HYROX Knee Pain: What to Actually Do About It (Part 2)
- Hannah Breal, PT, DPT
- 3 hours ago
- 5 min read
About the Author: Hannah Breal, PT, DPT is the co-owner of Made 2 Move Physical Therapy in Charleston and Charlotte. She helps athletes and active adults rebuild strength, mobility, and confidence so they can move pain-free for life.
Made 2 Move Physical Therapy – Charleston | Daniel Island | Mount Pleasant | Charlotte
If you're having knee pain training for HYROX, this is for you (part 2)
In Part 1 of this series, we talked about the most common knee injuries we see in HYROX athletes and why pushing through OR completely stopping are both bad answers. missed it? catch up here!
This week we're going over what to actually do to solve it.
Like we talked about in Part 1, most knee pain from HYROX comes down to the same principle: load management.
Your knees weren't prepared for the demands being put on them. The specific affected structures, underlying issues, and treatment plan will differ person to person.
The overall solution is to prepare the knees so they can handle that demand.
Not avoiding movement. not stretching. not icing. not dry needling for 6-8 months without any real relief.
This is essentially what we did with Malina addressed the specific structures involved, built her back up progressively, and kept her training the whole time.
Here's what that plan might look like:
One thing worth noting: it's pretty common to see multiple areas that need work. I'll often add hip work and calf training on top of the below - it's not always just about where you're feeling the pain.
Patellofemoral Pain (PFP)
This one is SO often managed in the wrong way, it's genuinely frustrating.
Most people with PFP are given clamshells, glute bridges, and IT band stretches and wonder why nothing is changing months later.
The quads are almost always the missing and neglected piece. Our quads do a TON of work to absorb and produce force every time we squat, lunge, or run.
But a lot of people aren't targeting their quads at all.
This whole section could be boiled down to just this sentence:
If your whole quad-training strategy is just doing back squats OR you're never isolating your quads or bending your knee past your toes... then your quads are not going to be strong enough to handle HYROX or all that running.
Quad-specific exercises that have helped our HYROX athletes:
Wall sit holds - great place to start and can help reduce pain
Knee extensions
Split squat progressions
Heels elevated goblet squat
Heels elevated wall squats - my fave once we can tolerate them
Single leg step downs
Single leg pogos
Depth drops
Progress toward more sport-specific loading from there
My general rules:
choose 1-2 to add (don't do all of them)
build gradually
choose exercises/weights that keep pain to under a 2-3/10
Patellar Tendinopathy
Most people wonder why they've tried dry needling, stretching, icing, massage, even shockwave without results. It's because tendons only respond and listen to loading. It's the language they speak.
& that's why avoiding load turns these issues into chronic problems. (That knee pain you've been dealing with since high school basketball.)
The key is how you load it and tendons are picky. Remember: goldilocks
Start with isometric holds (wall sit, leg extension hold) - these reduce pain AND start building tolerance
Move to slow, heavy loading through range of motion
Speed & plyometric work comes last - only once the tendon has actually built the capacity for it
The key thing here is seeing how your tendon responds the 1-2 days after training.
Tendons experience a warm up effect, so they usually feel good DURING the movements, but if you're wrecked the next day - you need to take it down a couple notches.
IT Band Syndrome
This one is confusing, because it's called "IT Band Syndrome" but that just means that you're having pain around your IT band it doesn't explain what's actually going on.
You cannot stretch or foam roll the IT band into submission. The IT band doesn't actually get tight - but the muscles underneath it and the muscles that attach to it (hips/glutes) might be the real problem.
It's not a muscle. It doesn't work that way.
What you CAN do is figure out why it's getting irritated and fix that instead.
Usually that's a combination of: hip strength and control, single leg stability, quad strength, plyometric capacity, sometimes running mechanics, and usually too much load too fast.
What actually helps is single leg strengthening (yes, every main muscle group), single leg stability work, and most importantly, a smart, gradual return to running volume not "it felt fine so I did my 8 mile long run"
It might feel good to smash it on a foam roller temporarily. It's just not solving anything on its own.
The Bottom Line
Here's the thing about all three of these diagnoses:
They are all solved through a combination of progressive loading, a personalized return to train plan, load management, and specific exercises to address strength, endurance, mobility, and force absorption/production.
None of them are permanent. None of them mean that you're broken.
None of it means HYROX is bad for you or that your body can't handle it.
You don't have to quit training.
Having knee pain just means that something needs to change.
We've had patients come in with YEARS of knee pain and after a few months of hard work, they hit a personal record and do things they never thought they'd be capable of. I'm telling you it is
possible.
If your knee has been hurting and you're sick of hoping it gets better on its own, we'd love to help.
Book a free phone consult with a member of our Made 2 Move team and let's get you back to what you love. We work one-on-one with HYROX athletes and active adults in Daniel Island, Mount Pleasant, Downtown Charleston, and Charlotte. See how we work with athletes or hear from patients who've PR'd after we helped them get out of pain.
If You’re in Charleston, Daniel Island, Charlotte, or Mount Pleasant…
At Made 2 Move Physical Therapy, we help active adults and athletes and recreational athletes get out of pain and keep doing what they love.
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Written by Hannah Breal, PT, DPT, Co-Owner of Made 2 Move Physical Therapy, helping Charleston and Charlotte move pain-free for life.
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