How to Prevent Runners Knee Through Science-Backed Training
Knee pain is one of the most common issues faced by runners, with runner’s knee (patellar tendonitis) being one of the leading causes. This condition often sidelines runners from the sport they love, but it doesn’t have to be this way! Strength training, when done strategically, can not only improve your knee strength and heal runners knee but also support tendon health to reduce your risk of developing it in the first place.
In this article, we'll explore how you can use strength training to bolster your knees, keep you running pain-free, and increase your longevity as a runner. We’ll dive deep into how this type of training can prevent patellar tendonitis and why it’s so effective. If you’re a runner who wants to keep running without worrying about injuries, keep reading!
What Is Patellar Tendonitis (Runner’s Knee)?
Patellar tendonitis, often referred to as runner’s knee, is a condition that involves irritation of the patellar tendon, the tissue connecting your kneecap (patella) to your shinbone (tibia).
When the demands placed on your knees—whether from running, strength training, or other physical activities—are greater than your tendon’s ability to recover, this leads to changes in your patellar tendons. Over time, if not addressed, this imbalance can develop into patellar tendonitis, causing pain that ranges from mild discomfort to severe, sharp pain, particularly when running, squatting, or jumping.
Common Symptoms of Runner’s Knee
Pain at the front of the knee: This is typically felt just below the kneecap (the orange area below your kneecap shown in the above video) and often worsens with activity.
Swelling around the kneecap: Often, with tendonitis, there is fluid accumulation in the tendon, which leads to swelling and tenderness in the area.
Stiffness after inactivity: You may feel stiffness in your knee when you first wake up or after sitting for long periods.
The Three-Pronged Approach to Preventing Patellar Tendonitis
To effectively prevent runner’s knee, we need to take a three-pronged approach that addresses tendon health, tendon recovery, and managing overall stress levels (also known as allostatic load).
1. Tendon Health: The Role of Resistance Training
You may have heard that it’s helpful to strength train as a runner but not really know why? Let’s break this down…
Over 80% of all running relates pains and injuries are due to tendon irritation.
So, it’s smart to have a plan that focuses on keeping all your tendons (not just your patellar tendons) strong and healthy.
Heavy resistance training has been shown by research to increase cellular turnover in your tendons. This cellular regeneration helps to:
Improve the structural integrity of your tendons (which helps heal and prevent tendonitis)
Reverse some of the effects of aging on your tendons (which helps improve your longevity with running)
Change the elasticity of your tendons (which helps with running performance)
Now, you might be thinking…”sounds cool but how long does this take each week? I’m busy!”
To quote a current client…
“I had no idea I could feel so much stronger and prevent injuries in less than 2 hours a week!”
What Does This Look Like in Practice?
Frequency: Strength train each key muscle group (hips, hamstrings, quads and ankles) 1-2 times per week.
Load: Use heavier weights with lower reps (3-6 reps per set) and longer rest periods (2-3 minutes between sets).
2. Tendon Recovery: Understanding the 24-48 Hour Cycle
Your tendons recover on a 24-48 hour cycle, meaning that the workout you did yesterday is still affecting your tendons today. This is why people experiencing runners knee might not feel pain during a workout but moreso after a workout.
This 24-48 hour cycle means that you want to give your tendons 24-48 hours to recover after any exercise to avoid overworking the tendons and kicking off a tendonitis reaction.
How to Optimize Recovery:
Space out your workouts: If you’re new to running or returning from injury, running every other day allows your tendons to fully recover before they’re challenged again.
Rest after intense efforts: After a speed workout or a long run, buffer your training with a rest day or a less intense workout to allow your tendons to recover.
Recovery imbalances often accumulate over time. You might not feel pain initially, but if you don’t allow your tendons adequate recovery time, the chances of developing patellar tendonitis increase.
3. Managing Allostatic Load: The Impact of Life Stress
Your body doesn’t differentiate between physical stress from a tough workout and emotional stress from work, relationships, or lack of sleep. All stress contributes to your allostatic load, which affects your recovery and performance.
Allostatic load is the term for the cumulative amount of work your mind and body is doing at any given time.
In fact, leading research shows that the number one risk factor for women to develop tendonitis in the hip is…life stress. Not strength, endurance or anything else!
Practical Tips for Factoring This In:
Listen to your body: If your legs feel unusually heavy during a workout, or if everything feels harder than usual, recognize that stress—whether from life or training—might be the cause. Dial back your effort instead of pushing through fatigue.
Buffer stressful periods: Research shows that athletes are more prone to injury during periods of high stress. If you’re going through a particularly stressful time, consider incorporating more rest or lower-intensity workouts into your training plan.
Conversely, during times of low stress and good sleep, you can push your body harder. The key is to balance your life stress with your physical training to avoid overloading your body (and your knees)
Runner’s Knee Prevention Checklist
So, how do you apply all of this information into a training plan that reduces your risk of patellar tendonitis?
✅Strength Train Regularly: Focus on strengthening the muscles around your knees, including your glutes, quads and hamstrings. Aim for 1-2 strength sessions per week, using heavy weights and long rest periods.
✅Gradually Increase Your Running Mileage: To avoid overloading your knees, follow the 10% rule, increasing your mileage by no more than 10-12% per week. Research shows that increasing mileage by more than 30% over two weeks puts you at a higher risk for knee pain.
✅Incorporate Recovery Days: Include rest days and ensure you're getting adequate sleep to allow for proper tendon recovery. This will help prevent the accumulation of stress that leads to injuries like runner’s knee.
✅Buffer Allostatic Load : Remember that your body responds to all forms of stress, not just the physical stress from running. This might mean adjusting your training volume during particularly stressful times in your life.
If you're ready to take the next step and want custom, science-backed workouts designed specifically to strengthen your knees and reduce your injury risk, I offer personalized strength and mobility plans tailored to your unique needs. You can learn more about them here.
Thank you for reading, and remember: smart training today leads to pain-free running tomorrow!
