Runners Knee

The symptoms of runners knee include pain near the knee cap usually at the medial (inner) portion and below it. Pain is usually also felt after sitting for a long period of time with the knees bent. Running downhill and sometimes even walking down stairs can be followed by pain. This has been called the "movie theatre sign".

Runners Knee is also called Patellofemoral pain syndrome. It is often caused by the kneecap not tracking smoothly in its femoral groove. The symptoms are aggravated when the knee is bent since (with increased vectors of force) increased pressure exists between the joint surface of the knee cap and the articular surface of the femur (thigh bone). This increase in force over-stresses the injured area and leads to pain.

Some of the mechanical conditions that may contribute to this include:

Wide Hips (female runners)
Knock Knees (Genu Valgum)
Subluxating Patella
Patella Alta (high patella)
Small medial pole of patella or corresponding portion of femur
Weak Vastus Medialis
Weak Quadriceps Muscles
Tight Hamstrings or calf muscles
Pronation of the feet

Treatment of Runners Knee

At an early stage running should be decreased to lessen stress to this area and allow healing to begin. It is important to avoid downhill running which stresses the patello-femoral complex.

Exercises performed with the knee bent should be avoided. When the knee is bent the forces under the knee cap are increased.

Vastus Medialis is the muscle that helps stabilize the knee cap medially and prevents it from shifting laterally and tracking improperly at the patello-femoral joint. The Vastus Medialis Oblique (VMO) and Vastus Medialis Longus (VML) have been shown to be considerably weaker than the Vastus Lateralis (VL) in patients with Patellofemoral Pain Syndrome compared to normals (Makhsous et. al. 2004).

Straight leg lifts strengthen the vastus medialis muscles and do not significantly stress the undersurface of the knee cap. They should be done in sets of 10 times on each side. Start with 5 sets of 10 and work your way up to 10 sets of 10. Straight leg lifts are best performed lying on a cushioned but firm surface, with the exercising leg held straight and the non-exercising leg somewhat bent to take pressure off of the back. Lying on a carpet or mat on the floor is a perfect place to perform this exercise.

Tight posterior muscles should be stretched. In many cases tight calf muscles or hamstrings lead to a "functional equinous" and make the foot pronate while running or walking. This pronation is accompanied by an internal rotation of the leg which increases the Q angle and contributes to the lateral subluxation of the knee cap. On occasion a tight iliotibial band may contribute to PFPS.

“...Straight leg lifts strengthen the vastus medialis and do not significantly stress the undersurface of the knee cap.”

If you over-pronate make sure you use shoes that offer more anti-pronation features. Move up a ranking in the amount of stability and pronation control that your shoes offer. If further control of pronation is needed orthotics should be considered. The late George Sheehan, M.D., sports medicine physician and philosopher, was the first to popularize the notion that it was important to look at the foot when runner's knee occurs. It is also important to rule out other knee problems when knee pain occurs in runners and not just lump every pain as "runner's knee".

Some authors have suggested that core muscle strength may play a role in this problem. Suggestions for improving core body strength including gluteal muscles have been made. There is nothing wrong with this suggestion and it may help. Be sure to perform the above exercises first, since they are more specific to the problem being addressed.

Treatment Summary:

Rest or Relative Rest: Run Less
Avoid exercises or activities that require your knees to be bent
Avoid running or walking downhill, downstairs or down inclines
Do posterior muscle stretches (hamstrings and calf muscles)
Do Straight Leg Lifts (Start with 3 sets of 10, work up to 10 sets of 10)
Check Your Feet and Shoes, overpronation often contributes to this problem
Consider More Stable Shoes (with better anti-pronation features)
Orthotics If Needed (OTC or Custom)

Source: http://www.drpribut.com/sports/spknees.html

KVSSNRAO, 10th May 2006

Stretching to Avoid Injuries in Running

Magic Six, Plus Two

George Sheehan recommended his "magic six" stretches in several of his columns and in his book "Running To Win", Rodale Press,1991. Dr. Pribut recommends a slightly modified version of Dr. Sheehan's Magic Six for runners:

Magic Six, Plus Two
Wall Push-Up: This is basically the calf stretch. My version stretches one leg at a time. Stand with the rear foot approximately two to three feet from the wall. The rear leg should be straight, the front leg is bent and your hands touch the wall. Feet point straight ahead, heels are on the ground. Hold for 10 seconds, switch legs, repeat 10 times.

