Avoid long-term knee pain

How foam rolling and stretching can help to prevent knee pain


There may be a nagging doubt in your mind about whether or not running is good for your joints. Some non-runners say that it will “wreck” your knees. But is that just an excuse not to run?

Running is a high-impact activity. When we run, at least two and a half to three times our bodyweight goes through the knees. But it can also improve joint health – particularly if you manage the volume and frequency you are running. “When we run there is a high stress and load going through the joints and bone tissue that can improve bone density, helping to prevent osteoporosis and osteoarthritis,” says Senior Physiotherapist Stuart Mailer from Kensington Physio & Sports Medicine (kenphysio.com).

Why stretch and foam roll?

It sounds like a cliché to say that the answer to addressing knee niggles early on is to stretch more. But when you understand the real reason why it’s so important, you’ll be reaching for the nearest stretching mat.

Physiotherapist Mark Buckingham from Witty Pask & Buckingham Physiotherapists in Northampton (wpbphysio.co.uk), has identified a knee issue that keeps cropping up. He blames an imbalance in the way the kneecap tracks on the front of the knee for initial knee pain, which can lead to problems if not remedied.

The cause is as simple as a stiff IT Band (the fibre that runs from the outside of the hip to the shin) and tight hip flexors, yet the longterm effects are significant. Mark explains,“ The main issue relates to the kneecap and the way in which it runs on the front of the femur (thigh bone). It’s to do with tightness on the outside of the IT band and tightness on the hip flexors. The IT band and hip flexors pull the kneecap towards the outside of the thigh and changes the way in which it runs on the end of the femur. This causes pain in a number of different ways.”

This mal-tracking issue causes joint pain because the kneecap doesn’t track properly on the front of the thigh. Mark explains, “The mal-tracking pulls on the ligaments on the inside of the kneecap that are trying to stabilise it and causes pain into the patella tendon (the ligament that attaches to the quadriceps to the shin bone via the kneecap). This is because of the change in mechanics and the forces going through it.”

He adds, “As soon as you get this imbalance in the way in which the kneecap tracks on the front of the knee, you alter how much force goes through the back of the kneecap. The kneecap shape is very clever – the more bend there is through the knee, the more the force is spread over a wider area of the kneecap. Think of the difference between a pair of flat shoes and a stiletto heel. You are always going to have the same bodyweight but it’s going to cause impact on a stiletto heel whereas it’s not if it’s spread over a wider load. That’s the same at the back of the kneecap. If you’ve got everything spread nice and evenly across the back of the kneecap, it spreads that load and force is dissipated.”

However, as the kneecap shifts by a few millimetres, the spreading of the load doesn’t occur and you end up with a lot of pressure over a smaller area. “That causes wear and tear, damage, bruising and leads onto arthritic changes,” adds Mark.

At first, it may not inhibit your running much. But as you accumulate years of running, it will get worse as the mal-tracking will have continued over a prolonged period. “You end up with this early onset of arthritic change in the knee,” adds Mark. “So from an early age it’s really important to make sure you’ve got all those imbalances resolved.”

Simply stretching the hip flexors and IT band regularly could prevent this unnecessary cause of wear and tear. “Foam rolling for the ITB and hip flexor stretches are often a very good place to start,’” says Mark. “If after a couple of weeks of foam rolling the IT band and stretching the hip flexors the kneecap pain disappears, then you have solved it. If it doesn’t, you need to go and seek help.”

To get help, it’s best to visit a running specific physiotherapist or a running coach and have an MOT or screening.

Here’s four stretches and exercises to try to help prevent knee pain, as recommended by Physiotherapist Tim Allardyce:

Hamstring stretch Hip Flexor Stretch


Ilustrations: Ben Foxall


Chris Macdonald

Written by Chris Macdonald | 352 articles | View profile

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