Runner’s Knee: A non-discriminatory form of knee pain

April 15, 2013 By Leave a Comment

Runner InjuryWhat is “Runner’s Knee”?  Runner’s knee is pain and inflammation that involves the kneecap, quadriceps tendon, and the surrounding soft tissues involved in knee extension. It is caused by irritation and excess loading of the cartilage lining on the under surface of the kneecap and the subchondral bone in the knee. Damage and irritation to the fat pad and other soft tissues in the knee can be sources of pain as well. While as you no doubt guessed runner’s knee is most often associated with long distance running, but any activity that places significant stress on the front of the knee can cause the same symptoms, hence the “non-discrimination”. This includes running, repetitive jumping, weight lifting, prolonged kneeling on rocky ledges, extreme stair climbing etc. Symptoms include pain in the front of the knee and around the knee cap. The pain can linger or even increase after activity and can also be aggravated by sitting for long periods.

Some of the risk factors that can increase you chance of developing runner’s knee are (in no particular order):

• Direct trauma to the kneecap
• Overuse with running and jumping activities
• Valgus collapse or “Knock Knees” resulting in patellar tracking problems
• Weakness or imbalance in the quadriceps and hamstring muscles
• Flat feet/overpronation

As there are multiple risk factors, strategies for prevention are also diverse. First make sure you have the right equipment. Use the proper foot wear including orthotics if necessary, if you are unsure what the proper foot wear is go to a reputable shoe store, run coach or podiatrist and have someone help you determine what the best foot wear is for you and your goals. While bicycling is typically considered a low impact activity the repetitive motion over several miles can cause significant stress to the knee if your set up is not right, so if you are having knee pain with bicycling a proper bike fit is a good place to start. Strength and flexibility training with obvious emphasis on the muscles affecting knee joint stability and motion is key: quads and hamstrings, plus work on the calves and hip muscles as well.

Conservative treatment for this condition is relatively straight forward most of the time. Avoid aggravating activities (if it hurts don’t do it). Correct imbalances, faulty biomechanics and tracking problems through exercise, movement training, and possibly bracing or taping; then gradually return to your normal pain free activity. I know for some of you however rest is not a word you understand or accept, so here are some other options for you. If running is your passion you can make several modifications that may help reduce the stress on the knee and reduce the discomfort:

Reduced body weight running in an AlterG anti-gravity treadmill is a great way to get your miles in pain free.

If you run a lot of hills or on the sidewalk you can reduce your impact by switching to running on a flat artificial track such as the one you might find at your local high school.

Losing weight.

Switching to a lower impact activity while you allow your body to recover such as swimming or biking is a great way to stay active without aggravating the affected tissues.

Anti-inflammatory medications can help relieve the pain, but be cautious, pain is one of your body’s ways of telling you something is wrong. Follow all warnings on the label and know that prolonged use can inhibit your body’s natural repair process.

Filed Under: Lower Extremities, Runner's Corner

Do you move?

December 26, 2012 By

Here at SportsPlus our motto for the New Year is: Move Better. Live Better. And in that spirit the next couple of posts will be about different exercises and movements that you can do throughout the day, whether at home or in the office, to move more often, and to move better. In the clinic we have tried all kinds of things to help people to move more often and to take frequent breaks from working and or studying, often to no avail. We have tried asking politely (usually useless), we have tried giving out timers that go off every 30 minutes (annoying), we have even tried scare tactics like this cool info graphic titled sitting is killing you (fear is never the answer). But all of this er… um… encouragement to stop sitting is useless without some suggestion of what to do instead and some reasons why those options are beneficial. In the spirit of one of my favorite TED talks I am going to start with the why today in this post and the how and what will follow in the next post.

                So why is it important to move throughout the day? 1. Common sense says it is a good idea, you know deep down inside that sitting for 8 hours a day at your desk and then another 3-4 hours sitting in your car and on your couch is bad for you, and deep down inside is usually a pretty good place to start when looking for advice. 2. Regardless of what you may have heard, there is no such thing as perfect posture, while some postures are more detrimental than others all postures put some amount of strain on some parts of your body and we need to change positions in order to vary that strain. 3. If you took the time to look at the info graphic in the link above you would have noted that sitting for any period of time, especially in a hunched forward position puts a large amount of strain on your low back. Prolonged sitting in particular is linked to chronic pain, obesity, diabetes, and increased risk of death, yes you read that right, DEATH. According to some studies sitting for more than 6 hours a day makes you 40% more likely to die in the next 15 years than someone who sits less than 3 hours a day, even if you exercise. Whoa, that last part about the exercise makes me stand up at my desk every time I read it.

