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Marathon's are super popular right now, people are getting educated on the benefits of exercise so they are grabbing an OK pair of trainers and hitting the roads, hills and treadmills. The result? Knee pain (sometimes). It's not all that surprising that novice runners get knee pain in the beginning or any stage of their new hobby. Seasoned runners are of no exception and have usually been through it and have had to educate themselves on how to avoid knee pain in the future. Their are a whole host of different knee conditions but generally just a few that are very common with runner's, hence why it is called runners knee.
The knee is one of the most complicated joints in the body, an area where the most orthopaedic testing can be done, a mirage of muscles, tendons, ligaments, bursa, nerves, veins arteries and fascia. These all mesh and intertwine together creating stability and movement. The knee is also a load bearing joint taking a large brunt of the impact during walking, running, going upstairs etc. This is why osteoarthritis is most common in these load bearing joints causing pain, swelling and limited motion. Our body is intelligent, it is built for movement and if something is not working it will recruit something else to take over. Enter dysfunction, pain and all that it entails. When someone starts running in their 20's and start to get knee pain it is unlikely an arthritic condition is at play, if someone in their 60's starts running and experiencing knee pain then yes it may be a factor. The most common reason runner's get pain is from muscle and/or mechanical dysfunction and of coarse maybe a little overstraining or lack of preparation.
As a Chiropractor I cannot just look at the knee. The ankle, hips and lower back also need to be looked at to make an informed diagnosis. If a person has a flat foot this tends to bend the knee inwards creating what we call a valgus knee. This puts extra pressure on the knee joint creating an increased tensile load on the inside of the knee. If a person has a high arch of the foot (supinated) then this can cause the knee to go outwards creating a varus knee, hence putting extra tensile pressure on the outside of the knee. If the hip muscles are tight then a persons stride can shorten also making other muscles to work harder increasing the likelihood of injury. If a persons lower back is weak then the hamstrings often take over, becoming too short and again the body is fighting against itself to work harder.
It's very much a chain reaction because that is how the body works. There is no knee motion without proper hip motion and without a stable back the hips have to work harder. The same scenario applys with poor ankle stability.
Why is runners knee so common? Often it is because when people start to run they are not used to it, a lot of heat is created in the joints and muscles. If someone does a job where they sit all day then go out for a 5 mile run in the evening then when has the body had time to adapt? It hasn’t. This is not always the case but because someone is sitting for the best part of a week the body is seated in a shortened position. Especially the hamstrings and psoas which are prime movers of the body. Prime movers are the big bulky muscles that power us along. What I am talking about is muscle imbalance and the second most common reason for runners knee. As we mentioned when a muscle cannot perform it's job another either takes over or aids in the movement of what that muscle was meant to do. The knee cap is also very important as it's position determins how it glides over the knee. If the quadraceps is too tight on one side then it can pull the knee cap to one side casuing a rubbing friction that creates irriation and pain.
Signs and Symtoms? It varies but generally pain is on the front of the knee, just above or just below the knee cap and either to the left or right of the knee cap. Some people may get some swelling, some feel a burning pain, dull ache or a stiffness. Clicking or popping sounds are common along with a sense of the knee may give way. If the knee locks then it is likely to be something other than a simple runner's knee.
Warning signs? Genrally knee pain is self limiting but in rare cases knee pain can be something more serious like cancer. If you have pain at rest, a deep boring pain that does not settle, pain at night, night sweats, unexplained weight loss, bone deformity or unusual swelling or lumps it is always important to get checked out.
What can you do? Ha! If it was that easy. Each and every one of us is unique and if you give me 10 people with runners knee their symptomology will be different, they will walk and run in different ways, have different lifestyles and feel and sense pain in different ways. You could have Bill who has mild pain but his X-ray shows he should have had a double knee replacement 10 years ago. Or you could have Bob who has the worst pain he has ever expeirienced and his X-rays show nothing. But there are steps you can take to avoid runners knee as follows:
Proper foot wear: If you are going to do long distant running invest in your feet. Go to a shoe shop that understands your individual needs regarding foot health, shape and function
Start slow: If this is your first run and you go ahead and feel like you are an SAS soldier by plowing through fatigue, pain and blisters...STOP. Try half a mile first, build up, build up, build up!
Hydrate: There is more water in our body that anything else, people have died in marathons due to dehydration.
Hydrate: just in case you missed it the first time ;)
Warm up: What do you get if you cross a marathon with a cold muscle? An injury….hahah (great joke)
Stretch off: It is better to warm up before the run but the time to stretch is after you have finished. It flushes out the toxins that build up and lengthens the fibres of the muscles that become short from over working during running.
What if it hurts straight away? Stop, go and see someone
Eat good: Great for the nervous system, heart, liver etc. But you need fuel. Good quality fuel like carbs and proteins. Get these from natural sources like nuts, avocados and vegetables. Eat an hour before so that you are not tasting your meal again during the run.
Begin on a flat surface: If you are a city dweller than you will be used to walking on a flat surface most of the time. The ankle is used to that and not a rough terrain. If you want to go rough then start with mountain walks to build up ankle stability to avoid an ankle injury.
Read: There is a plethroa of information on the internet, it's free and has quality information on running and all that it involves.
I hope this helps in some way and remember a smart runner is a pain free runner.
Till next time this is Corbin's Chiro blog
