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I have a persistent problem that I can't manage by myself by stretches & strenghtening.
First of all I'm 35 and for last 10 years I was running, mostly trail running and mountain running for no more than marathon distances. Never had knee issues of any sort, but for other health related reasons had to stop running for half a year. While preparing for return to my running activities, mostly warm-up routines, some stretching and strenghtening I noticed some problems.
My right knee clicks and grinds, grinding is heard during full straightening of the right leg from full bend of knee. Clicks, rather noisy but not painful, are heard mostly while doing motion like warm-up clock-wise circles with right knee, when straightening leg at 6 o'clock mark.
I had an MRI and ultrasound examination that don't show any significant changes that would explain my problems, as 2 physiotherapists and two orthopedists judged. I had hyaluronic acid injection 6 months ago, grinding now is a little less noticeable, clicking the same.

Now to my observations:

  • my right foot is rotated at 45 degree outwards while sitting on floor with straight legs, while left foot is rotated inwards for like 5 degrees, rotated from the hip, not from the knee, when lowering my back to the floor right foot seems to fall outwards even a little further;
  • I feel a little twisted in my pelvis and torso while standing relaxed, 15 degrees to the left;
  • when attempting to run for first couple of minutes it's fine, but gradually I feel increasing pressure/tightness in my knee, and upper right leg, while my right foot rotates outwards by itself, maintaining proper form with foot actively straightened makes knee much more tight and painful in front of the knee on both sides of patella;
  • while walking a feel pinching in my right hip, more to the outside than in front or back, the same feeling on the outside of the knee;

I stretch and strengthen every day, also do full leg foam rolling at least 4 times a week. I work on my core and upper body. I don't run at all to not hurt myself any further, not unless I work out this knee/hip issue. Stretchin and foam rolling of IT band doesn't work. Stretching hip flexors and glutes doesn't help. Strenghtening quads, hip abductors and adductors didn't improve my situation.

It's been at least 6 months without results so please, suggest something I might try to work these issues out.
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  • Not an answer, but you might want to look at the book "Ready to Run" by Kelly Starrett. he talks a lot about alignment issues and how they pertain to running, and suggests possible fixes for them – Dark Hippo Jan 15 at 7:50
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    Rather than looking for answers on this forum, you'd be better served by working with a physical therapist. They can work with you and recommend a program to correct your problems. – rrirower Jan 15 at 19:49
  • As mentioned above I met two of them for the last year. If their strategy worked I wouldn't be here. – zubergu Jan 15 at 20:38
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Here is what has worked for me, to some extent. (Unfortunately, I cannot guarantee that this will work for you!)

A physical therapist made me do single leg balance exercises. These exercises reinforce not only the hip adductors and abductors, but also the ankle and the muscle responsible for maintaining the arch under your foot.

After a few months of doing the exercises with her, the improvement was very noticeable and I was able to run for a while. Overtime, the pain came back though. So I started doing balance exercises once again, this time on my own. Since then I've been though ups and downs as tend to stop doing the balance exercises regularly when my knee feels better. It's been many years now and it looks like I will have to do these exercises for the rest of my life.

Context: I have the same issue. I think my right foot has always been externally rotated, but the pain in the external side of my knee came suddenly when I was about thirty. I have mostly stopped running since then and amazingly my heart rate is lower now with my "powerbuilding" routine than it was when I used to run!

In its most simple form, the exercise is just standing for as long as you can on your right foot while keeping your left foot off the floor. Try not to use your arms to help you keep balance. When this is too easy, you can progress to harder versions: flex your right knee or keep your arms parallel to the floor to your left or move them slowly from left to right or raise your left leg to the side or stand on a soft pad or pass a (very) light dumbbell from one hand to the other and back again... The possibilities are many! The goal is to build more stability and endurance over time.

I wish I could provide some treatment backed by strong evidence. I looked for this myself a while back. As far as I could tell, such a thing did not exist at that point.

One more thing: If the pain goes away and you find you can start running once again, do this very progressively. At first, run only once or twice a week and just for a few minutes. Run just a little more the next week and so on. I have found that I start feeling the pain once again when I suddenly start doing a new activity or I when increase the frequency of movements involving knee flexion.

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  • Hi Erwan. Thank you for your suggestion on balancing exercises. For the last couple of months I work out on bosu ( leg raises, deadlifts, squats, etc.) once-twice a week, no visible results yet. Can you recommend some specific exercises and how many times/week should I perform them? – zubergu Jan 22 at 10:35
  • @zubergu Sorry for the last reply! In its most simple form, the exercise is as follows: you just stand on your right foot for as long as you can while keeping your left foot off the floor. I'll update the answer. – Erwan Legrand Mar 10 at 9:13
  • Also, I suggest you keep strength training and rehabilitation work separate. This is what I do. Adding instability to squats and deadlifts seems counterproductive to me. – Erwan Legrand Mar 10 at 9:27
  • thank you again for keeping interest. For the last month I am working with yet another physio. She focuses on gluteus medius activation and tight IT band release. After one month I can't see any visible ( or audible ) progress, but I don't lose hope yet. I'll cut down strength exercises to absolute minimum as you suggest and also include your other suggestion into my workout. – zubergu Mar 10 at 10:47

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