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Runner's Knee Bible Question - Should I Run Unloaded?

Posted Nov 04 2010 4:51pm

I purchased the runner's knee book you created and I am really thankful that you created this. I've been a runner basically all my life and I've competed since I was in 5th grade. I have had knee pain since 2007 and was able to run on it at a really high level 1:50 in the 800, 14:54 5K etc for about 8 months and then one day I woke up after my last race of the season in June 2008 and my knee was crippled. Before that it was a dull aching pain constantly and occasionally a sharp pain when running that would only happen every so often. It went from that to the most jarring pain, tightness I have never felt before and I knew something was really wrong. I went to the doctor and the physical therapist, did a lot of research and nothing really worked. The pain and stiffness got better over time but when I tried to run the jarring sharp pain was still there. I tried all sorts of physical therapy to no avail. Finally in February 2009 I started Prolotherapy and by August 2009 I was able to run again without the jarring pain although my knee and now knees are still in pain (more the dull aching pain and occasional stiffness) and crack/pop (no pain associated with that) and I'm not able to run anywhere near as much as I used to or at the same level, but it is nice to be able to lace them up. I also do strength training and play soccer so I do have strong legs, but usually it doesn't hurt when I run but afterwards. I know I probably shouldn't be this active but I feel like I have to because I love it. 
I have read the material and I have already started doing quad sets multiple times a day which does seem to help. I do have a question though. I know in your blog you mentioned using an unloaded running program but you did not mention this in your book. I know this is probably because most people would not have access to a treadmill that could unload them, but I live in San Francisco and I can get access to an Alter-G treadmill for 2 months for $200. I would like to do this in hopes to work up to full body weight running over time. I guess I'd have to experiment and find a body weight that produced no symptoms after I completed the run. Correct? It seems like it would be a great way to get the 1000s of unloaded reps that you mention are needed for cartilage health. In hindsight I probably should have done this back in August 2009. Do you have any thoughts on this?

I'd really appreciate your feedback and thanks for creating the book. It is really needed especially with the lack of quality advice you can find on the subject.



James (not his real name)


James -

Thanks so much for purchasing The Runner's Knee Bible . I'm glad to hear that you've put to use some of the information already. If the quad sets are already helping you, I think you have a really good shot at recovery. Do your best to work your way through the drills sets in the book. They'll help you a lot.

About the unloaded running - yes, I left that out of the book because there are very few options for people to run in an unloaded environment. And, some people confuse unloaded running with running in water and they are very different modalities. Water has an unloading effect but it also increases resistance as you increase speed. And, there's not a easy way to incrementally increase the running loads as there is with a Newton or an Alter-G (and click here for my take on unloading devices).

If you have access to the Alter-G, I would consider trying it once you pass the Back Slider and the Hip Lift tests - as described in the book.You're right that cartilage requires thousands of repetitions to alter its biochemical properties but with the unloaded running, you're also re-training motor patterns; firing mechanisms of muscles that have been, perhaps, altered for years. When your knee joint is overloaded it shuts down certain muscles in your thigh and hip. So, when you try to run, those muscles are not as easily recruited; it's like an eight cylinder engine running on four cylinders. The more you train this pattern, the more engrained it becomes. Unloading can alter the neuromuscular pathway and re-train, below the level of conscious thought, how and when these muscles fire.

I usually start a client out with intervals --similar to what I outlined in the book - even if they are unloaded. You have to find your threshold - the Load Tolerance - the point at which pain shows up -  then increase your lift for training by 10%. This process is actually easier to do if running hurts during the run but in your case, it sounds like the pain shows up late and I'll guess that it hangs around for a while too - maybe a couple of days. If so, during a test at, for example, 65% body weight, and let's say that is equal to 130 lbs (in other words you weigh 200 lbs and are being unloaded 70lbs), you don't hurt at the time but notice symptoms the next day, you would increase the lift by 7 lbs (10% of the 70 lbs of lift) for your next session. Now, you're running at 123 lbs of body weight force; being lifted up with a force of 77 lbs. At some point you'll find a load where you can run and experience no symptoms - day of or day after. You train at this level but, as I discussed in the book, you have to edge the training. You have to go hunting for the point where symptoms show up, adjust, re-train, and go again. This is where people make mistakes. They fail to edge the training. They fear the pain. Pain is the guide; not the problem. You're correct in that there's a bit of experimentation; you want a gradual resumption of impact. Getting back to full gravity running is actually process of small failures; running into the barrier and then getting past it. It is every bit a struggle mentally as it is physically.

Make sure that you get through the whole book though and really look closely at your mechanics and fix as many deficits as you can. A lot of times, the mechanical deficits lead to focal loading of the joint surface and by correcting, for example, a weak hip, the force will shift off the worn or weak area onto a sturdier spot in the joint.

Again, I really appreciate you buying my book and hope that it helps you get back to running.


Just a reminder, the $10 discount on the Runner's Knee Bible expires this Sunday, November 7, 2010. Use "view1000" in the check out screen.  Click here to go to The Runner's Knee Bible page for info and to order.

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