Monday, September 3, 2018

Preventing Runners Knee - Part IV

Last week, we continued our discussion on how to prevent runner's knee with a discussion of the variety of diagnosis's that fall under the category of "runner's knee".  We also spoke about the first line in defense to preventing runners knee.  This week we will start off our discussion looking at stretches that can be performed to prevent runner's knee.
  • What are some exercises and/or stretches people can do at home to treat runner's knee? 
    • Stretches/soft tissue mobilization – in general terms, we typically have all runners work on mobility of the entire lower kinetic chain.  This would include the following stretches/mobility movements which we perform with a vibrating foam roller (Hyperice).  Key is to make sure you are not just “smashing” the tissue but providing a good stretch while providing comfortable pressure.  Use of the vibrating roller facilitates greater relaxation of the muscle and more comfortable stretch through greater ranges of motion.  This aids in recovery following a hard run.  We typically have runners do this on their non-running days or to help recovery following a hard run.  Typically we will spend a good 15-20 minutes on these recovery exercises.  
      • ITBand - Start by lying on the vibrating roller in the position indicated.  Slowly roll the foam roller from the TFL (from the crest at the hip) down along the ITband to the knee.  At the same time, move the leg in an adducted position while bringing the hip toward the floor. 


      • Hip flexor/quad – Start by lying on the vibrating roller in the prone position, keeping your abs tight, roll the foam roller from the anterior hip down along the quad.  You can increase the stretch to the quad by flexing the knee during the motion.


      • Hamstring/Glut – lying in a long sit position, roll the foam roller from the glut along the entire length of the hamstring.  To facilitate hamstring stretch, keeping your knee straight, abs tight, bring your butt to the ground and slowly flex forward while keeping your chest up.   
      • Calf – Sitting in the long sit position with your knee straight, roll the foam roller from the back of the knee to the Achilles tendon.  To facilitate the stretch, as you roll down the calf, slowly dorsiflex (bring your foot up) while keeping your knee straight.


      • Soft tissue mobilization - In addition to the above, we have also found another great tool to aid in recovery that is relatively inexpensive.  The Hypervolt is a percussion gun that we use primarily for soft tissue mobilization and will even use in combination with stretches.  This tool has some solid science behind it and you are now finding this in most athletic training rooms in professional sports.  I find a lot of athletes get some great relief especially when working our muscle soreness from a previous training session.  


      • Pre-Run Routine - In addition to these stretches, we also have runners do the Run Safe pre-run routine prior to each run.  These dynamic stretches aid in creating the level of mobility needed for a run in addition to providing a warm up to the neuromuscular system for providing stability through full range of motion.
  • What are some recommendations you have for runner's if they want to prevent runner's knee, something they can do at home?  The Run Safe program is specifically designed to address the biomechanical issues that result in runner’s knee.  This free app has videos for every exercise and has both a pre-run routine as well as a post run routine.  
    • Pre-run routine - prepares the runner by taking the lower kinetic chain through full functional range of motion all while maintaining stability.  This routine takes 5 minutes to implement and serves a warm up for running.  
    • Post run routine - is done immediately after the run.  This fatigue state training has better carry over to improving a runner’s biomechanics when it matters the most, when they are tired.  These exercises focus on single limb stability, proprioception, glut strengthening and core strengthening.  
    • The Run Safe program - has 4 levels of progression so that as the athlete masters one level, they can move onto the next.  This way they can continue to progress their strengthening program, constantly driving improvement in biomechanics and athletic performance.  This program has not only been shown to reduce injuries in runners but also shown to improve sprint speed and endurance.   


We hope you are enjoying this series.  Next week we will wrap up our discussion on runners knee.  Stay tuned and please share with others you think might be interested.  #ViPerformAMI #ACLPlayItSafe


Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu.