April 26, 2010

Runner's Knee

Running is a high impact sport. Every time my feet strike the ground, my body absorbs a force about 3-5 times my body weight. That’s a lot of impact considering I am increasing mileage every week. Today as I started my 4-mile run, I noticed my right knee was feeling a bit “off”. I can best describe it as discomfort… nothing sharp, nothing major and it slowly went away with the distance. I started to take note of how I was striking the ground and I adjusted my stride so that it didn’t feel as uncomfortable. It got me thinking though – there are going to be various injuries / physical ailments that I am sure to encounter as I start training for a marathon. In the book, “The Non Runner’s Marathon Trainer” by David Whitsett et al, he says that the reason for slowly increasing distances is to allow the body time to adjust to the impact (much like allowing your body to acclimate to higher altitudes). Makes sense. I graduated in Biology for undergrad – my brain just naturally tends towards the side of science. So as my knee started to ache, I thought – I need to include injury analysis in my blog. It starts with runner’s knee.
Runner’s knee (also known as chondromalacia patellae or patellofemoral stress syndrome) is when the kneecap starts to rub against its sides due to one of two factors: weak quadriceps and improper footwear. Running strengthens the hamstrings more than it does the quads, so when the two are out of balance, it can be enough for the kneecap to pull and twist to the side.
You know the song, “the hip bone’s connected to the thigh bone…”? Well, it’s kinda true. Through a series of connections, the knee will end up where the calcaneus is when the foot strikes the ground. Here’s a step-by-step visual of the problem: your foot strikes the ground > you pronate (flatten your arch) > the lower leg below the knee internally rotates > the upper leg externally rotates > this causes a twisting pressure on the knee > the kneecap (patellae) become irritated and painful. It’s a biomechanical problem and luckily it has biomechanical solutions.
The shoes I currently use are Brooks. I was given the 5-step test by an athletic store that watched my stride and matched me with a shoe accordingly. That said, after reading “Born to Run” by David Whitsett I am curious to attempt running in shoes that don’t overly-cushion. Many of my friends have invested in the “barefoot” shoes – little rubber sock things that look like Avatar feet. The concept is that our modern day shoe has actually destroyed our natural stride and increased the probability for injury. I don’t think I’m ready to run barefoot, but perhaps I should re-evaluate my shoe to ensure I’m not over compensating in either direction. I also think that perhaps some quick quad exercises immediately following a run could help lessen the disparity between my hamstrings and quads.
Problem: Discomfort and irritation behind or around kneecap.
Diagnosis: Runner’s knee
  1. Ice knees for 15 minutes directly after running
  2. Take an anti-inflammatory but only with a meal and never before a run
  3. Before bed, put a heating pad on your knees for 15 minutes
  4. Ensure you have the proper footwear
  5. Be conscientious of how you strike
  6. Do not overdue it on the runs. Rule of thumb is you don’t increase your weekly mileage by more than 10% and the longest run of the week should not be any more than 50% more than your longest run in the week
  7. Run slower and on softer surfaces
  8. Warm up and stretch before your run, especially the quad and ITB using a stick or foam roller to massage and elongate those tissues

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