An example of handling knee pain from running

Posted on July 12, 2017

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In Being old doesn’t have to mean being slow I profiled Judes, who is 59 yet capable of running at 11 miles per hour on a treadmill, for a quarter mile:

Judes has a twin, Joanne, who has also been running. Both the twins gave up running for about a decade due to knee issues. After training them for a few years with no knee pain, we all decided getting back into running would be fun to work at. They had run seriously for a long time before giving it up, and would love to get back into it.

Judes took off with the running. For months and months she kept improving. For Joanne it wasn’t so easy. Every time we got up to about 8 miles per hour, she’d come in the next session telling me her left knee was bothering her.

The first couple times this happened she had zero knee pain during the running, and nothing bothered her for a couple days afterwards. Usually when this happens I start looking at other areas, like activities of daily living, before blaming the exercise.

Eventually we found the first culprit. Thursday or Saturday tended to be a harder run, and Sunday -typically during the motorcyle rides they enjoy- or Monday is when she’d often have the knee pain. After talking to her about this regularly the pattern was Joanne’s knee would get flared up with deeper bending activities. Think sitting or walking down the stairs.

knee pain during sitting

I then found out she was doing these long motorcycle rides with her knees like so:

Notice the deep bend again, where the feet are under and behind the knees. I ask her to change this up the best she can, trying to make her feet more like this:

“Make sure you can see your feet.”

We do that and the knee pain clears up a good deal, but still not all the way.

We all know those twins who like to stick together. Joanne and Judes are much that way. They like to keep their workouts similar, if feasible, but it was becoming obvious I couldn’t have Joanne improve at the same rate Judes was running wise. (Though Joanne was improving on the lower body lifting more easily.) With Judes I was basically going by how she felt and looked, increasing the workloads accordingly. Joanne couldn’t get away with this, and honestly I was at the point I couldn’t just go on feel anymore. I needed to get much more regimented and structured with how I had her improve.

One of the topics I’ve belabored on this site, but which still hasn’t seemed to have gotten across well, is the need for incremental improvement at times, particularly when coming back from something painful. One form of this is simply going based on how a person feels. For example, increase a workload so long as nothing is painful.

But with Joanne, and many, this wouldn’t get the job done. She never had pain during the runs, only the day or so after. So going based on how she felt during a run didn’t work.

Furthermore, when doing things in this manner, we tend to increase too much, too soon. Joanne might come in and we’d go 7 miles per hour on the treadmill for a quarter mile. Felt good? Alright, let’s go 7.5 for a quarter mile. Felt good? Alright let’s do 7.5 again.

Next session, “My knee was a bit achey the next day.” Alright, we warm our way up. Feel good? Let’s try 7 for a quarter mile. “Feels good.”

Ok, but now we’re both lost. We don’t know what was the tipping point last time. Was it doing two sets at 7.5? Was it going to 7.5 to begin with? Or was it 7?

After two or three times of this, enough is enough.

What we started doing was each time we had the same warm-up. It would be,

  • 4.0 mph for quarter mile
  • Upper body lift (push)
  • Upper body lift (pull)

We did three sets of that for one workout, then moved on to other non-running stuff. In other words, I didn’t even have her run. We did a fast walk -4 mph is when many are on the cusp of needing to jog (some will start jogging, some won’t)- and that was it.

She comes back and feels good. So now we know fast walking is ok. We did that for a week to ensure the knee was calmed down.

From there,

  • 4.0 mph for quarter mile
  • Upper body lift (push)
  • Upper body lift (pull)
  • 4.5 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 5.0 mph for quarter mile

She came back and felt good. Ok, now we now a slow jog is ok (4.5 she was still walking). Next session,

  • 4.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 5.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 5.5 mph for quarter mile

Another couple workouts and we’re up to 6.5 mph. As you get faster, the risk for injury goes up. Because of this, the improvement increments got even smaller.

  • 4.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 5.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 6.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 6.7 mph for quarter mile

Around 7 – 8 mph is when I knew things went awry. Because of this, once getting to 7, I start this,

  • 4.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 6.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 7.1 mph for quarter mile

Then,

  • 4.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 6.0 mph for quarter mile
  • Upper body lift
  • Upper body lift
  • 7.2 mph for quarter mile

Is this excruciatingly tedious? Yes. But it leads:

Joanne running progression for knee pain

I typically print out workouts. This is actually Judes’ above, but Joanne is on the bottom. I stopped printing anything with her and just went bit by bit. (You can see Judes doing this during her runs as they got faster e.g. 10.6, 10.6, 10.6, 10.6 one week. Next week gets up to 10.7 but only once. Following week is two runs at 10.7.)

Joanne running progression for knee pain 2

You can see the x.25 for quarter mile. You can then see we did 8.0, then I crossed it out when we went to 8.1. We did that twice (sometimes I didn’t increase based on how she felt / looked, where I instead repeated a speed), then did 8.2, then 8.3, then 8.4, then I almost jumped to 8.6 accidentally, but crossed it out.

Joanne running progression for knee pain 3

Then you see 8.5, 8.6, 8.7, 8.8, 8.9.

After this long of things going well I felt a change was needed, if nothing else for variety. So we took a speed we know she had been fine at, and went a little further, going for a third of a mile (.33). We did 8.4. Not her fastest, but instead a speed which was slower to offset the fact we’d be going farther.

Joanne running progression for knee pain 4

Then 8.5, then 8.6. Then to focus on distance more, we stayed at 8.6 and went .33, .40, .50. .60, .70. for distance.

At some point I varied it up some more to give her one fast run and one longer run. She had been feeling so good for so long, I felt ok making a jump like this. So we did 8.9 for .33, then 8.0 for .50. (Note I still lessened the speed on the long run, despite knowing she could do more than this, because it was the first time we’d be doing two harder runs.)

Joanne running progression for knee pain 3

Notice the 8.9 in the upper left.

Then you can see we did 9.0 for a third of a mile, and 8.0 for .60.

Joanne running progression for knee pain 5

Then I kept things at 9.0 for a third of a mile, but pushed the distance. Where we went

  • 9.0 for .33, 8.0 for .70
  • 9.0 for .33, 8.0 for .75
  • 9.0 for .33, 8.0 for .85

That was working well, where we got a little more aggressive and have now gone,

  • 9.1 for .33, 8.0 for .95
  • 9.2 for .33, 8.0 for 1 mile
  • 9.3 for .33, 8.1 for 1 mile
  • 9.4 for .33, 8.2 for 1 mile
  • 9.5 for .33, 8.3 for 1 mile
  • 9.6 for .33, 8.4 for 1 mile
  • 9.7 for .33, 8.5 for 1 mile
  • 9.8 for .33, 8.6 for 1 mile

Note again, the above are either individual workouts or an entire week only getting up to that speed. (We only ran twice per week.) And roughly every four weeks we would have an easier / deload week, where we didn’t try to improve.

We never changed what she did during the workout between runs -it was always a couple upper body exercises. After the running we did lower body work, and I only ever changed one exercise at a time, out of 3 or 4. In that first week, after knowing walking was ok, we did another walking workout, but did the lower body exercises. That felt good, so we knew the exercises were likely fine too. I also had years worth of previous training with her to know lifting almost always was fine on her knees.

Even so, for a month I didn’t do any lower body exercises involving loading the quads. Namely, anything squatting or lunging oriented. Reason being I wanted to be sure the only thing that could flare her knee(s) up was the running.

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Posted in: Knee Pain, Pain, Sports