I was recently diagnosis with runners knee by a orthopedic (I had an MRI). I read a ton and know what it is but what is the real cause? I have run all my life and just as I increase my mileage- bam! Out of commission.
Imbalance of muscle? Not enough stretching? Mileage? Age? All of the above?
Here is my plan – What else should I do? I have a 70.3 in May and want to be able to run.
· Already had a shot of cortisone
· Appt for Sport Med Chiro
· Making appt with podiatrist for custom orthotics (should be covered by ins J )
· Picking liquid form of glucosamine from my orthopedic – He said it works for about 1 in 3 people
· Cutting back mileage to 15 - 20 mpw
· Start stretching more and do some leg lifts –strength that knee muscle
Wall squats slowly making sure your knees are over your toes
Step-ups (I use the second stair of my steps). Again, make sure your knee is not bowing out on the way up
Controlled lunges
(10-20 reps of each, twice per day)
Running man: Get on the first step of your stairs.
Face the wall (not up or down)
Step so one leg is on the stailr, one is hanging off towards the ground
Slowly move the leg that is free in a running motion. Make sure the leg that is on the step is partially bent at the knee, and not rotated.
Do 20-30 slow running motions with each leg (you will have to turn 180 degrees to do the other leg). It looks really silly, but the combination of all 4 exercises had me feeling better in a week after battling really painful kneecaps for an entire season
I got shoe inserts and they didn’t help. One of my buddy’s got custom orthotics and liked them, he is a bball player though.
Glucosamine works but you have to take it for a few weeks before it takes effect. If your race is in may you’ll have plenty of time.
I would imagine it is a combination of imbalance, tight ligaments, and form. I think i read you should be able to lift 1.5 times as much weight with your
quads than your hamstrings on the machines for proper tracking. Stretching is good. I like yoga classes cause it forces you to do more stretching than you would do on your own.
I think I remember it hurting a very little bit. I started with a smaller number of reps and moved my way up over the course of the week. Positioning of the knee is crucial. If you have runner’s knee, your knee will want to bulge out with all of the exercises. The point of them is to train your muscles to track straight.
When you do the wall squats, or if you do leg press, see if you can find something to stick between your knees and while you are doing the exercise squeeze your knees together so your body learns to use the Vastus medialis more. Also, I like to do the hip adductor machine. Don’t do the hip abductor or it will further the imbalance.
The general consensus as what causes “runners knee” or chondromalacia patella is that the patella doesn’t track straight and is pulled to the side (usually by the stonger vastus lateralis), thus softening/wearing out the undersurface of your knee cap’s cartilage. Runner in particular often have a weaker vastus medialis respective to the rest of the quads (although cycling lots usually remedies this!) hence the term.
so yes, all of the above! Strengthening the vastus medialis is the #1 treatment, Glucosamine/chondroiton for whatever articular cartilage damage is done (if it works). Orthotics will only help if some excessive pronation is also a causalgia (as this also puts more stress on the medial knee and the weaker vastus medialis).
The first step in seeking care for knee pain is to get an accurate diagnosis in order to eliminate other causes. In particular, the stress fracture (most likely of the tibular) needs to be eliminated. Assuming that the diagnosis of the Runner’s Knee is accurate here are my 2 cents on it.
I agree with rroof comments above (apart from the importance of orthotics). Here is a more elaborate write up on the same thing including exercises for Vastus Medialis.
The Runner’s Knee, or patellofemoral complex(PFPS) is, at least in the first approximation, a direct result of chondromalacia of the patella (softening of the cartilage of the knee cap). This softening is most likely a result of mistracking knee cap during running. The early running guru Dr. Seehan postulated in the 70’s that when you have a knee problem you should take care of your feet. A recent study of the Bay Area Dr. Saxena found that orthotics helped 75 % of the patients (Saxena A, Haddad J, The Effect of Foot Orhtoses on Patellofemoral Pain Syndrome. Journal of The American Podiatric Medical Association ( JAPMA ). Vol 93:4; July-Aug 2003:264-271.)
