My Exact Day-to-Day Runner’s Knee 1 Month Recovery Itinerary

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Runner’s knee always comes at you at the worst possible time. When you’re really feeling motivated and committed to your training, maybe for something big like a marathon or long distance trek, it arrives to humble you. That tracks – it’s an overuse injury most often caused by doing too much too soon and significantly ramping up your mileage beyond what your body is used to. It’s a slap across the face right at your most ambitious, hopeful, determined moment.

I bounced back from runner’s knee once before and already learned how to avoid the contributing factors that lead to it, but here I am again four years later, having to learn this lesson for a second time. Last month I made all of the usual mistakes and brought the curse back upon myself. When you go multiple years without any pain, I suppose you become complacent and quit taking preventative measures. My body hit me with the harsh reality that patellofemoral pain syndrome is something that can always crop up again if you let things slide.

I am a hiker, so runner’s knee can really stop me in my tracks and ruin my whole life. If you know, you know – despite nothing being broken or torn, using your knee with this type of injury can feel so painful that it brings tears to your eyes, and it may buckle under the slightest pressure. This time, I could not even walk five minutes down the street, let alone embark on an actual hike. I even had pain at rest.

With some long treks planned over the next few months, it was imperative that I jump on this immediately and really attack the runner’s knee rehab process. I was not going to allow this to sideline me a moment too long. This meant trying not to overdo it with exercise that could prolong recovery, but also not resting too much and allowing the knee to lock up – a difficult balance.

In terms of performing daily tasks, I became completely pain-free about 10-12 days after the initial injury (Day 1 of that being the day of injury, plus some accidental overtraining on Days 4 and 7 before I understood where my new limit was). I worked up to being able to hike 8 miles pain-free by Day 25 and I could run on the treadmill by Day 28. I consider this the moment of “full recovery” because it means I am comfortable to continue training at respectable mileages now, but of course I will not jump to hiking 20 miles in a day all of the sudden, lest I put myself back at square one.

This post is meant to provide other hikers with a general idea of what runner’s knee recovery can look like in terms of a timeline, what types of exercises and stretches to do, and how to ramp up intensity safely. I am not a doctor or physical therapist. This post is not professional medical advice. I am just a hiker. But I have recovered from this ailment twice, and when I was frantically Googling what to do about my knee so I could be ready for hiking season in time, I found tons of forum threads where runners and hikers were desperately asking each other for anecdotal stories about how they recovered from runner’s knee. Sometimes people just want a defined play-by-play: “this is exactly what I did on a day-to-day basis and these were my results.” This type of personal diary is what I am providing. Obviously everyone is different and what works for me may not work for you.

Runners should understand that everything I did during recovery was geared towards my sport: hiking. It was not important to me to be able to run. I didn’t even try running until Day 28.

What causes runner’s knee?

Runner’s knee or patellofemoral pain syndrome is an overuse injury from repetitive motions, similar to jumper’s knee/patellar tendonitis. It usually occurs when a runner or hiker ramps up their training way too quickly, trying to “go from zero to a hundred” or do too much too soon. If you’ve been running 6 miles a day for the past few weeks and then all the sudden one day you decide to run 15 miles out of nowhere, this could be an inciting incident. Or, if you usually hike flat surfaces and then you suddenly attempt something with serious elevation grade changes, the muscles that support this type of movement may not be built up enough.

Weakness in the muscles that are supposed to support the knee can be a major factor. They say that wherever your overuse injury is, the real culprit is probably located somewhere above or below. In the case of the knee, it could be weakness in the hips, glutes, hamstrings, and/or quads. Runner’s knee is often concurrent with iliotibial band syndrome, which is how it presented for me.

Both times I suffered with runner’s knee, it was after being too inactive over wintertime and then trying to get back into hiking in the spring. This is so frustrating because I really build up my trail legs all spring, summer, and fall, but I lose them so quickly during winter. Interestingly, in the last week I’ve spoken to four different friends who also have overuse injuries right now. They are all hikers or runners who sustained their injuries at the start of spring.

What does runner’s knee feel like?

Like a bitch. For me, the pain was underneath the patella and towards the outside of the knee. This was a clue that it was related to hip mobility problems and glute weakness. Some people feel it more on the inside or front of the knee. Pain may radiate down the shin or up the IT band, but it’s most acute under the kneecap. 

