver medallist Meb Keflezighi had knee trouble in the buildup to last year's Boston Marathon. He took two weeks off and ran only every other day for the following two weeks. The strategy worked: he clocked 2:09 at Boston.

Knee-d to know: How to proceed

Stop running
Pain on the inside or outside of your knee on waking, which doesn't ease through the day.

Run with caution
Twinges early in a run that dissipate, then come back post-run. Flares after prolonged sitting.

Go Run!
Pain-free, even after sitting through a two-hour film or tackling a  long hilly run.

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Discuss this article

Ballet foot exercises work really well for the plantar fasciitis.  They sorted my pain right out.  I have also started doing planks which seem to be helping as well.

Posted: 19/08/2011 at 22:52

They forgot the most obvious and common one. The stomach! Affects 1/3 of runners, if previous articles are to believed, and causes inescapable misery that can strike no matter how fit you are, no matter how much training you've done.

Posted: 23/08/2011 at 20:56

Great article! I have stopped running for just on 7 weeks with plantar fasciitis and am desperate to start running again, but still experiencing pain so not in the ''Go run!'' zone just yet...... Kimberlee, are ballet foot excercises just pointing and straightening your toes??

Posted: 23/08/2011 at 23:58

I have been diagnosed with Runner's Knee.  I'm finding it a long and slow rehab process.  I originally stopped running for a month (after attempting a couple of runs and being in pain throughout).  Since then the knee has got better, but it's still very painful after about 5k.  To the point that I can't actually run much further than this at the moment.

I've been given lots of physio and strengthening exercises to do.  Just feel quite depressed at the moment as nothing seems to be helping.  Maybe I want a quick fix and it's not going to be one.  I am signed up for a half marathon in October and really not sure whether to pull out.

Posted: 25/08/2011 at 12:49

Listen to your body.

If you are training for say a marathon or half marathon where the volume of training will require you to run consistently for maybe five days a week you are bound to feel tired either due to overtraining or general fatigue.

There are certain runners who feel that if they miss even a single training session then their fitness will suffer.

Wearing ill fitting shoes or running when feeling unwell due to a heavy cold or such like can result in muscle injury.

Simply over doing it and not listening to your body can result in injuries.

Check your heartrate regularly and if it's abnormally high think of some other form of excercise or even rest.

The secret to successfull running is to remain injury free and with a little sense and listening to your body injury's are not inevitable


Posted: 11/10/2011 at 16:23

what about back pain? i'm always suffering with it post-run, and have tried backward stretches lying on my tummy, but it hasn't helped. and when i lower my legs for 'that' ab exercise i get a clunking sound... i don't really have the time or inclination to start yoga...
Posted: 08/02/2012 at 11:06

Hey not sure if you still use this, but i have the same thing and feeling the exact same way, how are you getting on? did you manage to get rid of it and run your half marathon?
Posted: 22/04/2012 at 19:32

I'm always amazed by how little sports massage is cited in these articles. It's used by every Premier League football team, every professional rugby team, every top athlete and thousands of amateur sports people. It was part of the medical services team at the 2012 Games (250 therapists!) and at the Glasgow Commonwealth Games. It was in greater demand from athletes than any other therapy------and yet the most common recommendation for soft tissue problems is self applied foam rolling! Yikes! 

Is there any reason your experts seem to largely ignore this key component of soft tissue prehab and rehab? For the record I come from an utterly biased standpoint as Chair of the Sports Massage Association.

Posted: 01/10/2014 at 14:22

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