In this continuing series about aches and pains runners may develop, particularly relevant as training will be ramping up preparation for the Great North Run; we will cover knee pains. (Last week we covered foot pain, especially related to plantar fasciitis).
Knee pain is a common symptom of runners who are pushing themselves to increase their mileage. It is so common, that there is a particular condition called ‘runners knee’. This is often felt as a constant ache underneath or just below the knee cap that usually worsens as the intensity of exercise increases. It may also come on while squatting (especially activities that are similar to single leg squats) and climbing up or down stairs. While the cause can be multitude of reasons, the following is a list of common causes and possible solutions.
- Flat feet
This can alter the way an athlete runs so that the ankle rolls in, the knee collapses toward the other knee, excessive pressure is put on the inside of the knee (possibly causing cartilage issues) and strain is put on the hip. The muscles that pull the leg in the opposite direction, usually on the outside of the leg and thigh, are strained and become tight. This includes the iliotibial band (ITB), the leg and calf muscles. Correct footwear and possibly insoles often help to solve this problem. To ensure you have the correct footwear, you could visit a shop such as Up and Running where the staff will observe your running style, foot position and shape and prescribe you the appropriate shoe. This is best done in conjunction with a state registered podiatrist. It is also important to have full biomechanical assessment and possibly treatment in order to prepare the body for the changes in posture that will occur once you start to wear the orthotics. The chiropractor who does this may need to free up/realign the bones of the foot, ankle, hip and pelvis and relieve tension in the tight muscles e.g. iliotibial band and gluteal muscles.
- Inflammation underneath the knee cap
Regular icing of the knee especially around the knee cap can be useful. You may want to use an ice pack or a bag of frozen peas but make sure you use a tea towel (or something similar) between the icepack and your skin to prevent frost bite. The ice pack can be applied for 30 minutes three times a day. Acupuncture applied by an acupuncturist or a chiropractor adapt in dry needling could assist in easing the symptoms.
- Imbalance/weak muscles
An imbalance between the different sides/portions of the quadriceps and/or weak external hip rotators can be problematic. A rehabilitation programme as designed by a chiropractor or physiotherapist can be beneficial. This may include strengthening of the quadriceps, especially the outside portion (this can be done in various methods, although a word of caution; there are some quadriceps strengthening exercises that may aggravate an acute version of runner’s knee). Strengthening of the external rotators of the hip (the muscles that stop your hip and lower limb from collapsing/turning inwards) and the core muscles (as required) can also be constructive. A technique called Dynamic Neuromuscular Stabilisation as taught by the Prague School of Rehabilitation is particularly effective at enabling this. For UK practitioners, see their website: http://www.rehabps.cz/rehab/certified_practitioners.php
- Adequate rest between runs and reducing training regime to ensure you are not running to the point of causing pain. Although it is the last thing an athlete wants to hear; rest and recuperation while reducing the intensity of your training regime to allow yourself the chance to recover is critical.
Should you require treatment, please visit your local chiropractor for a full biomechanical assessment. Ideally your chiropractor should be trained in sports chiropractic and be experienced in helping runners recover. They should also work in conjunction with a podiatrist and be conversant in rehabilitation exercises.
We will continue this series of solutions to running injuries next week when we address iliotibial band syndrome. For more information or to speak to an expert visit our website www.headchiro.com