Runner’s knee hurts most when walking downhill or down stairs. Right after injury, though, you may feel pain on any type of terrain or even at rest. Landing hard and putting sudden impact on the knee can elicit a sharp pain during movements as unassuming as a little jog to catch the bus or cross the street. Kneeling also sucks.

Runner’s knee hates when you bend your knee at 90 degrees while sitting in a chair. When you go to stand up there is a crazy stiffness. It’s best to sit with your leg as straight out as possible. 

What are common mistakes athletes make during runner’s knee recovery?

After realizing they’re dealing with runner’s knee, a common mistake athletes make when trying to recover is that they keep reinjuring themselves because they want to get back to things as quickly as possible. They may take a few days or even weeks off from exercise since rest is recommended, but then when they come back to try training again, they do so at a much higher level than what the knee can handle at the moment. Even if you choose a distance or intensity that you would normally consider “easy,” that may still be too much for you at first. 

It takes some trial and error to understand what your new normal is, and it can feel seriously demoralizing. I hated feeling so incapable and not being able to do the sport I love. One of the biggest hurdles with these types of injuries is the mental aspect; I found myself becoming seriously depressed. I totally understand why people keep pushing it and can’t bring themselves to heed advice about resting or doing really low impact “boring” exercises. But at the end of the day, I’d rather feel weak and silly for a few weeks than push myself for ego reasons and prolong the issue for months or even years to come. Not only do I not want to be sidelined and in pain, but I also do not want to be depressed for that long.

Once you find your new sweet spot of how much mileage you can comfortably manage without pain being higher than, let’s say a 3/10 on the pain scale, just stick with that for a couple weeks. For me, I found out I could only walk about 2-3 miles without pain. From here, experts say not to ramp up your training by more than 10% per week. Since my starting point was 2 miles, I found the 10% rule impossible and much too slow. I ended up adding 1-2 miles onto my daily walking distance each week instead. I didn’t follow the rules.

Why might your individual recovery process look different than mine?

I will tell you some personal details about myself so that you understand why the recovery plan below worked for me, and so that you can add or subtract whichever elements will help tailor things to you. 

First of all, I am a woman. Some people might try to argue that this shouldn’t matter, but it really does. I am naturally knock-kneed anyway, and so are all the women in my family. Some single-leg exercises are not ideal for me because my knee really caves inwards. I get better at these after building strength in other ways, but I would not start out with something like a single-leg squat in the early days of my training program.

Secondly, I determined that the main muscle weaknesses contributing to my knee problems were in my glutes (gluteus medius and minimus) and hips, so I really focused on exercises that would improve those areas. If you believe you need to focus more on calves, quads, or hamstrings, you might assemble a different list of exercises.

How long does it take to recover from runner’s knee?

The official prognosis estimates a 4-6 week recovery time for runner’s knee. I felt pretty much “recovered” by Days 25-28, so I clocked in right at that 4 week mark. This is very annoying because I desperately wanted to beat the system and do it quicker, but apparently I am a statistic!

I put “recovered” in quotes because my goal is to be ready to complete a long multi-day trek with a heavy backpack. Trekking represents my ideal fitness level, so completing one will signal full recovery. I will begin a trek on Day 45, week 6 (I will update this post on how it went). I will never know if I could have completed this trek pain-free if I had started it on Day 28.

*Post-Trek Update: I completed the Malerweg Painters’ Way trek in Germany without issue! I carried a heavy backpacking pack full of tent, sleeping bag, etc. for 8 days. The Malerweg involves about 10,000 stairs, I am not exaggerating. There are ladders too. I didn’t realize the extent of the stair situation, so it was really the worst possible trail I could have embarked on just after recovering from runner’s knee. But somehow I did it and my knees didn’t snap in half.

I have read a lot of anecdotes online about people who took way longer than 4-6 weeks to recover and continued to have persistent issues for months. Like most people who suffer from runner’s knee, I did not want to slow down initially. Taking a break from my sport sounded like the worst possible punishment. This caused me to make a few mistakes in the first week as I came to grips with my injury, but then I got my act together and really tried to be smart about not pushing my training too much. I think this is what allowed me to meet the 4 week timeline.

I have also heard about quicker recovery periods, although these are fewer and farther between. Some hiker friends told me they just kept hiking through it and it eventually went away, which is exactly what I wanted to hear at the time, but it ultimately didn’t feel like an option for me.

