Wednesday, 4 July 2012

Running and knee pain

If you are a runner, chances are you have experienced knee pain.  The most common concern I hear is that the constant pounding and repetitive strain creates lasting changes in the knees.  As I wrote about in a past article which you can read by clicking here, there may be some truth to these concerns.

However, more often than not, the knee pain you feel related to your running is much more benign.

Recently I wrote an article about this topic for The New Hamburg Independent.  It is a basic summary, and is by no means comprehensive, but at least a step in the right direction.  Enjoy!

Your running-related knee pain may not be that bad after all
With the weather taking a turn for the better, it seems it is finally safe to come out of our state of hibernation.  One of the best ways to take advantage of this sun and warmth is to get outside and go for a run!

While many individuals start off with good intentions, the training and activity is often prematurely ended due to injuries involving the knee.

When a runner’s knee hurts, the first reaction is to suspect that the constant pounding of running has caused lasting changes in the cartilage and other internal structures of the knee. 

The good news: this usually is not the case.

Knee pain associated with running is typically associated with two very common anatomical structures; the knee cap and the IT band.

The knee cap is the circular bone at the front of your knee.  The large quadriceps muscle attaches to the top of it, while the thick patellar tendon attaches bellow it.  This knee cap is supposed to glide nice and smoothly in between two large prominences in your thigh bone (the femur) like a train on its tracks.

However, very commonly, the knee cap can slide off its track due to muscle weakness or asymmetrical tissue tension.  This can result in unwanted friction and pinching of the soft tissues under the knee cap, causing pain at the front of your knee.  This is referred to as patellofemoral pain, or more commonly “runners’ knee”.

Aside from patellofemoral pain, injuries associated with the IT band are also very common among new runners.  The IT band is a thick layer of tissue that runs along the outside of your thigh from the hip all the way down to your knee. 

Normally, as you run, there is sufficient flexibility in the IT band to ensure excess force is not transmitted through this band at the hip or at the knee.  Also, in an ideal world, the muscles that keep the pelvis stable are strong enough to maintain pelvic stability and prevent tension from being put through the IT band. 

However, in most new runners, the IT band can become tight and the pelvic stabilizers are often not ready for the demands of running.  As a result, friction and inflammation starts to occur at the hip and the knee, which can cause pain at one or both points of attachment.  This is referred to as "IT band syndrome" (for a more comprehensive look at ITBS, see my article from 2011).

Both patellofemoral pain and IT band syndrome can be very painful.  They are often made worse with running, and feel better as you rest.  They are discouraging injuries because they often prevent you from pursuing your summer fitness goals, and sometimes scare people away from running for good.

However, these types of knee pain should not be considered a death sentence.  They should not be interpreted as instances of permanent knee damage, and should not be viewed as a reason why you just “don’t have a runner’s body.”

So how do you treat these injuries?  The answer, as per usual, is multifactorial.  However, a good rule of thumb is that prevention is the best medicine.  Slowly progressing into running via jogging and walking intervals a maximum of three times per week will help these structures become prepared for running before you jump right into your longer runs.  Working on a strengthening plan to target the muscles around the hips and knees will also go a long way to help keep you pain free.

If you are interested in building up to running in a gradual, progressive, and safe way, feel free to check out some of our training groups!  We have a program that is right for just about everybody!