Hamstring Stretch: Straighten one leg, place it, with the knee locked, on a foot stool. Bend your body and bring your head towards the leg. Hold this position for 10 seconds. Switch sides, repeat 10 times.

Knee Clasp: Lie on a firm surface. A carpeted floor or grass is best. Bring both knees to your chest. Hold for 10 seconds. Repeat 5 times. This stretches the hamstrings and lower back.

Chest Push-Up: Lie on the floor with your abdoman pressed flat on to the floor. Place your hands flat on the floor, beneath your shoulders. Push your chest up with your arms and hold for 10 seconds. Repeat 5 times.

Backward Stretch: While standing straight, place the palms of your hands against the small of your back. Tighten your buttocks and bend backwards. Hold for 10 seconds, relax, repeat 5 times.

Shin Splinter: This is performed to strenthen the shins. Sit on a table with your legs dangling over the side. Place a 3 to 5 pound weight over your toes. Flex your foot at the ankle (bend it up). Hold for 6 seconds, repeat 5 times.

Straight Leg Lifts: This is performed to strengthen the quadriceps. Lying on the floor. Flex one knee to approximately a right angle. Lift the other leg rapidly to between 30 and 60 degrees. Lower and repeat 10 times. Switch legs, repeat 5 times and work up to 10 sets of 10 repetitions.

Bent Leg Sit-Up: This strenthens the abdominals. Dr. Sheehan recommended that the sit up be a gradual one rather than a rapid thrust forward. It should feel as if you are moving forward one vertebrae at a time. Lie on the floor with your knees bend. Come forward to a postion 30 degrees from the floor. Lie back and then repeat 20 times.

Since almost no runner will perform 8 exercises, even if disguised as 6 + 2, I have selected 4 of the above exercises that really should be done and 1 more to do if you have "runner's knee". I call these these:

Hopeful 4, Plus One:

Wall Push-Up: This stretches the achilles and calf muscles one leg at a time. Stand with the rear foot approximately two to three feet from the wall. The rear leg should be straight, the front leg is bent and your hands touch the wall. Feet point straight ahead, heels are on the ground. Hold for 10 seconds, switch legs, repeat 10 times.

Hamstring Stretch: Straighten one leg, place it, with the knee locked, on a foot stool. Bend your body and bring your head towards the leg. Hold this position for 10 seconds. Switch sides, repeat 10 times.

Knee Clasp: Lie on a firm surface. A carpeted floor or grass is best. Bring both knees to your chest. Hold for 10 seconds. Repeat 5 times. This stretches the hamstrings and lower back.

Bent Leg Sit-Up: This strenthens the abdominals. Dr. Sheehan recommended that the sit up be a gradual one rather than a rapid thrust forward. It should feel as if you are moving forward one vertebrae at a time. Lie on the floor with your knees bend. Come forward to a postion 30 degrees from the floor. Lie back and then repeat 20 times.

Straight Leg Lifts: This is performed to strengthen the quadriceps. Lying on the floor. Flex one knee to approximately a right angle. Lift the other leg rapidly to between 30 and 60 degrees. Lower and repeat 10 times. Switch legs, repeat 5 times and work up to 10 sets of 10 repetitions. This is best performed while watching the evening news or "sports extra."

Source: http://www.drpribut.com/sports/stayout.html

KVSSNRAO, 10th May 2006

Break in Training

I decided to take a break from runnning and restart from August 2006. In the mean time, I shall focus on strength training.

kvssnrao
Thursday, 4th May 2006

Full Marathon Training - Sunday - April 30

I did 8 miles at a pace of 13 minutes per mile. Throught out the day I felt mild discomfort. Even though it was not painful, still it was annoying. On Tuesday I did 6X400 repeats.

KVSSNRAO