What stretches, exercises, and strategies are bad or ineffective for runner’s knee?

If you have runner’s knee, then you know that squats, lunges, and leg extensions are excruciating. No-one needs to tell you this – you can feel it. Do not aggravate your injury with these exercises or listen to uninformed gymbros who try to tell you that squats are always the solution to everything. Eventually when you can work them back into your program, consider this a win and a big sign of your progress. 

Some online articles recommend exercises and stretches that involve getting on your hands and knees on the floor, and I don’t understand this. Something like a fire hydrant can be pretty painful for runner’s knee since you’re just grinding all of your bodyweight right into the patella, and the patella into the floor. 

If any of the exercises I recommend in this post hurt for you, then don’t do them. They were comfortable for me. “No pain no gain” is not applicable to runner’s knee. Pushing through by continuing to do exercises that hurt is not a sign of willpower and determination, it is just asking for more trouble. I know this is a difficult mindset shift for many of us who take pride in doing difficult things and prioritizing mind over matter, but if it hurts you need to lay off.

Many fitness experts recommend K-tape (kinesthesiology tape), sports massage, and foam rolling for runner’s knee. There is no scientific evidence (sources: 1, 2, 3, 4, 5, 6, 7) that K-tape, sports massage, or foam rolling have any healing benefits or long-term effects. It is believed that they may have a placebo effect. McConnell taping has some evidence in its favor, though other studies are inconclusive.

The RICE method is often recommended for any type of tendinopathy: Rest, Ice, Compression, Elevation. However, in recent years some studies have disproven RICE and people are starting to say this is outdated science. A friend who has her Wilderness First Responder certification told me that they don’t even teach RICE in backcountry medicine anymore. There are all kinds of new acronyms to replace it. I have also read that compression sleeves, like K-tape and foam rollers, may be useless, though many people swear they feel more stable with a compression sleeve or brace. Ice provides temporary pain relief by numbing the area and could help with inflammation. The RICE method may still be good if your injury is swelling, but otherwise I think you can take or leave whichever elements of it make you happy. 

What stretches, exercises, and strategies are good for runner’s knee?

Studies do back up that the rest part of RICE is definitely relevant for runner’s knee.

There is a study showing that patellar tendon straps may decrease strain on the patellar tendon.

Hikers need to use trekking poles. Just do it. I don’t know why some people feel like this makes them wussies?

Below are the exact exercises that I did almost daily for my runner’s knee recovery. When they became too easy, I added resistance bands or changed the amount of reps. Each day I picked a handful of them, as I found I couldn’t do the whole list at once. If I didn’t do much walking or other activity one day, then I’d do 4-5 of these exercises. Later in my recovery when I started hiking a lot more and going to the gym, I scaled back and only did 2-3 of these a day.

• Clam shells 3×10
• Side leg lifts (Jane Fondas) 3×10 or 3×12
• Straight leg lifts 3×10 or 3×12 (I didn’t do these quite as often because they made the front of my knee feel weird)
• Glute bridges or single leg glute bridges 3×10, holding for 10 seconds at the top
• Wall slides 3×10; after these became too easy, I would just do 3 sets of 1, but I would hold each slide for a full minute. When that became too easy I did 1.5 minutes, then 2 minutes.
• Single leg Romanian deadlifts 3×5; I focused on holding it and balancing on the standing leg for at least 10 seconds for each rep, rather than quickly doing lots of reps.
• Captain Morgan 3 sets of trying to hold it as long as possible; this is surprisingly hard if you have the right form.

As far as stretching, I often did standing calf and hamstring stretches, butterfly stretches, side lunges, standing chair lunges, and either lying or standing figure 4 stretches. On the advice of another hiker who was determined to recover from runner’s knee quickly before embarking on the Pacific Crest Trail, I also did “glute kegels” as often as possible throughout the day – basically clenching my butt like a freak.

