A Friendly Guide to the Runner's Knees
Over the course of a training cycle, many runners will be dealing with one or more of the common runner’s knee ailments. Here are a few of the ones I treat frequently, and some tips to help you navigate them:
· Patellofemoral Syndrome: Inflammation of any of a few key structures in the front part of your knee: the quadriceps tendon (above your kneecap), patellar tendon (below your kneecap), Hoffa’s fatpad (beneath your patellar tendon) and patellofemoral cartilage (beneath your kneecap). Experienced as pain in the front of the knee.
· Pes Anserine Bursitis: Inflammation of a small, fluid filled sack located at the inside part of the knee. Experienced as pain on the inside of the knee.
· Iliotibial Band Syndrome: Inflammation of the long band of fibrous tissue that runs from the outside of your knee all the way up to your outside hip area. Experienced as pain on the outside of the knee.
· Meniscal Tear: Tearing or fraying of one of the small cartilage cushions that sit between the upper bone of your leg (femur) and the larger lower bone of your leg (tibia). Experienced as pain at the inside joint line or outside joint line, and may be accompanied by swelling and catching or locking symptoms.
· Knee Osteoarthritis: Wear down of the cartilage inside your knee joint. Experienced as diffuse pain, swelling, and sometimes a collection of fluid behind your knee (called a Baker’s cyst).
Prevention: Flexibility and Mobility
Good flexibility of your quadriceps, hamstrings and calves is essential for healthy knees. Stretching can be a little boring, so I prefer more active forms such as active isolated flexibility. In this technique, instead of holding stretches for prolonged periods, you perform 8-12 reps of short, 2-3 second holds while contracting the opposing muscle group. This gives the added benefit of serving as a warm-up while you stretch. For some muscle groups, such as the hamstrings, assisting the stretch with a strap can be helpful. Running strength guru Phil Wharton of Wharton Health has some great active isolated flexibility routines to help restore flexibility in these important large muscle groups. Check out his website for some examples.
Another approach to improving flexibility and mobility is self-massage. Rolling on a foam-roller, or using a lacrosse or tennis ball to knead tight muscles promotes circulation and can serve as a warm-up before running or a recovery aid afterwards. If you’ve never done it before, you can check out this brief video from the TPI exercise library which goes over a simple lower body foam-rolling routine. You can also use a trigger point tool, such as the Muscle Angel Massager, or if you are really high-tech, automated tools such as the Hypervolt.
Prevention: A Strong Butt and Core...and don’t forget those quads!
A regular core and butt strengthening routine is another important tool in a runner’s arsenal. You don’t have to spend a lot of time to give your strength a real boost; a few simple exercises after running several times a week should do the trick. I am a big fan of the strength and mobility routines designed by Coach Jay Johnson and Dr. Richard Hansen – they are short and they target the key areas runners need to work on. Here is a link to their instructional videos if you want to check them out. The bottom line is: you need to have a strong butt and a strong core to take stress off the structures lower down, like your knees.
Many runners also have very strong and dominant outer quad muscles, but their inner quad muscles are comparatively weak. This causes the kneecap to track incorrectly, which can place strain on the structures around it and lead to inflammation. You can activate and strengthen your inner quad muscle with exercises such as terminal knee extensions, shown below.
From The Sports Medicine Patient Advisor, by Pierre Rouzier
Strengthening exercises can also be used for muscle activation as a warm-up for running. Try a few terminal knee extensions, clamshells or bridges prior to running (just 8-10 reps per side) until you feel your quad muscles and butt muscles turning on. You’re preparing them to engage and stabilize you while you run.
Get Expert Help: The Work-Up
If you find yourself with knee pain that won’t go away, you should be evaluated by a medical provider. We will examine you, and many times we can diagnose your injury based on the story you tell us and the location of your symptoms. We will want to know if your pain came on gradually, or if there was an “injury moment,” and we will ask about symptoms like swelling, buckling, or catching. We may check x-rays, which will tell us about the bones that make up your knee and the space in the joint, or we may want other studies that tell us about soft tissue structures and cartilage, such as ultrasound or MRI.
Get Better: Treatment
Many knee injuries will improve with modification of your activities and physical therapy. When you’re in the middle of a marathon training cycle, being told to alter your training, and maybe even to rest from running, can seem like extremely bad news. However, your best chance at getting out there on the roads, trails or track quickly is to let your injury recover and work on what you can while you heal (such as your strength and flexibility). Pushing through an injury at the early stages is almost always way more counterproductive than missing a scheduled run – or even a week of runs!
**Disclaimer: I do not officially endorse and have not received compensation for recommending any of the products mentioned in this article.