10 ways to avoid running-related knee injuries

Winter means running event season in Australia, while folks in other warmer parts of the world take advantage of the great weather by run training outside too. But anyone who's ever jogged regularly knows the first body part to suffer is usually your knees. Here's how to treat them with TLC and ward off pain, injury and damage so they show you some race-day love right back

Running injuries

Are you training for a half marathon or marathon? Perhaps you’ve got your sights set on the City2Surf in Sydney this year. Or maybe you just really love running for fitness and do it a lot.

Either way, it’s important to remember that your knee joint joins the foot to the hip and low back via long lever bones and many muscles, tendons and ligaments. Essentially, it’s stuck in the middle of a serious impact zone!

If you are getting knee pain only on one side when or after you train, then it usually suggests a bio-mechanical issue highlighting there is an imbalance somewhere (usually in the lower body).

If the knee pain is exactly the same on both sides then it is likely it is something you are doing (or not doing) causing the pain, such as poor or ill fitting footwear, poor technique, training distances introduced too quickly or running on a surface that is too hard.

Most knee injuries I see in the clinic stem from faulty pelvic or foot mechanics, and once these factors are fixed the knee pain magically goes away! Your feet and pelvis are the key foundations for running so in order to prevent knee injuries (or any lower limb injuries for that matter).

running advice, running related injuries, knee injuries

Here are my 10 tips for keeping your knees safe (and pain free!)

1Have your feet assessed by a professional

Sports-specific podiatrists, chiropractors or physiotherapists are great choices to have your feet assessed. If your feet roll out or in too much or your arches are weak, then you may be fitted with an orthotic to support your foot. In my opinion semi-rigid orthotics are the best as they are supportive but don’t lock your foot into a rigid structure. Rigid orthotics tend to lock the foot into ‘sub-talar neutral’ which is great when the foot is standing but not so good for runners who need the foot to naturally pronate in order to absorb the ground reaction forces and distribute them as evenly as possible up the legs and spine. Rigid orthotics tend to move the problem from the foot up the bio-mechanical chain (usually the shins, achilles or lower back) and they tend to be super uncomfortable!

2Get your footwear professionally fitted 

Have your running shoes fitted by a professional EVERY time. Brands change their designs every six to 12 months, so just because a certain shoe suited your foot last time does not mean it will this time. It is hard not to go for the pretty colours but when it comes to preventing injuries the correct foot wear will make your long term performance much prettier.

3Have at least a few training sessions with a technique specialist

Many people go for strength or extra training to overcome shortfalls in technique. At the end of the day the better your technique the better your chance of preventing common running injuries will be. Many runners over stride in an attempt to go faster instead of focussing on foot placement and using the ground reaction forces to create a longer stride naturally. Poor foot placement, over striding, excess pelvic rotation, lack of arm drive etc all place more stress on the bio-mechanical system of the body and increase the chance of injury, especially in the knees and shins.

4Have your spine and joints checked

Regardless of whether you have pain, have your full spine and joints checked by a sports specific chiropractor, osteopath or manipulative physiotherapist who can take X-rays (or refer for them) and assess you for anything that may affect your running biomechanics. Best time to do this is BEFORE you start an intense period of training as it will identify any areas of muscle weakness, bio-mechanical breakdown, nervous system firing issues or potential injuries that can then be addressed with treatment or support such as strapping, stretching, massage, adjustments, technique advice, nutritional advice, supplements and activation exercises. Be proactive and don’t wait until you are injured.

5Service your body regularly

Just like you service your car before it breaks down, your body also work best when serviced regularly. Not only does it run better but there is less chance of it breaking down. Treatments that work well for maintenance care are massage, reflexology, chiropractic, osteopathy, bowen therapy and physiotherapy to name a few.

6Strengthen your feet and avoid barefoot running unless you’ve properly prepared

This day and age our feet are much weaker than they were designed to be as we are in shoes often before we even take our first steps. There is a movement back to barefoot running and although there are many benefits to being barefoot the main issue I see is that people often don’t allow enough time to transition from shoes to barefoot. In my opinion, unless your lifestyle supports the transition to be predominantly barefoot then you are increasing your chance of injuries, and as a runner even more so as impact from running compared to even walking can be up to ten-fold if your feet are not strong enough to cope. Foot and arch strength exercises are essential to keep the feet strong, especially if you are wearing orthotics (which although they support the feet and prevent injuries, they are actually doing the work for the foot and hence make them weaker over time).

7Progressively overload your training program and train on softer surfaces

We all know you cant just train at high intensity all year round or just throw yourself into full training after a rest or an injury. A well planned and periodised program that includes progressive overload is another key in preventing injuries as it allows your body adapt to the training load over time. Running on softer surfaces (like dirt or grass), rather than on the hard surfaces (like road or cement pathways) also gives the body more longevity as there is less impact on the joints and muscles.

8Make sure your core is strong and do exercises specific for your body

Many people don’t realise the importance of core strength in prevention of running injuries. Having a strong core protects your lower back and also gives you a strong base to pivot around when you run. If your core is strong, then the lower back is more stable, which allows the gluteals to fire better and in turn takes load off the hamstrings and knees. Have a professional prescribe specific exercises that will target your weaknesses but a great general exercise for strengthening your knees is to do wall sits.

9Stretch regularly

No matter how flexible you are, running tightens your muscles. A regular stretching program incorporated into your training will most likely prevent injuries and also assist performance and recovery. This can be teamed with massage, epsom salt baths, sauna’s, heat, ice and hot/cold treatments if required. If you don’t like stretching think about joining a yoga or Pilates class to combine core activation and stretching together.

10Make sure you’re hydrated and eat well

If your body is dehydrated and/or nutrient deficient you are much more prone to injuries. Seeing a naturopath, nutritionist or dietician could help you tweak your diet to make sure you are replacing what you lose whilst exercising. General rule for water is 1L of water per 25kg of body weight per day. Magnesium, potassium, sodium and calcium are important for bone and muscle recovery (particularly assisting in the prevention of delayed-onset muscle soreness, muscle strains and stress fractures). Omega three and curcumin are great for anti-inflammatory support (assist recovery and prevent inflammation) and glucosamine and chondroiten are great for supporting joints and cartilage (especially speeding up recovery of knee and ankle issues) to name a few important minerals for athletes.

SOURCEiStock/ yanJLane
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Dr Kate Wood
Born and raised in rural Northern NSW, Kate's love for health and the body started when she won her first athletics race at age 8. During her many years of study – a Masters of Chiropractic and post grad training in acupuncture, clinic neurology and advanced injury rehabilitation, amongst other things - Kate also developed a passion for family wellness, in particular pregnancy and paediatric care. In any one day, Kate will perform adjustments, mobilisations, soft tissue techniques, dry needling, kinesiology, diet and lifestyle advice, and even meditation for her clients; and what sets her apart is her commitment to not only addressing the physical ailments of her patients but also the chemical, emotional and spiritual connections they have to the issues and ailments they are facing. Together, she and husband Nick Wood own and run Healthspace Clinics, a series of healthcare clinics across Sydney.