Once I was totally pain-free during daily life activities and 5 miles of walking didn’t bother me, I started incorporating the gym. At the gym I prioritized the following exercises for runner’s knee:

• Cable glute kickbacks 3×12. Keep your standing leg slightly bent at the knee, do not hyperextend. Start with a very low weight and focus on reps, at least until you have confidence in your knee.
• Lateral step downs with dumbbells 3×12. This exercise is beneficial to prepare hikers for downhill terrain.
• Hip thrusts with weight 3×10, holding for 10 seconds at the top.
• Stairmaster At least 15-20 minutes set to a glute workout setting. On some machines, “quick start” only lets you increase speed, but a glute setting will have resistance.
• Treadmill on an incline At least 15-20 minutes. I did a Level 10-12 incline but a less steep grade is probably better to avoid sesamoiditis of the toe joint.

Should you see a physical therapist for runner’s knee?

Anytime you try to ask someone for advice about runner’s knee, they will just shrug you off with, “go see a PT.” However, I’ve read feedback where people who went to a PT felt the therapist didn’t provide any extra education or recommendations beyond what is easily found on the internet. In one forum that is for physical therapists to talk amongst themselves, one professional wrote that they don’t think most people who come in for PT actually need it, and that the main benefit for a lot of people is that it helps them mentally to just have an official diagnosis. 

Personally, I know what my diagnosis is and I know that a physical therapist would prescribe rest and gentle bodyweight/resistance band stretches in the beginning, followed by gradual ramping up of mileage/intensity at 10% per week. I know that other people who have been to see physical therapists ended up being prescribed the exercises I’ve listed above, such as clam shells and wall slides. I do not want to pay the money to go to a doctor. I know that I caused the injury by being stupid and I know how to prevent it in the future. So, for me, it was not necessary to see a physical therapist for runner’s knee. 

99% of other people will tell you yes, you should see a PT, and of course there could be other structural issues at play with your unique physiology. Maybe you have a knee tracking problem where things are not aligning as they should, or maybe there’s something off about your foot strike when you run/hike. If you have the means and the interest, seeing a physical therapist is probably the wise thing to do.

Recommended reading for runner’s knee recovery

Runner’s Knee Exercises from [P]rehab (thank you to trainer Luis Benitez for sending me this link)
Knee pain in runners – A quick guide
3 Minute Mountain Legs
How I Fixed My Knee Injury in Time to Hike 2,450+ Miles This Summer
STOP Knee PAIN When HIKING Downhill
The Myrtl Routine

I have not done the Mountain Proof Knees program because it costs money, but I like this section on their website:

“The biggest problem facing us as hikers is that there is a great deal of misinformation about knee pain on the internet. Information that is not specific to the common problems that come with walking up and down steep hills. The standard approach to building leg strength like squats, lunges and deadlifts will only work the muscles that are probably already dominant. Those standard exercises can often only make your knee pain situation worse. So rather than strengthening the muscles that are already strong from hiking, my solution is to strengthen the muscles that are weak from inactivity and to stretch and mobilize the tight muscles causing pain and inflammation when hiking.”

Yes! This guy hikes. I’m tired of other fitness gurus recommending squats and deadlifts across the board regardless of your situation.

This study on female endurance athletes even says that “adding heavy strength training to endurance training did not affect performance or running economy compared to endurance training only…or change the mechanical properties of the patellar tendon.” There are plenty of health reasons to do the typical heavy lifts, but those reasons have nothing to do with making you a better hiker or endurance athlete or improving patellar pain. Functional strength training focused on underutilized muscles seems to be the way to go.

Can nutrition help with runner’s knee recovery?

Studies show Vitamin C is good for tendon repair because it helps with collagen production; your knee problems may involve the IT band, patella tendon, hamstring tendons, and/or quadriceps tendon. Obviously protein is always great for muscle repair as you work on gaining strength. I am not a nutritionist so I won’t get too deep into supplements or diet.

Day-to-day runner’s knee recovery diary

Legend: red = horrible pain, grey = minimal pain, blue = moderate/intermittent pain

Week one: mistakes

Day 1

Day of the injury. I chose a 13 mile trail, which doesn’t sound crazy considering I’ve hiked longer distances a million times, but in retrospect the most I’d hiked in the prior few months had been about 7 miles. So this doubled the hiking mileage I had grown accustomed to lately, and this trail also involved a ton of steep up and down elevation change. About halfway through the hike I could feel my right hip (IT band, I presume) getting angry, and towards the end of the hike, each descent hurt my knees. It was a familiar feeling from when I had runner’s knee four years ago. I knew I was in trouble.

Day 2

I decided not to hike today in order to give my knees a break, but there was no pain while I walked about 5 miles around town. I even went up and down lots of stairs without issue.

