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If you, like many of us, are running more to break up the doldrums of everyday life in the time of global pandemic, your odds of experiencing knee pain are high. Whether you’re a new runner or you’re just getting back into the swing of things, there’s a litany of new, uncomfortable sensations, aches, or niggles you might experience, one of which being knee pain.
Yes, there are many different causes and solutions to knee pain or runner’s knee, but one often overlooked fix? Kegels.
It’s unorthodox, sure, but Kegels provide quite a few benefits to men (yes, really) and women alike. We spoke to experts to get the lowdown on why, and how seasoned and beginner runners should incorporate Kegels into their regimens to help eliminate pain during runs.
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So, What Exactly Is a Kegel?
Kegels, named after the gynecologist who developed them, are an exercise that contracts the pelvic floor muscles, per Harvard Health Publishing. The pelvic floor is like a small hammock of muscles that runs between the pubic bone in the front and the tailbone in the back. These muscles function to support the organs that sit on top (bladder and bowel in men, bladder, bowel, and uterus in women). “When you do a contraction, you’re shortening and strengthening the muscles,” says Amy Stein, D.P.T., a pelvic floor specialist at Beyond Basics Physical Therapy in New York City. It’s like doing a biceps curl, but for your pelvis.
How to Do Kegels the Right Way
So how do you contract these inner muscles? First, identify your pelvic floor muscles. “Think about the muscles you engage when you’re trying to stop urination mid-stream or hold back gas,” Stein says. When you clench, “those are Kegels. If you can’t stop and can only slow the stream, that indicates pelvic floor weakness.”
Then, practice the technique. Start by sitting, standing, or lying down. Perform a Kegel at full strength just to get a feel for it; every time thereafter, you’ll want to do half that intensity. “Do a full contraction, then relax for a couple seconds to get the full range of motion,” Stein says. That’s it, that’s a Kegel.
Why Your Pelvic Floor Matters to Running
Core strength generates stability and reinforces proper posture while running. Think of your core as a cardboard box: “You have your abdominals in the front, obliques on the side, erector spinae along the back, diaphragm on top, and pelvic floor on the bottom,” explains Ken Johnson, P.T., director of Outpatient Rehabilitation Therapy Services at Johns Hopkins. “When all the sides are intact, you can stack a tremendous amount of weight on it, but if you were to open up the bottom, that weakens the structural integrity,” he says. Running is dynamic, so all of these muscles need to operate as a unit.
Weak pelvic floor muscles are typically more common in older women and those who are pregnant or have given birth. Overall, about one in four women has some level of pelvic floor dysfunction, according to the National Institutes of Health, which can cause symptoms like incontinence. It can also plague men who’ve had their prostate removed, as well as individuals with overactive bladders, per the Mayo Clinic. But strengthening the pelvic floor muscles, whether you have a noticeable weakness or not, is beneficial to runners of any age because you’ll tap into a newfound power source.
“Most people have under-toned transverse abdominis, which is the deepest layer of abs under your six-pack muscles and obliques,” says Julia Lucas, retired professional runner. “It ties the top and bottom half of the body together.” Understandably, these muscles are hard to isolate. This is an issue for runners, in particular, because you can suffer from what Lucas likes to call “slinky dog effect.” At the beginning of a run, you feel light and taut, but as you tire, your form starts to get mushy; “your legs are doing the right thing, but your body is lagging a half-step behind,” she explains.
Moreover, “pelvic instability is one of the primary factors for knee pain,” Johnson says. The pelvis is tied to your hip rotators, not just your core, Stein adds. If they’re too tight or weak, they can pull your femur into internal rotation, which causes the kneecap to track improperly, Johnson adds. Your knees cave in upon impact (i.e. valgus collapse), which causes pain.
Women also need stronger cores to combat valgus collapse because they have a more severe “Q angle”—the angle between the outside of the hips and knees, due to the natural spread of their hips for child birth, Lucas says. Instead of the tension in your core helping you land softly, that internal weakness causes more of a crash-landing every time you stride, further contributing to lower-body niggles and injuries.
How Kegels Can Eliminate Knee Pain
Strengthening your pelvic floor optimizes the entire biomechanical structure, placing your muscles and joints in proper alignment. You might not be able to flex your deepest core muscles at first, but you do have direct access to your pelvic floor muscles. When you do a Kegel, the transverse abdominis compulsively contracts, too, so your body slowly learns what it means to have tension here. This can “tweak your posture and create a reflexive change in how you activate your hip muscles because there’s greater awareness in that general area, which positions you better, mechanically, to absorb and load stress while you run,” Johnson says.
How to Incorporate Kegels into Your Training
Start by practicing your Kegels sitting, standing, or lying down before you try them midrun. Here’s how to incorporate them into your regimen before, during, and after runs.
Prerun: Do Kegels to activate your pelvis before heading out. Just as you’d perform glute-activation drills to fire up your gluteus medius and maximus, do a few Kegels as an awareness exercise, Johnson suggests.
Midrun: If you start to feel nagging knee pain, engage your fast-twitch pelvic floor muscles for a body “reset.” Perform 3, 2-second holds while running to see if it alleviates your pain.
Postrun/Prehab: To work your slow-twitch muscles (80 percent of the pelvic floor), hold a Kegel for 8 to 10 seconds, taking a breath in between contractions, for 2 sets of 10, Stein recommends. To work your fast-twitch muscles (20 percent of the pelvic floor), perform 2-second holds with 2-second rest for 2 sets of 10. Do this once per week to strengthen your pelvic floor.
What to Do if You’re Still Experiencing Pain
You don’t want to overhaul your form, but you should try to make small tweaks to optimize it. “Think about running into the wind and putting your trunk in a 10- to 15-degree forward lean to activate the hip muscles better,” Johnson says.
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Cadence and footstrike are also huge. Aiming for a cadence of 180 steps per minute is the sweet spot, Johnson says, as it limits the amount of impact your joints absorb. Take a look at your sneakers, too. “If you wear the rear of the shoe out, that’s a recipe for disaster,” he adds. “When you’re a heel striker, that impact is like taking a jackhammer to your pelvis, which takes its toll on your musculature.”
If you find cross-training (supplementing your training with Kegels as well as full-body strength training) doesn’t eradicate your knee pain, make an appointment with an orthopedist, who will be able to better diagnose your case and recommend a physical therapist.
Brittany Smith is a writer and editor who specializes in fitness, gear, and adventure travel. Her running journey began as a track & field sprinter and has since evolved to include Olympic-distance triathlons.
