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Associated articles: Inside
Knee Pain and Running
Outside
Knee Pain and Running
Knee Pain
and Running
Location of Pain
Pain around
and sometimes behind the knee cap while running.
Function
and Anatomy of Knee
The knee is essentially
made up of four bones. The femur, which is the large bone
in your thigh, attaches by ligaments and a capsule to your
tibia. Just below and next to the tibia is the fibula, which
runs parallel to the tibia. The patella, or what we call the
knee cap, rides on the knee joint as the knee bends.
When the knee
moves, it does not just bend and straighten, or, as it is
medically termed, flex and extend. There is also a slight
rotational component in this motion. This component was recognized
only within the last 50 years, which may be part of the reason
people have so many unknown injuries. The knee muscles which
go across the knee joint are the quadriceps and the hamstrings.
The quadriceps muscles are on the front of the knee, and the
hamstrings are on the back of the knee. The ligaments are
equally important in the knee joint because they hold the
joint together. You may have heard of people who have had
ligament tears. Problems with ligaments are common.
How
it affects your running
This is a very
common running injury and usually affects those that have
just started to increase the distance to 40 miles per week.
This condition can produce a crunching or clicking sound while
running which can be highly disconcerting. The pain may also
increase when running downhill and even after periods of rest.
Cause
of Knee Pain
Runners Knee
is a result of a muscular imbalance in the legs and feet.
It is not related to the structures surrounding the knee cap.
The knee caps need to move up and down in a smooth motion
to insure a balanced running stride. When the muscles in the
feet and legs are imbalanced the knees go off track causing
the cartridge to grind away at the knee cap. Weak quadriceps
are usually caused by the very strong hamstrings over powering
them. This causes the knee cap to be imbalanced as the weaker
quadriceps are unable to support the knee cap and prevent
twisting and pulling of the knee cap. Foot imbalance (over
pronation) can also lead to your knee cap being imbalanced
and thus producing knee pain. Sometimes this condition can
be aggravated by a sudden increase in mileage, speed and running
on uneven surfaces.
Some runners
complain of knee pain around the top of thetibia (inside knee).The
pain can be so severe that it even affects your feet and putting
shoes on can be painful. Popliteus tendon runs behind the
knee and attaches to the larger tibia bone. If it is a tendon
injury, the injury appears to be associated with the tibialis
anterior muscle. Or, extensor digitorun, or extensor hallucius
longus since these attach to the tibia. They assist in flexing
the foot which could be the source of the pain when putting
on shoes.
Recent medical
evidence suggests that the quadriceps angle (q angle) increases
the likelihood of runners knee. The q angle is an estimate
of the effective angle that the quadriceps average its pull.
Normal is below 12 degrees, an abnormal q angle is anything
above 15 degrees. Some of the mechanical reasons that contribute
to the higher q angle are:
Treatment
of Knee Strain
Initial treatment
should consist of an ice pack. Some runners
prefer to use a wet towel that has been in the fridge. We
recommend you use commercially available ice packs for focused
pain relief. Anti-inflammatory tablets and gels such as Ibrobrufen
will help to release the swelling. Please note this should
be taken with meals and never before running. You can also
alternate cold therapy with heat therapy to further increase
the healing of soft tissue damage.
It is important
to strengthen the quadriceps using quadricep strengthening
exercises. Recent sports studies have suggested that “retro-running”
can stretch and strengthen the quadriceps and hamstrings to
improve stability. Retro-running is walking or running backwards.
It is important to start slowly with a slow walk and progress
to a gentle jog. Choose a smooth, flat road or you can utilize
a treadmill with handrails for support. Alternate your neck
position to prevent strains and limit your retro-running to
two sessions per week starting from 50 meters and progressing
to 500 metes.
Tendons and
ligaments are most vulnerable and keep the memory of the previous
troubles longer. After them our muscles go who are active
memorizers of the problems. The origin of the problem can
be incorrect running movement.
Are you a heel
striker or a forefoot runner? From this point we can go to
a different scenario of treatment.
You need to re-educate
yourself into the proper pattern of movement, which will start
a healing process. Several rules will help you not to aggravate
your problem. Do not land on your heels. Do not land ahead
of your GCM (general center of mass). Do not push off, or
straighten your knees on the support. It is already half of
the solution to the problem. You need to restore the normal
relationships between muscle/tendon work in this area.
We also strongly
recommend the use of sports orthotics/ insoles to dramatically
speed up recovery time. Knee pain supports provide compression
and stability to the affected area to increase the healing
phase of the injury.
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