Day 3

This was a rest day where I only walked about 2 miles around town and felt fine, no pain.

Day 4

The prior two days gave me a false sense of security. Today I tried a 7 mile hike plus an accidental 3.5 miles of town walking afterwards (I didn’t know my plans in the city would add that much). After about mile 4 or 5 on the hike, the pain set into my right knee. There was a descent that I had to take really slow. Everything after that was excruciating for the rest of the day. I visited a building with lots of stairs and had to hop down them by hoisting myself on the handrails. 

Coincidentally, it seems like everyone else on the internet who has shared a story about runner’s knee also mentioned they could go up to 4 miles without issue, and then the pain sets in. This distance must be a common trigger point.

Day 5

I rested at home, did my stretches in my room, and only limped down the street to the grocery store and back. It’s a five minute walk one-way. The stretches felt good but walking to the store sucked, and then my knee was way too sore while just sitting. It was tender to the touch and I massaged it frequently.

Day 6

I woke up with no pain, but within a couple hours of being awake and walking around, the nagging tenderness came back. I did my exercises over the course of the morning and early afternoon. I walked down the street and it hurt at first, but not like it did yesterday. It felt better the longer I walked and didn’t hurt much when I got back home. 

At this point I struggled to decide whether my course of action should involve more RICE or more “active rest.” I remember from the last time I had runner’s knee, full rest for too long can really make things worse; you need to load the tendons at least a little bit. The fact that it felt better the longer I walked today made me think I should lean more towards “active rest” tomorrow and get some more walking in on flat, gentle surfaces.

Day 7

Nope. Mistake! 

My knee felt great when I woke up but got worse throughout the day. I did most of my exercises in the morning and then walked around the city. I ended up going up and down more stairs than anticipated, which really hurt. The pain stuck around all day after the stairs, even as I only continued walking on flat surfaces. I came back home after lunch, having walked maybe 2 hours/4 miles, put a compression sleeve on, and rested in bed. When I stood up to go to the bathroom or kitchen, there was a sharp pain.

I read the following advice online today about a different type of knee injury, but it still got me wondering: “Let it settle – Allow your knee three to seven days to settle before you start any serious rehab exercises. You don’t need complete rest, but limit how much time you spend on your feet (standing and walking) – if your knee hurts more in the afternoon or evening, it may be a sign that you’re doing too much.”

Hmmm…

I wondered if maybe doing my exercises every single day might be too much; some people on forums said they only did theirs a few times a week. But this video says you should do them every single day, so I will continue I guess. However, I will cut way down on walking.

Week two: becoming pain-free during daily activities

Day 8

It was sore when I woke up. I did my exercises in the morning and didn’t walk anywhere all day. 

Day 9

It was sore when I woke up. I walked down the street and it felt fine I guess, but there was a low grade ever-present ache. I did my stretches in the morning and also tried one set of bodyweight squats (usually the most painful exercise with runner’s knee), very slowly, and they didn’t hurt. My total walking mileage for the whole day was only about 2 miles, and that didn’t hurt either! I sat for 3 hours in a movie theater which didn’t create pain; I made sure to sit with my leg stretched as straight as possible since I knew sitting with it at a 90 degree angle would aggravate it. 

I ended the day feeling proud, like I made the right decisions. I felt more optimistic and less achey in the evening than when I woke up. However, it did feel a bit…unstable? Like it might pop or do something weird at any moment. I hope that no-one accidentally bumps into me or that I don’t have to quickly pivot and jump out of the way of a passing bicyclist. 

Now I know my threshold – I can walk 2 miles comfortably.

Day 10

It felt fine when I woke up, though there was a slight persistent ache while I was sitting eating breakfast. I did my stretches in the morning. I’ve noticed a pattern that I can get maybe 4-5 of the exercises done in one go each morning before my legs get fatigued – I’ve been prioritizing clam shells, side leg lifts, and wall slides every time, and then I decide each morning whether I’ll do romanian deadlifts, glute bridges, captain morgans, or something else. The injured leg usually struggles to finish all the reps of side leg lifts in particular.

My afternoon walk was 1.5 miles. I felt a slight twinge in it afterwards and it wanted to lock up when I sat with my knee bent at a 90 degree angle. I rested a few hours with it stretched out in bed, and the twinge went away by late afternoon. In the evening I walked another 1.2 miles and it felt fine during and after. 

