Ask the physio: Knee pain

Q I get knee pain when I run, which continues afterwards. I also feel pain going downstairs and am starting to get twinges at the hip and ankle. Shall I just give up running?

Martin Alexander, via email


The problem

Don’t give up running. The knee accounts for the highest percentage of visits to my clinic. The fact that your knee pain is worsening suggests a biomechanical issue. When you run, you are creating excess force around the knee, which is resulting in damage. This excess force could be caused by poor foot and ankle control, or lack of strength around the hip and pelvis, causing rotation or varus (movement in, toward the midline) forces around the knee itself.

The fact that your pain is present as you’re going downstairs – when your knee is bent more than when you run and with a higher load – suggests this movement is the most aggravating factor. My feeling is that your knee is travelling in a varus direction and is not sufficiently supported by the muscles that control that movement – via the iliotibial band (ITB). This assumption is supported by the twinges you are now starting to experience at the hip.

As you are also feeling some ankle pain, it’s possible that your running shoes are worn out and therefore not offering as much support as they should. A trip to your local running store for a new pair may be in order.

The fix

My advice is to build strength in the problem areas. Begin by trying a limited version of a single-leg squat, with very little knee bend. This should be pain-free and will also improve your ankle proprioception (balance). Over the next four weeks, increase the bend in your knee during the single-leg squat by a couple of inches a week, ensuring that your knee is over your middle toe at every stage. Use your glutes to push up from these squats in each repetition, and repeat hundreds of times a day in the first couple of weeks. Once the angle of the squat is about 40 degrees you can reduce the number of reps, but continue to do as many as possible. Do them while you’re waiting for a lift, standing in a queue, cooking or brushing your teeth. Do some bridging (such as the glute bridge move, below) and core strength work alongside these squats, and stretch the tensor fascia latae (also below) four times per day.

If this doesn’t solve your problem, you will need a more thorough assessment.

GLUTE BRIDGE

Lie on your back, arms by your side and knees bent. Squeeze your glutes and slowly lift your bum until your body is straight from your shoulders to your knees. Slowly return to start position. Do three sets of 15 reps.

TENSOR FASCIA LATAE STRETCH

Cross the tight
 leg behind and
 away from your
 supporting leg
 as far as you
 can. Keep your
 body upright,
 supported on 
one side by a wall, 
and lower your hip
 toward the ground. You should feel the stretch in the outer thigh and hip of your tight leg. Hold for 45 seconds, and repeat four times each day. 

Paul Hobrough is founder of Physio&Therapy UK (physioandtherapy.co.uk). Got a problem? Email askthephysio@rw.co.uk.