Runner’s Knee (PFPS): Return to Running Pain Free
In this final section on Runner’s Knee (PFPS), we will review how to safely progress back to running. At this point, you have learned the factors that can lead to PFPS, how to calm the knee down, and how to build up knee and hip strength as outlined in previous blog posts. Now the question is, how do I return to running? In this post, we will outline a few considerations prior to starting a return to running along with a sensible return to run program. Remember, this is general information as each person and case varies. There is no one “perfect plan” to get you back on track.
Readiness Checklist:
Before getting back into running, consider the following questions:
Are you pain-free with daily living?: Walking, navigating stairs, and sitting for prolonged periods with pain < 2/10.
Do you tolerate single-leg loads?: Perform 10 consecutive single-leg box squats or step-downs with steady hip alignment and pain < 2/10.
Can you manage dynamic impact?: Complete a 30 second single-leg hop test or a "jog-on-the-spot" drill without symptom progression.
Have you developed knee and hip strength?: Tolerating dynamic quadriceps and glute strength work at ~12 RM resistance without next-day knee pain.
If you answered yes to all these, then great! You can feel confident about moving onto the next steps for the return to run progression. If you were not able to answer yes for all these questions, you may want to consider addressing your specific deficits prior to moving forward. It should be noted that these are not the end all be all. For some, they are able to progress into early stages of return to running while still improving their current limitations.
Return to Run Framework:
This framework will provide a basic guide for the progression from walking to full return to running speed intervals. However, this is not all encompassing as there should be intermediate progressions within each “step.” For example, notice how the first two sections are only focused on walking progressions. For some, they may be able to skip these sections completely and move into a walk/jog progression depending on symptoms.
Step 1: Easy Walking / Flat Cycling
Goal: Build aerobic capacity with minimal load on the patellofemoral joint
Time: Start at 15-20 minutes to start, progress to 30-45 minutes
Frequency: 2-4 days/week with at least 1 rest day between sessions
Step 2: Fast Walking / Medium-to-Hard Cycling
Goal: Increase load on the patellofemoral joint while improving aerobic base
Time: Start at 15-20 minutes to start, progress to 45 minutes
Frequency: 2-4 days/week with 0-1 rest days between sessions
Step 3: Walk-Run Intervals & Slow Jogging
Goal: Expose the patellofemoral joint to short intervals of running load
Time: Start with 5-10 intervals of 1 min jog/1 min walk, progress to 5-8 intervals of 4 min jog/1 min walk
Frequency: 2-4 days/week with 1 rest day between sessions
Step 4: Continuous Flat Running & Stair Climbing
Goal: Build tolerance to continuous knee joint loading cycles
Time: Start at 10-15 min, progress to 45 min
Frequency: 2-5 days/week with 0-1 rest days between sessions
Step 5: Medium-Speed Running, Moderate Hills & Light Plyometrics
Goal: Improve capacity to handle high levels of joint load at various paces and inclines
Time: Start at 5 intervals of 30s with at least 90s recovery, progress to 10 intervals of 60-90s with at least 90s recovery
Frequency: 1-2 hard workouts per week with at least 1 easy or off day between hard sessions
Step 6: High-Speed Running, Speedwork & Full Sport/Race Return
Goal: Experience full knee joint load in all conditions
Time: Start at 4-6 intervals of 15s with at least 90s recovery, progress to full return to desired intensity
Frequency: 1-2 hard workouts per week with at least 1 easy or off day between hard sessions
Keys to Progression:
Before progressing to the next step ensure that symptoms remain less than 2/10 during the activity and for the next 24 hours upon completion. If symptoms do flare up greater than 2/10 during or after, allow for additional rest time until symptoms subside before attempting another session at your given step.
Ensure that early walks and run progressions should be performed on level ground. This will help to avoid the excessive forces that downhill running places on the patellofemoral joint. As tolerance levels increase, downhill running can be progressed as well.
Management Moving Forward:
In combination with this running progression, strength training activities and lifestyle management remain key factors. Sleep, nutrition, and managing stress levels remain important during these phases as your body learns how to manage higher joint loads and build its capacity. So, if you are able to start jogging again but completely skip out on strength training, don’t be surprised to find yourself back in a flare up state. Remember, runner’s knee is a nagging condition that has nearly a 50% recurrence rate!
Despite being a complex multifactorial condition, runner’s knee or PFPS is a condition that can be overcome. Through the proper understanding of the condition, building of tissue capacity, management of lifestyle factors, and progressive return run program, you will be able to get back to achieving your running goals. We hope that through this post and our previous ones, you have been able to learn some more about runner’s knee, how to manage, and how to better trust your body as you continue on your running journey.
If you live in the CSRA and are looking for more guidance on runner’s knee management or a return to run program, set up an appointment with us TODAY on our booking page! We look forward to helping you achieve your goals!
Disclaimer: This information is for educational purposes only and does not constitute medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or health-related goals.
References
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