Day 11

No aches or pains at all when I woke up. It didn’t even hurt to go down the couple of stair steps I have to descend to get to the lobby, although I never put all my weight on the right leg when I do this. 

I walked a mile in the morning, did my stretches, then walked another mile in the evening. The right knee was not sore during any of this, except when I had to do a little sprint across the street to show an oncoming car that I was hustling. Oddly the left knee had a bit of a twinge today; I wonder if it’s because it’s been taking on the brunt of the stress the last few days to compensate for the other leg. 

I sort of rushed through my stretches because I couldn’t find time and space to be alone. I added bodyweight squats to my routine though and I was able to do 3 sets of 10 without any pain at all.

The demon on my shoulder whispers to me that I should ramp things up since everything is feeling alright, but I remember all the stories online about people who immediately tried to increase their training intensity every time they felt better, and threw themselves right back to square one. I don’t want to be that person.

Day 12

Again when I woke up it felt fine and I could descend a short staircase without pain. I experiment with walking down the stairs like a normal person, putting all my weight on whichever leg is stepping down, and that feels fine.

I walked 3.5 miles in the morning with no issue. By the end of the day, after running an errand, it’s a total of 4 miles. Every once in awhile I could feel a tiny twinge, but I wouldn’t even call it pain, and there was actually more of an ache in my hip than in my knee. I buy resistance bands at the store and then do stretches at home. I use the medium resistance band and I can’t feel much stretch or “good” muscle soreness from it, so tomorrow I will try the stronger band. I am also noticing wall slides are very easy for me now, I have to hold the slide longer to feel any quad effects. 

Based on this diary so far, it’s fair to say that it takes about 10-12 days to get rid of the generalized pain of runner’s knee, especially if you’re like me and you could initially feel it all the time, even at rest or while walking short distances, and you exacerbated it a couple times in the beginning while finding your new mileage threshold for pain. 

Note I am saying it takes 10-12 days to get rid of the generalized pain, meaning it took this long to feel comfortable just existing and doing everyday tasks. I do not mean it only takes 10-12 days to recover fully to the point of being able to return to your pre-injury athletic routines. I think I am now at the point where I can slowly ramp up my training; I will try to increase daily mileage incrementally and add weight or resistance bands to strength exercises. Unfortunately I have another 5 days to waste before I can start a gym membership (I am traveling and the gym is in my next location). 

Day 13

I walked down a long staircase putting all my weight on each leg and felt no pain. I did my stretches in the morning, adding the strong level resistance band to clam shells, glute bridges, and side leg lifts. I do wall slides holding each one for 1-1.5 minutes. I do feel a nice muscle soreness in the glutes for the rest of the day.

I walked 3.5 miles today. I never felt any pain at all, and my knees felt very stable, but my legs did get fatigued. Later in the evening, I felt the tiniest twinge when going down a spiral staircase.

Day 14

I took a day trip and logged a little over 5 miles of walking. I had to take a lot of stairs today. Overall my knees felt pretty good, although I eventually had slight twinges on the stairs, and while sitting on the train back it became stiff while at rest. I’ll do my stretches sometime tonight after some down time. 

Week three: increasing mileage and introducing the gym

Day 15

I only walked about 1.7 miles today, which is less than I intended, but every time I walk around town I end up spending money and I didn’t feel like going anywhere in particular today. I have also started to notice that while my knees don’t hurt, I now have a bit of pain on the outside of my lower leg, above my ankle, perhaps peroneal tendonitis? Jesus, my pain just hops around from one location to the next. 

Day 16

I walked 5 miles along the beachfront today. My legs started to get fatigued and the above-ankle pain started to flare up, but my knees never hurt, even on downhills and stairs. I think 5 miles is a good new limit for the next week, and I’ll go up to 6 or 7 miles by the weekend.

Day 17

I traveled today and wore my giant backpack full of everything I own, including my tent and sleeping bag. I wondered if the weight of it would aggravate my knee, but it didn’t at all. This is awesome news since getting back to trekking with a big pack is the ultimate goal.

I did all my stretches using the strong resistance band and they were all easy. It is definitely getting to the point where I should move up to gym machines and weight.

