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One of the most common injuries I see is often referred to as “Runners Knee”. This is really anterior knee pain that commonly afflicts runners, but could be caused by several different tissues. Most commonly, the condition reflects lateral tracking patella and patella femoral pain. In point of fact, most people I see are also suffering patella tendinitis in addition the pain caused by the loading of the patella against the femur. I consider the combination of these two to be a more accurate reflection of the diagnosis “runners knee”.
Runners develop these complaints largely because of their biomechanics. Not to put too fine a point on it, but structure governs function. What this means is that the architecture of the knee is ultimately determined by the architecture of the foot on one hand and the hip on the other.
Since our feet sprout from the trunk sole up in utero, and later in development rotate to assume the position that allows us to ambulate in a bipedal fashion, we end up with a foot that is either partially rotated (supinated) or one that has simply rotated too far (pronated).
So in the end, since the knee, which is a simple joint, follows the tibia in space and since the tibia follows the talus, and since the talus follows the calcaneus, the position of the calcaneus at the time the foot hits the ground and its subsequent motion ultimately determines where the knee ends up in space.
This is important because the foot has two jobs in life: It is either a mobile adapter (as it swings through space during the swing phase of the gait cycle) or it is a rigid lever (as it prepares to propel us forward off the ground). It is the transition between these two end points that is interesting to me.
It turns out that if the foot is pronated or supinated, the knee will probably end up too medially, which will put pressure on the patella to located itself more laterally and this will indeed lead to excessive patella femoral contact and possibly pain. The stress on the patella tendon here will also likely cause irritation in the tendon as well.
The shape of the pelvis and the location of the femoral neck on the femor will also play a roll, with the wider hips of women being to blame for the more severe “Q-angle” at the knee in women, again a factor in lateral tracking patella.
OK, so you have runners knee and want to know the way back.
First, you need to use ice. I advocate ice plus water in a plastic bag on the knee for 30 minutes,
either that, or an ice popsicle (freeze a paper cup filled with water) and rub that over the knee for 10-15 minutes. It is sometimes easier to use the ice popsicle, and sometimes easier to use the plastic bag. If your pain is largely in the tendon, then the ice massage technique works better. To get the cold to penetrate so that the patella femoral irritation is reduced, then the ice bacg seems to be a better strategy.
You also need to stretch the quad and ITB if they are tight, and you need to use the stick or foam roller to massage and elongate those tissues.
For patella tendinitis, you need to do the following: Take a dinner spoon or fork, and place the long neck of the implement against the tendon. Press firmly into the tendon and rub back and forth to resolve any irritation in the tendon. It is often quite painful at first, but over a few days this technique seems to reduce the irritation significantly.
Don’t forget that this is really a biomechanical problem at its root, and so you need a biomechanical solution – i.e. Custom Orthotic Therapy. You need to get fit with custom made orthotics, especially if you find yourself wanting to walk or stand on the outside of your feet (implying an uncompensated forefoot varus). You can read more about orthotics in an earlier post.
From a long term intervention perspective, you need to take a joint supplement if you don’t already. I also posted about joint supplements earlier.
And of course, there is no substitute for common sense. You can do things like avoid down hill running, avoid hard surfaces (concrete, pavement and blacktop), moderate your distances and of course make sure your shoes are in good repair.Make sure to return to running on a gradient…ie do not run too fast, too far or too early.