Knee & Ankle By Sophie Xie / May 13, 2016 Running knee pain? 3 surprising muscle weakness you need to address Knee pain happens at any point of one's running career. Running knee pain is more than discomfort, it can affect your athletic performance, change your movement pattern, and may potentially lead to other body pains and more severe knee injuries. Running, as a exhilarating exercise, puts our musculoskeletal mechanism to the test. Certain muscle weakness unnoticed under normal daily functions will force our body to compensate during running. It does not take too long before our joints start to scream complaints.In this blog post, I have listed the top three muscles weaknesses that causes running knee pain, yet often go unnoticed by runners and athletes. Easy and convenient exercises are also provided to help you overcome these weaknesses and resolve your pain with the least amount of downtime and disruption to your running routine.If you are a novice runner, or planning to start running, you can prevent running knee pain by starting on the listed exercises to strengthen these muscles.Weakness #1: Gluteus medius weakness causing outer knee pain and hip painAll gluteus muscles are super important in the mechanism of running. Gluteus max muscles are the powerhouse of lower back movements. Gluteus medius team up with the tensor fasciae latae muscle and gluteus minimus to support our hip and body on a single leg, and running is all about on a single leg. Runners normally have strong gluteus max muscles, allowing them to sustain this excellent cardio exercise. However, the oversight often occur at gluteus medius muscle. Weak gluteus medius muscle will overload the tensor fasciae latae muscle, thus shooting pain down the IT band and causing outer knee pain.Weakness in gluteus medius can also overload the piriformis muscle, forcing the piriformis muscle to tense up, causing severe pain in the buttocks and resulting in piriformis syndrome.The clamshell exercise is an excellent core exercise to strengthen gluteus medius muscles.Clamshell Exercise Lay on your side (choose one, you will need to do it on both sides anyway). Ideally, you want to press your back and heel against a wall or furniture to prevent compensation.Bend your knees 90 deg and place your foot so that they form a line with your trunk.Then, without moving your trunk, lift your top knee off the bottom knee, while keep your feet together.Once you cannot move your knees further, slowly place it back on top of the bottom knee.Repeat this exercise anywhere from 10 to 50 repetitions until you are tired and start feeling the burn in your hip. Switch and do the same on the opposite side.Frequency: My personal preference is to encourage patients to slowly increase their clam shell exercise repetition over time, until they are able to perform 50 on each side. At the mean time, you should also include an IT band stretch (or TFL stretch) and piriformis muscle stretch as part of your stretch routine to prevent knee pain with running. #2: Quadriceps muscle weakness causing running knee pain over knee capPain over the knee cap during activities is a condition known as patellofemoral syndrome, or PFPS. This condition is very common among active individuals, resulting in pain, swelling and possible secondary injuries. Tons of studies has been done attempting to isolate the cause of PFPS. For a good decade, the blame was placed on a specific part of the quadriceps muscles called the vastus medialis oblique muscle, or VMO. It was believed that the VMO was responsible for keeping the knee cap in proper tracking during movement, thus a weak VMO equals poor tracking of the knee. More recent studies brutally killed this golden standard in the world of knee rehabilitation. Studies such as Kooiker et al's, showed significant evidence that strengthening of entire quadriceps muscle group is more effective in treating the PFPS. If you are a beginner runner and would like to start slow, the straight leg raise exercise is a good and safe place to start if done properly.Straight leg raising: Lie on your back with your affected leg straight and your other leg bent. Tighten your thigh muscles then lift your leg no higher than the other knee. Keep your knee fully straight while you lift and lower your leg. Keep your thigh muscles tight while you lower your leg. Repeat 10-20 times, 3-4 times per sessionHowever, if you are a seasoned runner and ready for more functional exercise, you can start with the wall squat exercise. Wall squat is a closed-chain exercise that involve both quadriceps and hamstring muscle control. Wall squat: Stand with your back to the wall and your feet about 12 inches away. Perform a small squat by sliding your back down the wall, making sure your knees stay over your ankles. Hold the position for 5-10 seconds. Return to standing and repeat 10-20 times.Pain with wall squat? If you experience pain in your knee cap while performing the wall squat exercise, please do not push through the exercise. No pain no gain does not apply here. Try straight leg raises exercise until your knee condition improves.While working on quadriceps strengthening, I highly recommend you consistently stretch your hamstring and quadriceps muscle before and after your running sessions. Stretching is as important as strengthening for athletes in pain. #3: Tibialis posterior weakness causing running knee pain and ankle painThe tibialis posterior muscle is a deep calf muscle. Just like the meaty gastrocnemius and soleus muscle, the tibialis posterior muscles help to lift your heel and propel your body forward when you run. The tibialis posterior muscles also stabilize your ankle and support the long arcs of your feet.Those individuals with weak tibialis posterior muscles may observe decreasing arcs in one or both of your feet. You may also notice one or both of your ankles collapsing or rolling inward towards each other. This is prone to happen to those with recent or repetitive ankle sprain, and those with hip weakness and increasing body weight.Weakness in tibialis posterior muscles may be overloading ankle joints and muscle tendons, causing inner ankle pain. This weakness will also place extra stress on larger calf muscles and knee joints, causing inner knee pain or pain in the back of the knee.Heel raises with a tennis ball is an effective yet convenient exercise to strengthen the tibialis posterior muscle and gastrocnemius muscle at the same time.Heel raises with a tennis ball Place a tennis ball or a baseball between your anklesGently squeeze the ball to prevent it from escaping and raise both heels up and downYou may hold onto walls or furnitures for balance at firstRepeat 10-20 times until or you feel muscle burn You should follow this exercise with the tibialis posterior stretch for 30 seconds. To stretch tibialis posterior muscle, perform regular calf stretch with outer side of foot propped up with a small subject like towel roll. This stretch will prevent development of tibialis posterior tendonitis.These are the three common muscle weaknesses that could cause running knee pain.What do you think? Do you agree? What is your experience? Please leave comments for me follow.Thank you for reading, and I hope you find this post helpful.Like what you just read? Share this post via our social media buttons! They are everywhere on this page!Want to know more about treating your own pain with techniques from a physical therapist?Please subscribe to our newsletter!