Day 18

At the gym I did cable glute kickbacks, glute bridges while holding a weight plate on my stomach, hip abductor and adductor machines, and the stairclimber. I think I went way too heavy on the cable kickbacks because it felt like I was using everything except my glutes to do the exercise, and my standing leg kept twisting around. It irritated my knee a bit. I will decrease weight next time.

The weighted glute bridges seemed productive; by the end I could feel a good soreness. On the hip machines I was able to increase the weight quite a bit, yet I didn’t feel activation in any particular muscle. I remember I always hated these machines for this reason. I probably won’t include them in future sessions. The stairclimber didn’t hurt my knees at all. Regardless, just in case pain might catch up to me afterwards, I stop at 15 minutes. 

I did squats with a light backpack on when I got home. I walked around the neighborhood a bit, too. During the squats, the walk, and for the rest of the day, I felt a slight pull in the back of my right knee, I suppose the hamstring. I think this was caused by the cable kickbacks.

Day 19

I did a 5.5 mile hike today – an actual hike on uneven terrain, not just a walk around town. It went pretty well! I felt a few hints of discomfort here and there, but nothing I ever would have noticed if not for the fact that I’m paying hyper attention to everything right now. 

The hike involved some uphill at the beginning, then was flat, and then at the end there was an extremely gradual downhill. It was so gradual that I’m not sure I can count it as a good indicator of how my knee will fare on descents. 

Towards the end my legs did start to feel fatigued. On the bus ride back, the problem knee became stiff when I forgot that I shouldn’t sit with it bent. On the short walk from the bus stop to the house, I felt tiny twinges and stiffness again – not enough to call it “pain” but enough to heighten my sense of worry. I decided to rest for the remainder of the day, except for the clam shells and a couple other stretches. I upgraded to the extra strong resistance bands today.

Day 20

The stiffness and slight pain in the problem knee was back 🙁 Today I decided to take it easy and do a little day trip to a nearby village. I walked about 4 miles in total. The issue flared up when I sat with my knee at a 90 degree angle or when I walked downhill or down stairs. It’s not terrible pain like in the beginning, but it’s clearly a warning.

I’ve realized that even though I am increasing walking distance gradually, since it has mainly been on flat ground, it hasn’t been sufficient to prepare me for hiking. It’s not working the right muscles. I need practice walking on a decline and I also need to do lateral step-downs at the gym.

Day 21

My knee felt pretty normal in the morning, with no stiffness or pain at all. I had a good day at the gym this time! I found my ideal weight on the cable glute kickbacks and was able to keep proper form. 

I did lateral step-downs while holding dumbbells in each hand. I tried different angles but wasn’t sure if I was doing it right. I felt a bit of activation in the quads but not much, and most of my focus was on keeping balance and trying to keep my leg aligned without letting my knee cave inward.

I also did hip thrusts with 22kg weight and this felt difficult by the last set. I did squats with a kettlebell and used the stairmaster for 20 minutes on the glute setting, which gave me resistance instead of just speed. 

I did some of my stretches back at the house in the late afternoon, and added in the 3 Minute Mountain Legs exercises. 

The only negative outcome today was that at the end of the night I tried to do a simple hamstring stretch by touching my toes and had a weird click or pop sensation in the back of the right knee. As I tried to sleep, I felt an ache all down my leg, but not the good kind of muscle soreness. It felt more like the tendon. 

Maybe I don’t need to keep working it so much throughout the day; I should let the gym and a few resistance band exercises be the extent of it, and not add in the 3 Minute Mountain Legs on top of it all. I read a study saying that the best course of action for tendinopathy is to have rest days. I realize I have had very few full-on rest days, I’m always at least walking a couple miles or doing the resistance bands. Maybe tomorrow I will fully rest and then the next day I will hike.

Week four: longer mileage, running, and near full recovery

Day 22

I woke up with DOMS in my glutes and thighs, which is encouraging! It means the exercises I’m doing at the gym are targeting the right muscles and the intensity level is having an impact. 

Rather than work my leg muscles another day in a row by doing the hike I’ve been looking forward to, I rested today and tried to eat right to support recovery. 

I remember in the very beginning, I only gave myself two “active rest” days after the hike that ruined my knee before hiking again on the third day, and that was detrimental. Then I only had two rest days again before trying to walk four miles around town, and that was also bad. So maybe two days between hikes isn’t enough and it’s a good idea for today, day 3 after hiking, to be a full rest day. 

