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

A Search of Blogs using my surname "Kambhampati"

Today I made a search of blogs using my surname "Kambhampati". The search returned 19 results of which only two blogs are by persons with the same surname.

1. Hi Everybody, my name is Kambampati Anirudh Durga ...
3 Feb 2006 by Anirudh Kambhampati
Hi Everybody, my name is Kambampati Anirudh Durga Sarma. This is my first blog, my daddy created this for me to keep in touch with all of you. Whenever I feel talking to you, I will update this blog. Also I will share my photos & ideas ...

myfirst - http://anirudhdurgasarma.blogspot.com

2. Photo Album: Animals
11 Aug 2005
Animals. No photos.

Bharathi - http://spaces.msn.com/members/bharathi-kambhampati/

I have to add that the surname of Vallabhacharya is "Kambhampati."

kvssnrao, Thurday, 27th April 2006

Full Marathon Training - 16 Miles - 23rd April 2006

I completed the training run of 16 miles on sunday 23rd April 2006. I wanted to run at a pace of 14 minutes per mile. But it took much longer time. I started actual running at 6.45 a.m.. I stopped at 11.30 a.m.. Till 9th mile I could run cleanly with 2 walk breaks per mile. From 10th to 13 miles I did 50% running and 50% walking. From 14th mile it was walking only. One can take comfort from Jeff Galloway's comment that stamina improves irrespective of speed. I did some stairs climbing during the run as this time I went to my house after every two miles to have some gatorade. Surprisingly, I did not have any significant pain in the legs at the end of the run. Of course I took leave on Monday and stayed at home for the full day. Galloway says that by slowing down, one can recover faster and avoid injuries during training for long runs.

Today, tuesday, 25th April 2006, I did stairs climbing. I did 12 rounds of 7 stairs alternating between regular climbing and two step climbing. Now I look forward to the next long run. I plan to do 20 miles on 14th May.

TRAINING FOR FULL MARATHON

My training for full marathon is going on fairly smoothly. On Sunday 2nd April, I ran the half marathon distance. I ran the Mumbai half marathon 2006 at a pace of 12 minutes per mile. But during this training run I took 14 minutes per mile. But what is good is I did clean running this time. Running for 900 metres and walking for a minute following Galloway's method. I did not feel the pain that I normally feel for a full day after the long run. I recovered pretty fast the next day after a two kilometre walk. I am now looking forward to 16 mile run on 23rd April and a 10*800 runs on 9th and 16th April.

I came to know during this week that President George Bush ran a marathon during 1990s.

Yesterday (4/3/06), I went around the Parel area looking for shoes. The salesmen do not know anything about suggesting appropriate running shoes. They do not even ask what is the distance you want to run and whether you are a beginner or a seasoned runner. The situation needs a lot of improvement.

KVSSNRAO

ON RESEARCH

On 25th March 2006, I had the opportunity to chair the session on Finance in the National Research Conference organised by St. Francis Institute of Management & Research (SFIMAR, Borivili, Mumbai during 24-26 March 2006. I made the following observations on Research projects, research papers and support for post-Ph.D. research in academic institutions.

A comprehensive research project starts with a practical problem that is being faced by a large number of entitites. The aim is to find a general solution that is applicable across all the entities. After selecting the problem on which he wants to use his research expertise, the researcher spends time and effort on observing the entity and collecting relevant data. The researcher has to creatively arrive at a solution that uses his existing knowledge of various sciences that have applicability to the problem at hand to identify the independent variables and dependent variables and explain their relation in a way that provides a solution to the problem. The solution so arrived at has to be checked first for logical correctness. This effort may have taken even 100 years and more for certain problems. Research is a risky activity. Answers to the problems may not be found for hundreds and thousands of years even though the wisest of people of the day spend their time and effort on them.

After finding a logically correct solution to a problem, the researcher has to test the solution in a sample, the size of which is determined as per the principles of Statistics. If he gets a satisfactory resolution of the practical problem in the sample, the researcher has found a useful solution to the problem and he can declare it to the society at large for use. If the solution does not deliver the result, the researcher is back in his research effort. First he has to find out the lacunae in his logical solution and then try once again to find a new solution. The cycle continues till some researcher finds a practically successful solution to the problem being faced by the society.

Every Ph.D research project and every research paper presented or published by a researcher will not be a comprehensive research project. Researchers need to do many projects involving some component of the comprehensive research project to make research results useful to the society.

For instance, just because one researcher declares that he discovered a solution will not lead to its immediate implementation commercially. Other researchers have to do similar investigation and confirm that the solution is delivering the result. As more and more researchers confirm the result, the commercial entities will start implementing the solution. Hence we see a need for research projects that focus on testing the solution only. Many of the Ph.D thesis are of this nature. The solution proposed needs to be tested in different geographical locations, different cultures, differnt demographic segments etc. Thus there is a need and scope for a large number of research projects whenever a new solution is found for a practical problem.

There are certain researchers who specialise in refining the logical solution put forward by other researchers. These researchers, called theoretical researchers, do not select practical problems and do the observation and data collection themselves. But once some researcher does the primary observation and comes out with a theoretical conjecture, they spend their knowledge on refining the theory and provide a more logically correct and more refined solution.

