HOW TO

OVERCOME
RUNNERS
KNEE PAIN

By Dr. Ray Peralta, PT, DPT, Run Coach

DO YOU HAVE RUNNER’S KNEE PAIN?
Hi Runner!
Runner's knee is a common knee problem, especially
for people who run a lot. It's also called patellofemoral
pain syndrome. That's a fancy way of saying pain in
the front of your knee. More women get it than men,
and sometimes the pain comes back again and again.

It usually hurts when you do things like go up or down

stairs, squat, kneel, or run.

You might feel like your knee is unstable, hear a

grinding noise, or think your knee is swollen.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
HOW TO HEAL
WITH PEACE & LOVE

Overview

For runners facing knee pain, the PEACE & LOVE protocol offers a
holistic approach to recovery. This method is more comprehensive and
accurate compared to traditional methods like RICE (Rest, Ice,
Compression, Elevation).

In the immediate aftermath of an injury, PEACE emphasizes the need

for protection and gentle care. It advises against the immediate use
of anti-inflammatory medications, which may impede natural healing
processes.

Instead of resting completely, as suggested by the RICE method,

PEACE encourages gentle movements early on to promote healing.

The LOVE approach for runners starts with load management, which
involves reintroducing activity without overloading the recovering
tissues. Optimism is key, as a positive outlook can significantly
influence recovery.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
HOW TO HEAL
WITH PEACE & LOVE

The P.E.A.C.E Protocol for Healing after Injury

Protection: Avoid activities that cause knee pain. Utilize aids

like a walking stick for even weight distribution.

Elevation: Keep the knee elevated above heart level to

reduce swelling.

Avoid Anti-Inflammatories: The body has a natural

inflammatory process that helps promote healing in the early
stages.

Compression: Apply an elastic bandage for continuous

support and swelling management.

Education: Understand your condition and the recovery

process.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
The L.O.V.E Protocol

Load: Gradually reintroduce weight-bearing activities as

tolerated to encourage strength without straining the knee.

Optimism: Maintain a positive outlook. Your mental state can

significantly impact your physical recovery.

Vascularization: Engage in exercises that promote blood

flow to the knee without causing pain.

Exercise: Focus on building the strength and flexibility of

muscles around the knee

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
EARLY PHASE EXERCISES
Early Phase (Weeks 0-3)
During the initial phase of treatment, the goal is to minimize pain
and inflammation while maintaining mobility. Exercises should be
low-impact and focus on gentle strengthening and flexibility.

Quad Sets: Sit with your leg straight and tighten the thigh
muscle. 3-5 sets x 30-60 second holds, daily

Straight Leg Raise (SLR): Lying flat on your back, tighten

your thigh muscle with your knee fully straightened on the
affected leg, then raise the leg just off the bed. Hold for 3-5
seconds, then lower slowly.

Quadriceps Stretch: Lying on your stomach, and with a

stretch strap, bend your knee to feel the quad stretch.
Perform 3 sets x 30-second holds.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
MID PHASE EXERCISE
Mid Phase (Weeks 4-7)
Focusing on increasing strength in the quadriceps and hamstrings
while introducing activities that improve patellofemoral alignment
and knee stability.

Step-Ups: Using a 6-inch box, step up with the affected leg

and bring the other leg up to meet it. Return to the starting
position and repeat.

Wall Squats: With your back against a wall, lower into a

squat position with thighs parallel to the ground. Hold for 5-10
seconds, then return to standing.

Terminal Knee Extension (TKE): Straighten your knee using

a light resistance band around the back of it to tighten the
quadriceps.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
LATE PHASE EXERCISE
Late Phase (Weeks 8-12)
The late phase focuses on further strengthening and gradually
reintroducing running and other high-impact activities while
monitoring for any signs of returning symptoms.

Single-Leg Deadlifts: Standing on the affected leg, bend at

the hip to reach forward while the other leg extends back.
Keep your back straight and return to the start position. If
necessary, add a dumbbell or kettlebell for additional
difficulty.

