Leaving Knee Pain Behind

Thu, 13 Oct. 2011 - 1:09 a.m. MT
Credit: ARA Staff - American Running Association

By some estimates the number of Americans identifying themselves as runners has now grown to some 40 million. With roughly a third of the injuries treated annually for these dedicated followers of fitness affecting the knee, and roughly 60% of those runners suffering an injury in an average year, odds are one in five that you’ll experience a knee pain or a knee injury in one 12-month period of training.
 
So how can we mitigate the inevitable knee problem awaiting us down the long and winding road? Kevin Plancher, MD, orthopedic surgeon for the US Ski & Snowboard teams says, yes, of course running puts stress on the knee, which is the largest joint in the body and one of the most easily injured. But this doesn't spell automatic trouble. "The key is to understand your body's mechanics and pay attention to any signs that your knees aren't moving properly," he says.

The knee joint comprises three bones: the femur (thigh bone), the tibia (shin bone), and the patella (kneecap), which slides in a groove on the end of the femur. It also contains large ligaments connecting the bones to each other and helping them move correctly. Tendons connect the bone to muscle, and cartilage cushions everything and helps to absorb shock.

Knee problems in runners can often be traced to a few key factors:

Overuse. Any repetitive activity can fatigue your muscles and lead to excessive loading of the joints, which need time to repair themselves. Inflammation and damaged tissue are par for the course after hard workouts, and so if you don't rest enough between them, either by scheduling easy days or days of altogether rest, the cycle of inflammation, damage, and diminishing returns puts you at increased risk of injury.
 
It’s important to assess your “readiness to run” on any given day. Generally, you should not push past what your body is telling you it can do. You’ll only render the next day a day of flat-out rest, when it could have been another training day.

Lack of strength and flexibility. If your leg muscles are tight and/or weak, they won't absorb enough of the stress exerted on your knee joints. A long warm-up is useful here and can also help you assess the delineation between what you feel like doing and what your body is capable of doing, safely and injury-free. But many people avoid strength training those supportive structures around the knee, blaming the joints when really it is the muscles’ inability to take up the job of shock absorption that causes undue joint stress. Put simply, weight training is a vital component of knee pain avoidance.

Mechanical problems. Having certain structural abnormalities, such as a malalignment of your knees, flat feet, or a leg length discrepancy, can leave you more prone to knee problems. Be sure to get a biomechanical assessment from a sports medicine doctor at the earliest onset of knee pain. (S)he may be able to recommend a corrective shoe, orthotics, or other solution to keep you training pain free.

Overweight. Carrying around even a few extra pounds increases stress on your knee joints. It can also put you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

If you experience knee pain that isn't severe or disabling, try taking a few days off from your running routine and icing and elevating the affected knee. An over-the-counter nonsteroidal anti-inflammatory drug (NSAID) may reduce pain and inflammation, but can sometimes interfere with GI function, exacerbate fluid imbalance, and contribute to short-term liver dysfunction in long distance runners. Use NSAIDs on a regular basis only under the guidance of your doctor.
 
If you don't notice any improvement in knee pain in a week or so, see an orthopedic professional. You should call your doctor immediately if your pain is so severe that you can't bear weight on your knee, have marked swelling, or develop a fever.

(Plancher Orthopaedics & Sports Medicine, PLLC, New York, NY, www.plancherortho.com; Orthopaedic Foundation for Active Lifestyles, Cos Cob, CT, www.ofals.org; Running & FitNews, Vol. 23, No. 1, pp. 1, 5)
 
(RUNNING & FITNEWS® September / October 2007 • Volume 25, Number 5)


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