Researchers sometimes identify the problems and bring it to the notice of fellow researchers for doing furthe research.

One author commented that just because a research paper was published in a journal may not mean that the society will get benefit immediately. The publication may mean that the author of the paper and one or two referees may have read the paper. There is no guarantee that a published article gets converted into a benefit for the society. Hence papers that do literature reviews and discuss various papers that pertain to a topic become useful to disseminate research carried out so far to a larger audience.

The initial successful commercial implementations of a solution proposed by a researcher is worthy of being described by researchers and published in journals and conference proceedings.

Thus we see a variety of papers being presented in the research conferences. People should discriminate between comprehensive research papers and partial research papers. An aspiring Ph.D candidate should not feel that doing a literature review will get him the degree. The review is only a beginning for starting his creative work on the gap in the literature on the topic. The reviews can be research papers but they cannot be dissertations. They are essential part of a thesis, but the real contribution comes from a new theoretical conjencture and a new test of an old theoretical conjecture.

Regarding promoting post-Ph.D Research

Most of the times, Ph.D degree holders acquire 50-80% of the expertise in the research process. Rest of the required inputs come from the guide, other faculty members, and other researchers. Hence unless, some more elaborate research projects are carried out, Ph.D degree holders may not acquire the full expertise. Academic institutes have to motivate, facilitate. monitor and provide incentives to the fresh Ph.D holders to take up further research. In my post-Ph.D experience in four institutions, I find such opportunities are scarce. Routine academic work itself takes up the full time of a new recruit. I appealed to all the persons present in the conference to think of providing such opportunities to fresh Ph.D's.

ICFAI INSTITUTE OF MANAGEMENT TEACHERS, MUMBAI

I was asked to coordinate the activities of IIMT, Mumbai. First class postgraduates who want to become faculty members in management schools are given a three year education in management teaching and research. Third year of the program is under a foreign professor. After three years, they are absorbed as senior lecturers in ICFAI Business Schools. In the first year of the program, the candidates get a stipend equal to the salary of a lecturer, Rs.18,000/- p.m. The last date for applications for the batch starting in August 2006 is 25th March 2006. Details can be seen from www.icfai.org

A USEFUL QUOTATION

I noted this quotation long back may be in 1992. I had no interest in running or walking at that time. Now that I developed interest in running and trying to do some regular training every week with three days of running and three days of cross training, this quotation seems to be more relevant to remember. I thought it is relevent for many long-distance running enthusiasts, who want to break at least their personal recods.

Herb Elliott, the unbeaten Australian one miler said it: "Any one can train when he feels like it. But you have to keep training when you don't feel like it. You have to keep going at it all the time. Even when you're tired. That's what makes a champion. And that's what proves you're a man."

Active Portfolio Management-EEP

The program went on well. Eight participants were there. We had discussions on basics of Sharpe Model and Treynor Black's use of the model to pronounce an active trading strategy. This program gives me the confidence to think of one more program in the near future.

Added a site metre

Added a site metre

Active Portfolio Management for Exceeding Benchmark Performance

I am offering an executive education program on the above topic during 17-18 March 2006. Interested persons are requested to send an email to my id nrkvss@ rediffmail.com for the brochure.

KVSSNrao

Faculty Positions - ICFAI Business School, Mumbai

Faculty Positions in ICFAI Business School, Mumbai

ICFAI Business School, Mumbai is looking for persons with excellent academic background and professional experience for faculty positions in all areas of management. Interested persons can send their cv to my email nrkvss@rediffmail.com.

KVSSNrao

My Comments on Mumbai Marathon on www.rediff.com

12-2-2006

My comments on Mumbai Marathon appeared on www.rediff.com

Page: http://mboard.rediff.com/board/board.php?boardid=sports2006jan16msg&page=3

Subject: I ran the Mumbai Marathon

I ran the half marathon in 2 hours and 36 minutes. The certificate says 25 in my age class. I am just short of 50 years. The organisers must have published the full list of persons who completed the full marathon and half marathon. For the recent Singapore Marathon, the full lists are available on the net.

For a marathon event, the number of persons who complete the marathon, and the number of persons who completed marathon for the first time are important information. More and more marathons are organized to create more and more marathon runners. But unfortunately all the media coverage is being given to the top three or four athletes forgetting the new entrants into the marathon club. I hope this neglect is recognised by the organisers and the media.

Narayana Rao

Posted by K.V.S.S. Narayana Rao on 03-FEB-06

Blogs are valuable

9th Febrauary 2006

Yesterday, I spent considerable time in searching for persons who participated in the Mumbai marathon. The blogs of various runners proved to be very useful. I did read the blog of a volunteer, who mentioned his friend who was associated with the organisers of the event. I sent an email to him regarding the improvements to the event management and got an instant reply. I also got replies from two runners. A productive day from the point of meeting the mumbai marathon participants.

I ran 6*400 mts interval running yesterday. Today I went cycling for around 6 kms and then for strength training.

KVSSNRao

Became a blogger

February 8th 2006

Wanted to post a comment. In the process started this blog.

Nrao