Conditioning: Phase 1

The following is the first of four phases that will guide you from Runner’s Knee injury toward healthy running. Progress from each phase as instructed, applying rehabilitation modalities such as taping where needed.

Duration: 1 Week (at least)
Goal: Reduce pain through unloading
Frequency of Exercises: Phases 1a & 1b are twice per day, and should be pain free. Phase 1c is once per day, in which mild pain is okay. Begin with one of the phases below based on your pain scale.

a. HIGH PAIN

START HERE if pain is >7/10 with squatting and/or running
Goal: Reduce Inflammation. Do not run.

Tape: See video below.

Short Arc Quads: 2 x 20 reps, 2-3 sets per day until pain decreases. On your back, place a foam roll or pillow under your knee. While keeping your knee resting on the pillow, bring your foot off the ground for 2 seconds then back down. Purpose: improve circulation and reduce pain.
Offset Bridges: 3 x 10 reps. Place your injured leg’s foot away from the body. This will decrease load on the affected limb. Bring your hips up and down. If it is too painful on the injured knee, then bring the foot further out or put less pressure on the foot. You should feel your hip and thigh muscles working. Purpose: improve circulation and reduce pain.
Calf Stretching: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight. Purpose: address calf restrictions.
Walking: If minimal or no pain when walking, walk throughout the day in 5-10 minute intervals on a flat surface. Purpose: maintain some loading of the knee.
Ice: 10 minutes. Place around the knee to reduce pain and inflammation.

b. MODERATE PAIN

START HERE if pain is 4-6/10 with squatting and/or running
Goal: Continue to reduce pain. Can work into very mild pain (<2/10). Do not run.

Tape: See video below.

Double Leg Bridges: 3 x 10 reps. Place your legs shoulder width apart with knees bent. Bring your hips up and down. If it is too painful on the injured knee, bring your feet away from your body. Should feel muscles working on the hips and thighs. Purpose: increase circulation and mild load on the knee.
Long Arc Quads: 2 x 20 reps. Sitting upright, bring your injured foot in the air and hold for 2 seconds. Bring it back down and repeat. Purpose: increase circulation, improve healing, and reduce pain.
Clamshells: 3 x 16 reps. Lying on your side with your knees bent (hips to 45 degree angle), bring your top knee up and hold for 3 seconds, then back down. Repeat until 16 reps or fatigue. Should feel muscle work in the hips. To add a challenge, you can add a Resistance Band around your knees (recommended). Purpose: address glute weakness.
Walking and/or Biking: (light resistance) Perform with seat higher to reduce pressure on the knee. Walk on flat surfaces as tolerated.
Calf Stretching: 1 minute per position, each side. With shoes on or arch support using a towel, keeping your heel on the ground in a split stance, bring yourself forward keeping your knee straight for 1 minute, and then bend for 1 minute. Purpose: increase ankle mobility to decrease strain on knee.
Ice: 10 minutes. Place around the knee to reduce pain and inflammation.

c. MILD PAIN

START HERE if pain is < 3/10 with squatting and/or running
Goal: Wait to begin adjusted running until the end of Phase 2.

Single Leg Glute Bridges: 3 x 8 reps. On your back with one knee up. Bring hips up and down slowly. You should feel muscle work on the thigh and hips. Purpose: Increase glute strength to reduce knee caving in.
Rose Hips: 3 x 12-16 reps. On your side with your body straight, bring your lower leg up for stability. Your top leg, with toes biased downward, goes up and down slowly to recruit muscles on the side of your hip. Be careful not to let your top hip come forward (easiest to do this along a wall to prevent compensation). Purpose: increase hip strength to reduce knee caving in.
Shallow Squats: 50% of depth (mild pain okay) with Resistance Band (if accessible). 3 x 8-10 reps. With knees shoulder width apart, slowly come down into mild pain (<3/10), and come back up. If able, place the resistance band around your knees to recruit your glutes with the squat. Perform shallow squat to prevent excessive loading. Purpose: begin loading the kneecap to increase load capacity.
Single Leg Balance: 3 x 30 seconds (each leg). Ideally, complete this in front of a mirror. Stand with both hands on your hips while your feet are directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Hold that position. Purpose: improve hip, knee, and ankle joints stability.

Stretching: Quads and Calves (1 minute per side). Purpose: reduce compression forces on knee.
- Quads: With one leg on the table/couch/bed, the other leg is off the table. Grab a belt or two (or Resistance Strap) and hook one end on your foot that is on the table. With your body aligned up straight, begin to pull your heel towards your hips until you feel a moderate stretch in the front of the thigh. Hold for at least one minute. If pain increases, place a towel under your thigh to pre-stretch the quad.
- Calves: 1 minute per side. Standing with one foot back, place your toes on a half roll or rolled-up towel to increase stretch. Lean forward while keeping your knee straight.
- Hip Flexors: In the kneeling position with your arms supported on the wall, engage your abdominals by doing a posterior pelvic tilt (i.e. low back is flattened with a limited curve). Engage your glutes on your kneeling side and keep your body as a unit until you feel a stretch in the front of your hip. You may increase your stretch by leaning away from the side.
Ice: 10 minutes. Place around the knee to reduce pain and inflammation.

TO GRADUATE TO PHASE 2

Required: Can do a squat (<3/10 pain) for three consecutive exercise sessions
Required: Can sleep without waking up from pain in the knee
Note: If you begin at Phase 1.a., before graduating to Phase 2, be sure to progress in turn through Phases 1.b. and 1.c.

Principles of Runner’s Knee: A Review

CAUSE – overuse and/or overloading of the patella
NEED – offload and reduce compression forces on the patella, and also increase quad and glute strength
PLAN – once pain is decreased, gradually reload the patella to increase strength

Still Need Help?

You are welcome to meet virtually with our PT for additional feedback and assessment. Otherwise, continue to the next step to learn how best to manage the pain from your injury.