Day 23

Today I hiked 6.2 miles, the most I’ve walked since the injury. This hike had more up-and-down elevation change than the last hike and the knee did pretty well. It was definitely talking to me on the downhills, but it never became angry. After some time walking flat or uphill, it always went silent again. 

I did notice that the hamstring was feeling odd during uphills. Not painful, but a weird feeling. It went away by the end of the hike and the last few uphills were fine. The right knee stiffened up on the bus ride afterwards. I iced the knee when I got home as a “why not?” preventative measure and didn’t do any exercises or stretches, except a standing calf stretch.

Day 24

No pain or stiffness at all when I woke up – all felt normal, like nothing ever happened. The DOMS from the gym a few days ago was gone now too. 

At the gym today I did the stairmaster, lateral step-downs, weighted hip thrusts, cable glute kickbacks, and single leg Romanian deadlifts with a kettlebell. On the stairmaster I did 20 minutes with the glute setting and jacked the difficulty level up. I hoped I would feel strong enough to do 30 minutes, but I was huffing and puffing too much at 20 and walked on the treadmill to cool down instead. 

I wanted to do the cable kickbacks first thing while I still had all my strength, but other people were using it and I had to do it last. This confirmed that doing it last is not great – with fatigue setting in, my standing leg was not as able to hold solid and I also had a weird sensation in my hip. But, nothing felt aggravated or painful. Back at the house, I just do clam shells and wall slides at 2 minutes per slide.

Day 25

No DOMS in the morning. I completed an 8 mile hike today without pain! It even had some up-and-down elevation change. On gradual descents I felt nothing. On steep(ish) descents I felt a little niggle, but I tried to focus on proper downhill walking form – mainly, keeping knees slightly bent and trying not to lean too far back. I did not have any residual stiffness while eating lunch nor while riding the train home. Today is a big win!

Day 26 

Rest day. It would have probably been a good idea to at least walk around town or something so I could put a bit of tension on the tendons/muscles, but life got in the way and I didn’t go anywhere. No pain or stiffness at all today.

Day 27

Gym. I was able to do cable kickbacks first instead of last, thankfully. 15 minutes on the stairmaster and 15 minutes walking uphill on a level 12 incline on the treadmill. 

The lateral step-downs felt really good today, I think I am getting better at them. I can actually feel them working the right muscles now. I think the trick is to not shift any of your weight onto the leg that is stepping down; maybe don’t even let your toes touch the floor so that you’re not tempted. Keep balancing on the standing leg throughout the entire movement and focus on hinging at the hips. 

Back at the house I did resistance band exercises. 

Day 28

Gym. Was able to run on the treadmill with no pain! I was really nervous about attempting this but it went great. I did 40 minutes, though the beginning and end involved walking on an incline or walking flat for a warm up/cool down. It was maybe 2 miles of straight running with no walk breaks. I do resistance bands back at the house.

Every subsequent day has given me no trouble; I have continued to run on the treadmill and push things harder at the gym and on the trail, and I’ve been feeling great.

Before my injury, normal life meant not having to avoid any particular machines at the gym, being able to run a few miles on the treadmill at the drop of a hat, and completing ~8 mile day hikes on a regular basis. At Day 28 of the runner’s knee recovery process, I am back at this level and can hold myself to my typical expectations. Of course, this is different than being at my peak physical fitness level. When I am at my peak, I can thru-hike 100 miles with a giant backpack over steep terrain without any pain. In the lead-up to such an adventure, I can bust out a longer 10-15 mile day hike without hesitation. This usually represents my summer fitness level, so I am not far off track and I will get there soon if I keep ramping up slowly. It’s only April!

I think it is perfectly acceptable to not be there quite yet; our bodies go through different seasons and we can’t all maintain top performance year-around 100% of the time. In fact, if I maintain that level of performance for too long, I start to suffer other ailments indicative of the Female Athlete Triad, so I think it’s healthy to have periods of time where I lower my demands on my body. However, there is clearly a middle ground. I’ve learned (again) that I cannot let my training fall off too much or I am at risk for injury upon return. Next winter there is no way in hell I am staying in a blizzardy location where I can’t go outside; I plan to base myself in the desert somewhere!

If you’ve had runner’s knee, how long did it take you to bounce back? Has this problem recurred for you over the years? What lessons have you learned from being humbled by overuse injuries?

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