Forward Lunges: Step forward with the affected leg,

dropping your back knee towards the ground. Keep your
front knee behind your toes. Push back to the start.

Gradual Return to Running: Begin with short distances on

flat, soft surfaces. Focus on form, and gradually increase
distance as tolerated, avoiding pain.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
RETURN TO RUN WALK-RUN
Steps 1-3

This 8-step Return-to-Run program guides runners on the mend

from knee pain. It aims to gradually reintegrate running into your
routine, balancing recovery and strength building.

Complete one step per week over eight weeks and get to a 30-
minute continuous run.

1) Initial Reintroduction: Start with 7 sets of a 2-minute gentle

run followed by a 1-minute walking interval. It's essential to
assess how your knee feels with each step and provide self-
feedback.

2) Building Endurance: Progress to 6 sets of a 3-minute run and a

1-minute walk, ensuring knee stability and comfort.

3) Enhanced Duration: Shift to 5 sets of a 4-minute run

interspersed with 1-minute walking periods, focusing on smooth,
pain-free movements.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
RETURN TO RUN WALK-RUN
Steps 4-8

4) Consistency in Practice: Continue with 5 sets of a 5-minute

run and a 1-minute walk. Offer self-feedback during the first,
third, and fifth sets to monitor for any discomfort or regression.

5) Increased Repetition: Move up to 6 sets of a 5-minute run

followed by a 1-minute walk, limiting feedback to the initial and
penultimate sets to encourage self-regulation and awareness.

6) Extended Running Periods: Elevate the challenge to 2 sets of

a 15-minute run with a 1-minute walking break, focusing solely on
your body's responses without external feedback.

7) Combining Intervals: Incorporate a session consisting of a 20-

minute run, a 1-minute walk followed by a 5-minute jowith self-
feedback, and conclude with a 5-minute silent run to internalize
the recovery progress.

8) Return to Normalcy: Conclude the program with a 30-minute

continuous easy run, relying on internal cues and confidence in
your knee's resilience and recovery.

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
PAIN TRAFFIC LIGHT GUIDE
Using the numeric pain scale 0-10, where 0 is No pain, and 10 is
worst pain, this traffic light guide breaks it down into zones

Green Light: Safe Zone (0-3 pain)

Running is considered safe; maintain or slowly increase your
distance.
Focus on good form and proper warm-up exercises.
If pain is consistent at 3, consider a rest day.

Yellow Light: Caution Zone (4-7 pain)

Reduce running intensity or distance. Consider cross-training
activities that put less stress on the knees, such as cycling or
swimming.
Implement strength training exercises on hip and core
stability to support knee health.
Continue running only if the pain does not increase during the
activity and returns to 3 or below afterward.

Red Light: High-Risk Zone (8-10 pain)

Stop running activities immediately to prevent further injury.
Apply ice to the affected knee for 15-20 minutes following
activity to reduce inflammation.
Consult with a healthcare professional to assess injury and
receive appropriate treatment. Consider physical therapy to
address underlying issues contributing to pain
Dr. Ray Peralta, PT, DPT
@dr.ray_peralta
PAIN MONITORING TIPS
Signs you need to hit the brakes

Monitor your pain during and after running, ensuring it does

not exceed a 5 on the pain scale.

Pay attention to morning-after pain; it should not exceed a 5

on the pain scale.

Any increase suggests insufficient recovery.

Weekly pain and stiffness should not increase; this indicates

that your knee is not recovering adequately between runs.

If you swelling in or around the knee that is another sign that

you need to slow down

If you have knee soreness that doesn’t subside with 1-3 days
of rest, indicates that you need additional recovery

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta
WHAT’S NEXT?
Throughout all phases, it's crucial to listen to your body and
adjust exercises based on pain and discomfort levels.

Which one of these tips was the most helpful?

Let me know & DM me @Dr.Ray_Peralta on Instagram!

https://www.instagram.com/dr.ray_peralta/

Dr. Ray Peralta, PT, DPT

@dr.ray_peralta