How can I protect my knees before running?

Protecting Knees Before Running: A Comprehensive Approach

Strengthening and conditioning exercises combined with proper warm-up techniques are essential for protecting your knees before running. 1 This approach addresses the biomechanical factors that contribute to knee strain and stress injuries while preparing your body for the demands of running.

Pre-Running Strengthening Program

Lower Extremity Strength Training

• Calf strengthening exercises:

  • Calf raises (3 sets of 15-20 repetitions)
  • Seated calf raises (3 sets of 15 repetitions)
  • Eccentric heel drops (3 sets of 15 repetitions)

• Hip strengthening exercises:

  • Clamshells (3 sets of 15-20 repetitions per side)
  • Lateral band walks (3 sets of 10-15 steps each direction)
  • Single-leg bridges (3 sets of 10-15 repetitions per side)
  • Hip abduction exercises (3 sets of 15 repetitions)

• Core strengthening:

  • Planks (3 sets of 30-60 seconds)
  • Side planks (3 sets of 20-30 seconds per side)
  • Bird-dogs (3 sets of 10-15 repetitions per side)

Biomechanical Optimization

• Address running gait abnormalities by focusing on:
  • Reducing stride length or increasing cadence to reduce tibial stresses 2
  • Maintaining proper knee alignment during running
  • Avoiding excessive hip adduction and rearfoot eversion angles 2

Effective Warm-Up Protocol

Dynamic Warm-Up (15 minutes before running)

• Begin with 5-10 minutes of light aerobic activity (jogging or brisk walking) at 60-70% of VO₂max 3
• Follow with dynamic stretching exercises:
  • Walking lunges with rotation (10-12 per leg)
  • High knees (20-30 seconds)
  • Butt kicks (20-30 seconds)
  • Leg swings (front to back and side to side, 10-15 per leg)
  • Walking knee pulls (10 per leg)

Dynamic warm-ups have shown greater benefits than static stretching alone, as they enhance musculoskeletal, neurologic, cardiovascular, and psychological readiness for performance 4.

Surface and Terrain Considerations

• Start on appropriate surfaces:

  • Begin on level surfaces with moderate firmness 2
  • Gradually introduce varied terrain as conditioning improves
  • Initially avoid hills and uneven surfaces that can increase strain on knees 2

• Progression guidelines:

  • Increase running distance before increasing speed 2
  • Follow the 10% rule for weekly increases in distance or time 2
  • Monitor for pain during and after running; if pain occurs, rest until resolved and resume at a lower level 2

Footwear and Support

• Wear appropriate running shoes with adequate support and cushioning
• Consider custom orthotics if you have biomechanical issues like excessive pronation or supination 2
• Replace running shoes regularly (typically every 300-500 miles)

Common Pitfalls to Avoid

• Ignoring pain signals: Pain during or after running suggests overloading; rest until symptoms resolve, then resume at a lower level 2
• Skipping warm-up: Proper warm-up has been shown to decrease injury risk 5, 6
• Progressing too quickly: Rapid increases in running volume or intensity significantly increase injury risk 1
• Training while fatigued: Muscular fatigue increases bone stress and injury risk 2
• Neglecting strength training: Reduced lower extremity muscle strength is associated with higher injury risk 2, 1

By implementing this comprehensive approach to knee protection before running, you can significantly reduce your risk of knee strain and stress injuries while maintaining your running program for the long term.