Prevent "Inner" Knee Pain from Ruining Your Runs: Advice from a Doctor of Physical Therapy

There's nothing worse then finding your rhythm,

settling into the run,

and an unexpected twinge in your knee snaps you out of the zone.

It's ok when it goes away...

But it's not so hot when it lingers.

Sticks around.

And grows strong enough that it forces you to stop.

What can make knee pain in general so frustrating, is it often feels vague.

It can move around.

Was it at the bottom of your knee cap?

Or was it off to the side?

How "inside" was this "inner" knee pain?

Underneath the knee cap?

INSIDE the knee joint?

Or just running alongside your inner knee near the surface?

Can you start to see the conundrum?

(and that's only a third of the questions I would ask as your physical therapist.)

So when I started to get questions from you all, the running fit fam, about how to fix inner knee pain...

I decided the first thing I need you to know is:

Knee pain is nuanced.

Think of your knee joint as a congested highway overpass.

There's a LOT of stuff crammed into a tiny space.

Big and small muscles wrapping all the way around the knee
ligaments running along the sides the knee and INSIDE the knee
tendons connecting and encasing bones like your patella
bigger bones making up the knee joint itself
menisci inside the joint helping everything seat and move correctly
not to mention major nerves and blood vessels.

With that itty bitty anatomy dump, can you start to appreciate the anatomy-marvel that is your knee joint?

And why questions like "why do I have inner knee pain? What's wrong with it and what exercises do I do to fix it?"

....well, frankly require a little more information?

Don't worry, I won't leave you hanging!

Because I know you want the CAUSE/CULPRIT of your "inner" or medial knee pain and how to FIX IT.

As a Doctor of Physical Therapy and a runner who personally struggles with right inner/medial knee pain, here the top 3 culprits I look out for:

poor eccentric quad strength
not fantastic endurance when it comes to concentric quad strength
potential glute weakness

WHAT THESE MEAN....well, keep reading. ;)

How to Prevent Inner Knee Pain when Running

Circuit:

3 sets each // medium-heavy weights

WARM UP: Wall Push High Knee "Kicks"

3x on painful side to fatigue

STRENGTH CIRCUIT:

Single Leg Squat Box "Sits"

5-8 reps. 8 reps if bodyweight; 5-8 reps if HEAVY weight
NOTE: 2-3 secs to sit DOWN, 1 sec to stand up POWERFULLY and FAST.

Bulgarian Split Squat: UPRIGHT torso

9-12 reps ea side X heavy weight

Backwards Lunges

6 reps ea leg X medium-heavy weight

Inner Knee Strength Exercises for Long Distance Runners that actually Work

WARM UP: Wall Push High Knee "Kicks"

This is my secret "insta-fix" exercise for knee pain.
THE SECRET: the reason this particular corrective-movement style exercise works so well for inner/medial knee pain is that it "super charges" your quad, asking it to contract fast, powerfully, repeatedly! It's basically telling that quad muscle to work....or else.
I find as a PT a lot of medial knee pain is often from weak quads or fatigued quads that are struggling to handle the repeated, high impact load of running, especially on concrete. So realize, just because this exercise "turns your quad on", doesn't mean it takes the place of your strength exercises below. Because if there's no strength "to turn on", well...this exercise won't get you very far.

Single Leg Squat Box "Sits"

I know what you're thinking, "that looks incredibly dumb and easy..." Then answer me this: WHY IS MY RIGHT LEG SHAKING? Ok, maybe you can't see it in the video, but I saw it while I was filming.
PRO TIP: I need you to first get comfortable with sitting down on the box, bench, chair whatever using ONLY one leg and no hands.
Then, I want you to sit down slowly, taking 2-3 seconds on your descent, and 1 second to stand back up FAST. Think "get up!"
This is deliberately working on eccentric quad strength on your way down, and powerful concentric strength standing up. Once you've conquered this, begin to load it up with heavy weight!

Bulgarian Split Squat: UPRIGHT torso

It wouldn't be a drwhittfit circuit without a Bulgarian split squat ;)
You knew this was coming, so you're not even surprised ;) but the question is: are you doing them regularly yet?
THE REASON: I keep on keeping on with BSS's is that they have literally changed my running. No more knee pain; I'm able to run long again. They're a spicy miracle exercise especially for runners struggling with medial knee pain.
To make them more quad-focused, you want your torso to remain upright. To find this position and do this version correctly, you can start with a weight overhead as this will force your torso into this upright position and gradually bring the weight down to your side once you feel confident you can find and maintain this position on your own.

Backwards Lunges

There's a method to madness...
THE MADNESS: We, as runners, have a tendency to rush and whip through strength training. And as a result, we smash our knees into the ground during our lunges.
THE METHOD: So I often give my runners backwards lunges to not only slooow down, but also give them a little extra eccentric quad strength in a position that looks like their running stride.
Because here's the real trick: lunges are HARD. And yes, allowing your knee to bounce off of the ground technically makes it easier but it also leaves end-range strength gains on the table AND sets you up for MORE knee pain because you're smashing the under-side of your patella into the rest of your knee joint. (trust me, been there, done that. Got the tshirt).
So while it can feel harder, it is 100% worth it to stay mindful, deliberate and lunge backwards to make your quads and glutes that much stronger and injury-resistant.

WRAPPING UP

Let's talk quick fixes

When you google "how to prevent inner knee when I'm running" I'm sure you'll find suggestions for:

57 different kinds of braces
colorful looking taping techniques
gnarly looking foam rollers
and obviously advice on getting new running shoes

Sorry to burst your bubble, but in the long run, these are all bandaids.

But listen when I say:

They may truly help to alleviate pain in the moment, and help you return to running immediately.

But you NEED TO UNDERSTAND, the strength work still needs to get done.

Take from a PT who requires custom made orthoses to actually run. (it's true). Without my fancy-shmancy molded plastic in my running shoes, my right foot and right knee pain would be devastating.

So I wear the inserts.

AND make sure I strength train 2-3x a week so I can make my body more resilient to higher mileage, faster paces, and steeper hills.

Because colorful plastic doesn't keep us strong and injury free.

Muscle and running-specific strength does.

So if you're looking for even more injury-proofing, running-specific strength exercises that keep you running longer and stronger so you can PR your next race, check out my FREE strength guide for runners.

FREE Strength Workouts for Runners

And until next time running fit fam,

Dare to Train Differently,

Marie Whitt, PT, DPT //@dr.whitt.fit