Marathon preparation: taking care of your knees
It's hurtling towards us at a huge rate of knots, like Brexit, Christmas and Whitsun all rolled into one, but none of these require the same volume of physical, mental and emotional preparation as the London Marathon* (except perhaps Christmas....). As your mileage racks up, certain areas can get tighter, having a knock-on effect elsewhere - in particular the outside of the knee.
If you notice that your running style has started to involve a little more of either your foot turning outwards whilst your knee is facing forwards or your knees turning inwards whist your foot is facing front, this can often end up to soreness in the outside of the knee, increased tension in the iliotibial band (ITB) and/or tightness in the outside of the hip. As the miles increase and this pattern is repeated, it can become very sore. However, there are a few things you can do to check the cause of this.
Where does it come from?
The reason the knee will be turning inwards, or the foot relatively turning out will be related to one of 3 areas:
Tight calf muscles
Weakness/inhibition of the hip rotators
Overactive lateral hamstrings
Knee valgus - this isn’t A Good Thing.
Tight calf muscles:
If the alignment issue corrects by doing a decline small knee bend (see images below), it is likely the calf muscle (particularly the gastrocnemius, fact fans) is likely to be part of the main drive of the problem.
Decline small knee bend
If you think you aren't stretching your calves out sufficiently, then start. As soon as possible. If not sooner.
As we fatigue when we run, certain muscle groups will become less effective leaving us with few options to propel us forwards. It often comes down to the calf to drive this and if they aren't getting a sufficient stretch, then the change in mechanics can become problematic. Stretching the calf with a straight knee (fully straight) and holding for up to 20 seconds at a time will help. Not only after a run, but check and stretch regularly through the next few days too.
Weak hip rotators:
If the decline small squat doesn't correct things, it is likely to be a problem with the rotators in the hip, including gluteus medius and some of the deeper rotators. Some light conditioning work can help resolve this problem
Overactive lateral hamstrings:
Difficult to spot on yourself, but if after toe off, your foot tends to turn outwards as the knee comes forward, the outer hamstrings might be dominating the movement. Exercises to balance out knee flexion by using the more medial hamstrings can help, as can identifying which of the other two problems need addressing and working on all of them
Anything else?
Lateral quads stretches can be really useful for this. Think of doing a normal quads stretch (i.e. heel to backside) but stretch using the opposite hand to the affected leg and pull it across to the opposite buttock and push your hip forward. This should favour the outside of the quads around the tight area
Do I really need to stretch?
Stretching is a bit of a faff and it means extra time added onto your run, however it is one of the key practices at this stage to return you ready to run again when you need to train. Just do it!
* other marathons, indeed, other long distance races do exist.
Don’t ignore your niggles or pains this late in your marathon training. Call us for an appointment on 02030 12 12 22.
Words by Paul Martin. Images courtesy of www.medi.de and runningreform.com.