PREVENTION: In the first place I would definitely suggest orthotics. If you are a light weight runner and/or a mild pronator definitely try to get soft orthotics. They are much lighter and much more comfortable. In the second place, in principle, the amount of running should be reduced. However, your weekly mileage does not seem excessive and this may not apply to you After that you may consider stretching posterior leg muscles (hamstrings and calf muscles) and the Vastus Medialis. For the latter do straight leg lifts (10 sets of 10 lying on the mat or carpet with the other leg slightly bent to take pressure of the back). Also avoid running downhill, and doing activities and workouts that require your knees to be bent.
TREATMENT: In my experience, unless the pain is chronic and mild, the best treatment is total abstention from running until the pain is gone (generally around 2 weeks for me). This may be difficult for runners, but triathletes should consider this is the only way to deal with the problem since they can maintain their aerobic capacity through swimming and biking. It is interesting to note that the treatment for the stress fracture is the same, but the rest need to be longer (6 weeks or so). In practice, just rest until the pain has stopped.
Otherwise known as the VMO. It’s the muscle that’s on front-inside of your quad, that shows to the inside of your knee cap. If you stick your leg out straight and flex your quads, it’s the muscle to the inside of the leg.
Easiest way to strengthen it is to do leg lifts at the gym, but start halfway. In other words, sit in the leg lift machine (the one where you start with your legs in a 90* position and then straighten them to a horizontal position) and do reps from 45* to 90*. This is what surgeons often tell folks who are rehabbing major knee injuries – strengthen the VMO, and do this (among other things, but this is the biggie).
LOL! I hope you don’t often quote “papers” by Amol (Dr. Saxena) since I know him pretty well. 'Course, he rarely actually SEES patients, but publishes prolifically.
Again, orthotics ARE helpful in some patients if excessive pronation is an issue. Since almost all podiatrists think it is, then guess what, it is in the literaure! I disagree with that 75% number - as do others. Have to keep in mind what you are seeing with respect to where it comes from.
I recommend the book, The Knee Crisis Handbook. Helped me a lot and is very thorough at explaining reasons for different exercises based on specific studies. I’m glad I read it before beginning any exercises.
Glucosamine also seems to help. At least every time I’ve stopped taking it for a few days, I’m reminded to take it by a few aches.
With the exercise recommended by rodio you can also externally rotate the foot to further isolate the VMO.
The VMO can be difficult to isolate so I usually recommend keeping your hand on it during this exercise so you can feel the contraction and focus on it. As the problem is a weak VMO - DO NOT USE HEAVY WEIGHTS for this exercise because you will over power the VMO and recruit the other quad muscles. You are better off going light, focusing on isolating the VMO as much as possible and doing more reps.
I was diagnosed with runner’s knee last year shortly before IMAZ. I did the race anyway (incredibly painful). For me, the pain was the worst on the bike, second worst on the run, and hurt even when I swam. Painkillers and glucosamine did nothing for me.
I took a month off training after IM, got orthotics, and had 3 PT sessions (though I still continue to do the stretches and exercises even now).
The orthotics played the largest role in my recovery (I’d say I’m 80% better). This was because my issues were due to my feet (and in part muscle imbalance). I wear one set of orthotics in my regular shoes and biking shoes. I also have two separate sets for my running shoes (one is a bit more pumped up than the other - in case I’m experiencing more pain). They are the light weight foam type and I barely notice them now. They did take a bit of time to get used to (I have really high arches, so that part of my foot was not used to having contact insoles).
However, I think the rest and PT also played a part, so I would recommend trying them as well.
Your story touches on the most crucial part of dealing with any injury - finding out the root cause. In your case it was pronation of the foot leading to tibial rotation aggravating your knee pain. Therefore, orthotics are the best treatment choice. For many others it is weakness of the VMO leading to patellar tracking issues, for them VMO strengthening is key. Glucosamine would be indicated if there was degenerative issues in the articular cartilage.
