Got Pain? Don’t Stretch, Strengthen

If you’re like many runners, stretching is your first course of action when you feel pain. Sore Achilles tendon? Stretch the calf. Sore knee? Stretch the quads or the IT band.

The problem is, tight muscles are rarely the root cause of pain, so stretching rarely solves the problem. A better solution for chronic, training-related pains and injuries—one with more evidence behind it—is strength training.

Passive Treatment Limitations

Besides stretching, you may have tried foam rolling, massage, dry needling, acupuncture, heat, cold, electrical stimulation, drugs, or laser therapy to treat your pain. These are passive treatments. These treatments may calm your symptoms—which is fine. But, these strategies do nothing to make you stronger or make your muscles or connective tissue more durable.

Training Stress & Adaptation

In an optimal training situation, you apply stress to your body, rest and eat—and your body adapts positively by getting stronger. In contrast, tissues that are stressed too much, too fast, too soon, or not allowed to recover may become weak and painful.

Stretching may exacerbate the problem. What happens if you stretch something too far? It breaks! Apply enough force fast enough, in fact, and you get an acute injury like an ACL tear. Those weak tissues need strength. You can further facilitate healing and durability by strengthening supporting muscles above and below the site of the pain.

Effects of Strength on Injury and Pain

In a 2018 review published in The British Journal of Sports Medicine, researchers at the Department of Sports Medicine, Norwegian School of Sport Sciences analyzed several studies on the effectiveness of strength training for injury prevention. They found that “A 10% increase in strength training volume reduced the risk of injury by more than four percentage points.” And, “Increasing strength training volume and intensity were associated with sports injury risk reduction.”

If strength training helps prevent injuries then it follows that appropriate strength training will help you overcome injury. Strength training is a powerful injury recovery tool for several reasons:

1) Pain Relief

Exercise tends to produce an analgesic (pain-relieving) effect. Research shows that both isometric (muscular contraction without movement) and dynamic strength training (muscular contraction while moving against resistance) work well to reduce patellar and Achilles tendon pain.

2) Mental Health

If pain robs you of a deeply meaningful activity like running then the psychological and emotional toll is tremendous. Pain is frustrating and potentially scary. Confronting your pain with strength training creates a sense of agency over your pain and restores optimism. Strength creates resiliency.

3) Strong tissues

The most obvious reason to strength train is for strength. Your muscles and tendons must be strong to tolerate the forces involved in running. The following exercises build both muscular and connective tissue strength.

The Exercises

Here are a selection of strength exercises for the common running issues of IT band syndrome, Achilles pain, and patellar pain.

Each series begins with isometric exercises—static holds of targeted muscles. Isometrics tend to calm pain and are usually tolerated well. For the isometrics, you should press as hard as possible while respecting the pain guidelines: Minor pain is allowed while doing these exercises but should be no more than 3–4 on a scale of 1–10 with 10 being the worst.

Do the exercises 1-2 times per day. Dynamic exercises are also useful. Watch the videos for instruction.

IT band syndrome

Wall Knee Press Isometric:

Stand on the leg that hurts, close to a wall in a partial squat stance. Press the inside knee into the wall as shown above. You should feel this in the stance-leg glutes. Hold for 45–60 seconds. Rest. Repeat 4-5 times.

Standing Glute Band Process Exercises:

Wrap a resistance band around both legs below your knees. Stand and balance on one leg and lift the other leg outward, then drive it out and back, as shown in this video:

Single-Leg Tubing Squat:

Attach one end of a light to moderate resistance length of tubing to something solid like a fence, squat rack, dumbbell rack or heavy table leg. Attach the other end around the bottom of your knee on the leg that hurts. Turn so that the tubing is pulling from the inside of that knee. Keep your knee aligned straight ahead as you squat. Work up to 20 reps. You can progress to higher tube tension or a stronger tube.

Achilles tendinopathy:

Calf Isometric: Stand as shown above on the leg that hurst, pressing the foot hard into the ground and the hands into the wall. You should feel this in the stance leg calf. Hold for 45–60 seconds. Rest. Repeat 4-5 times.

Heavy Heel Raises:

Hold a dumbbell in your hand on the side that hurts. Support your balance against a wall, as shown in the video below. Raise and lower your body using your calf. Use a load that causes fatigue in 6–10 reps. Always lift using good control and precise technique.

You can also use a leg press as shown here:

Standing Glute Band Process Exercises:

The same exercise described in the ITB section above is useful for strengthening the lower leg and relieving Achilles pain.

Patellar (knee cap) Pain

When treating knee pain, strategies that target both the knee and hip muscles are best for reducing pain and restoring athletic ability.

Wall Sit Isometric:

Sit as shown above, pressing your feet into the ground and your back into the wall. You should feel this in the quadriceps on the top of your thighs. For a more challenging version, sit using one leg instead of two. Hold for 45–60 seconds. Rest. Repeat 4-5 times.

Various Glute Bridges

Stand on one leg in front of a bench or chair about the height of your knee. Lower yourself slowly back and down to sit on the support, then stand back up. Make sure your support knee never moves forward farther than your toes. Do 15–20 reps.

There are no guarantees that these exercises will fix your pain. Some issues deserve clinical assessment and treatment. That said, research supports the use of strength training to overcome certain painful conditions.

Personal note: Anecdotally, I’ve seen the positive effects of strength training on my and my clients’ injuries. I’ve spent time and money on passive treatments for low-back pain, plantar fasciitis, and Achilles tendinopathy. I foam rolled and stretched consistently only to have my aches and pains remain. I made rapid progress once I attacked my problems with strength training and I soon resumed running. Several of my clients, other trainers, therapists, and athletes with whom I’ve spoken have similar stories. I hope some of the information presented here will help you.

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Kyle Norman, MS, is a Denver, Colorado-based personal trainer, strength coach and running coach with 20 years of experience. He specializes in helping people move well, get strong and get out of pain. You can follow his blog at www.denverfitnessjournal.com.