Conditioning: Phase 3

The following is the third of four phases that will guide you from Runner’s Knee injury toward healthy running. Progress from each phase as instructed.

Duration: 2 Weeks (at least)
Goal: Progressive Loading and Mechanics
Frequency of Exercises: 3 x per week (day off in between)
Warm Up: For at least 5 minutes before activity (e.g. Pre-Run Warm up).

Split Squats: with weight, load to mild pain (<3/10); 3 x 8 reps (slowly: 3 second down, 3 second up). Standing with one leg forward and the other leg back, come slowly straight down towards the ground by bending your knees. Your body should not lunge forward during the movement. Come slowly back up and repeat movement. Purpose: increase load on knee for improved resilience in tissue.
Single Leg Balance (Running Man): 3 x 30 seconds. Stand with both hands on your hips with your feet directly under you. Keeping your pelvis as stable as possible, bring one leg up without causing your pelvis to tilt or rotate. Bend the standing leg slightly, and go through a running motion with the other side by bringing the leg backward and forward. Purpose: improve balance and stability.
Captain Morgans: 3 x 30 seconds (each side, along wall) or 3 x 8-10 reps. Next to a wall, stand straight and bring your “wall side” knee up; you can use a ball, but if you don’t have one just use the wall. Keeping your torso straight with hands in front, begin to squat down by bringing hips back then bending knee. On one leg, without that knee caving in, push your knee hard against the ball or wall. If it’s too easy, you can go up and down slowly, but should primarily feel your hip and thigh muscles working. Purpose: increase hip strength to reduce knee from caving in.

Side Planks (Leg Up): 3 x 30 seconds (with leg up; each side, or until fatigue). With elbow aligned with shoulders, come up on your side. Keep your body straight throughout. Purpose: improve hip strength and core stability to reduce risk of knee caving in.
Front Plank: 3 x 30 seconds or until fatigue. On your elbows and knees, bring your knees off the ground and hold. Try to keep your body level throughout this exercises by keeping your hips level and engaging your abdominals and glutes. Keep your elbow below your shoulders and push up to engage your scapular muscles. Purpose: strengthen core and glutes for running form stability.
Single Leg Calf Raises (On Step): with weight, 3 x 12-16 reps (each leg). Place your toes on a step with heel off of the step. Come up and down, raising straight up in the air without moving forward. Purpose: increase calf strength to reduce knee flexion with running.
Run/Walk Progression
Jump Roping: 3 x 30 seconds to begin plyometric loading.

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.

TO GRADUATE TO PHASE 4

Required: no pain with split squats (10 reps) or squats with weight (10 reps) for 4 consecutive exercise sessions
Ideal: can hold a side plank for 1 minute (each side)
Ideal: able to complete 25 reps of single leg calf raises
Ideal: quad flexibility to hips – able to bring heel to hips with minimal stretch while you’re lying on your stomach
Ideal: able to hold a single leg glute bridge for 60 seconds (each side).

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.