Strengthening Between Prolotherapy Treatments for Runners with Knee Pain

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Many runners identify strongly with their sport and struggle when knee pain limits their ability to train. The goal during Prolotherapy treatment is not complete inactivity, but rather to maintain fitness while minimizing repetitive pounding on healing tissues. This period can be an opportunity to address strength deficits, improve stability, and prepare for a successful return to running.

  • Walking, progressing to incline walking as tolerated.
  • Deep-water running (aquajogging) to maintain cardiovascular fitness with minimal joint stress.
  • Cycling with appropriate seat height and moderate resistance.
  • Elliptical training for a low-impact alternative to running.

Strength Training (2–3 times per week)

  • Gluteus medius strengthening
  • Gluteus maximus strengthening
  • Hamstring strengthening
  • Calf strengthening
  • Hip abductor and adductor exercises
  • Core stabilization exercises

Examples of Strength Exercises

  • Clamshells
  • Monster walks with resistance bands
  • Bridges and hip thrusts
  • Step-ups
  • Split squats (if tolerated)
  • Single-leg Romanian deadlifts
  • Calf raises

Balance and Proprioception Training

  • Single-leg stands
  • Single-leg reaches
  • Balance pad exercises
  • Eyes-closed balance progressions

Return-to-Running Considerations

  • Progress gradually using walk/run intervals.
  • Advance training only if there is no increase in pain or swelling over the next 24 hours.
  • Avoid sudden increases in mileage or intensity.

Activities to Avoid During Healing

  • Sprint workouts
  • Hill repeats
  • Plyometric or jumping drills
  • Running through pain
  • Large, abrupt increases in training volume

Sample Weekly Schedule

  • Monday: Strength training and walking
  • Tuesday: Deep-water running or cycling
  • Wednesday: Strength and balance work
  • Thursday: Elliptical training or walk/run intervals (if appropriate)
  • Friday: Strength training and mobility work
  • Saturday: Longer cycling session or pool running
  • Sunday: Rest or an easy walk

Key Message

Patients who continue to build strength, stability, and cardiovascular endurance during Prolotherapy often transition back to running more successfully. The focus shifts from simply avoiding pain to developing a stronger foundation for long-term participation in the sport.

Detailed Exercise Instructions

Clamshells (Hip Stabilizers)

  • Lie on your side with knees bent and feet together.
  • Keep your feet touching while lifting the top knee upward.
  • Avoid rolling your hips backward.
  • Lower slowly.
  • Prescription: 2–3 sets of 10–15 repetitions on each side.

Bridges (Glutes and Hamstrings)

  • Lie on your back with knees bent and feet flat on the floor.
  • Tighten your abdominal muscles.
  • Squeeze your buttocks and lift your hips until your body forms a straight line from shoulders to knees.
  • Lower slowly.
  • Prescription: 2–3 sets of 10–15 repetitions.
  • Progression: Perform with one leg lifted.

Monster Walks (Hip Stabilizers)

  • Place a resistance band around your ankles or above your knees.
  • Slightly bend your knees.
  • Take 10–15 small steps sideways in one direction.
  • Repeat in the opposite direction.
  • Prescription: 2–3 rounds.

Step-Ups

  • Use the bottom step of a staircase.
  • Step up with one foot and bring the other foot up.
  • Step down slowly and with control.
  • Prescription: 2 sets of 10 repetitions on each leg.

Sit-to-Stands

  • Sit in a sturdy chair.
  • Cross your arms over your chest.
  • Stand up without using your hands.
  • Slowly lower back into the chair.
  • Prescription: 2–3 sets of 10 repetitions.

Calf Raises

  • Stand while holding onto a counter for support.
  • Rise up onto your toes.
  • Pause briefly and lower slowly.
  • Prescription: 2–3 sets of 15 repetitions.
  • Progression: Perform on one leg.

Single-Leg Balance

  • Stand near a counter for safety.
  • Lift one foot slightly off the floor.
  • Maintain your balance.
  • Prescription: Hold for 20–30 seconds and repeat 3 times on each side.
  • Progression: Close your eyes or stand on a folded towel.

Straight Leg Raises

  • Lie on your back with one knee bent and the other leg straight.
  • Tighten the muscles on the front of the thigh.
  • Lift the straight leg 12–18 inches.
  • Lower slowly.
  • Prescription: 2 sets of 10–15 repetitions.

Single-Leg Romanian Deadlifts

  • Stand on one leg.
  • Hinge forward at the hips while extending the other leg behind you.
  • Keep your back straight.
  • Return to standing.
  • Prescription: 2 sets of 8–10 repetitions on each side.
  • Tip: Hold onto a chair initially if needed.

Wall Sits

  • Lean your back against a wall.
  • Slide down into a partial squat position.
  • Hold the position.
  • Prescription: Hold for 15–30 seconds and repeat 3 times.
  • Avoid if this increases knee pain.

Simple Starter Program

  • Clamshells – 2 sets of 15 repetitions on each side
  • Bridges – 2 sets of 15 repetitions
  • Monster Walks – 2 rounds of 10 steps each direction
  • Step-Ups – 2 sets of 10 repetitions on each leg
  • Calf Raises – 2 sets of 15 repetitions
  • Single-Leg Balance – 3 repetitions of 30 seconds on each leg

On alternate days, consider walking, cycling, elliptical training, or deep-water running to maintain cardiovascular fitness while minimizing stress on healing knee structures.

Remember: Strong hips and good balance help reduce stress on the knees with every stride. This phase of recovery is an opportunity to build a stronger foundation for a successful return to running.