                Enough with the bad news though already, how about some good news. While it may be difficult to rearrange your day so that you sit less than 6 hours there are some practical things you can do to help reduce the stress that sitting places on your body and decrease some of the aches and pains associated with prolonged sitting. First: MOVE! take frequent breaks, get up, stretch, get a drink of water, instead of calling the guy down the hall to ask him a question walk over and ask him in person, whatever you need to do… move. Second, even as little as two minutes a day of exercise has been shown to significantly reduce the frequency and intensity of headaches in office workers. Two minutes, that’s less time than it took you to watch some video about dancing cats this afternoon (and as a side note you could probably do the exercises from this study while watching the video about dancing cats), anybody can find two minutes in their day and that means that you can too. Third, microbreaks, especially in 20 minute intervals have been shown to reduce general discomfort without having any negative effects on productivity.

                So in conclusion move, it increases your lifespan, it reduces pain and it does not reduce your productivity.

 

(here is a cat video for you to watch while you stand up and stretch)

 

 

 

Filed Under: Therapeutic Exercise

Elliptical vs Walking

December 19, 2012 By

 

Move Better.  Live Better.  That is the mantra at SportsPlus Bay Area.  Sometimes this is more difficult than it appears.  Being a chiropractor, patients often seek me out for lumbar spine pain. Lower back pain usually requires me to modify patients’ activity while they are recovering.

treadmill.eliptical

When I am returning someone to normal activity, I have to be careful with my recommendations. If I push them too far, they flare up and it sets them back. If I don’t push hard enough, then they don’t recover as quickly. It is a gentle balance and one that I do not take lightly. I like to say, “I am going to push you to the end of the cliff but not let you fall over,” meaning I am going to be aggressive with your rehabilitation but not so aggressive that I cause a major setback. Keeping people as active as possible for their condition is always my goal.

I am lucky that I have professionals to rely on when making recommendations. For those who know me, I often reference Professor Stuart McGill, PhD, out of Waterloo, Canada. He has taken spine biomechanical research and put it in a format that allows clinicians to use it in their practice.

Once such recent publication, “How Do Elliptical Machines Differ from Walking: A Study of Torso Motion and Muscle Activity” (Moreside and McGill 2012), was published in the Journal Clinical Biomechanics. Many patients and clients like using the elliptical trainer for cardiovascular exercise because of its relatively low impact on joints, with a metabolic cost similar to treadmill running (Mier and Feito, 2006). Burnfield et al. (2010) described increased lumbar flexion but a corresponding decrease in lumbar extension when comparing elliptical training to walking. This posture may be a precursor to intervertebral disc damage due to increased intradiscal pressure (Adams and Hutton, 1980).

Summary of Important Findings:

1. Spine motion on the elliptical trainer is not the same as the spine motion produced when walking. Increased forward flexion was present in all variations of elliptical use that were tested.

2. Lumbar rotation was greater on the elliptical trainer compared to walking in all positions, except hands on the bars in front.

3. Increased speed on the elliptical trainer increased the amount of lumbar flexion, extension, and rotation.

4. Both lumbar forward flexion and lumbar rotation were greatly increased on the elliptical trainer compared to walking. Repetitive flexion and axial rotation are known to cause lumbar disc degeneration and annular delimitation (Callaghan and McGill, 2001).

5. People with flexion intolerance are encouraged to avoid holding onto the central bar for support as it encourages a more flexed posture of the lumbar spine.

Ed’s Contribution:

Everyone is different, and this study was limited to young, healthy males, but we should apply the findings to our clients, our patients, and ourselves. If your client constantly complains of lower back pain, especially in the morning and with sitting, they are probably going to have trouble using the elliptical trainer, especially at higher speeds and with their hands on the moving bars.

Make sure to evaluate the client (such as the Functional Movement Screen) of how good hip mobility is because if mobility is lacking in the hips, the lumbar spine will compensate with increased motion. Increased repetitive motion is a precursor to lower back problems. Have the client foam roll and perform hip mobility corrective exercises prior to his or her workout to make sure everything is moving as well as possible. If the condition persists and you are not sure what may be contributing to it, have the client see a health care professional who understands lumbar biomechanics and can make appropriate modifications to the client’s fitness program.

Our focus should be on keeping our clients training for a healthy lifestyle and keeping them out of medical offices for treatment. The available research helps us make good recommendations, but we need to do our homework to convey the message to our clients. Move well. Live well and have a great holiday.

Filed Under: Rehab, Runner's Corner