Why the Knee is Key; knowledge is power

Runners have thankful soles and are thankful souls. We spend a lot of time in motion and consistently use the same muscles over and over again and if not mindful we can overextend ourselves, which can lead to muscle overuse and injury. Notwithstanding minor aches and pains every once in a while, I’ve been running for about 20 years, 15 of those pretty consistently, and have been sidelined with an injury only two or three times, including now. Now that’s some pretty good odds right there.

I’m currently dealing with some sciatic nerve pain. Your guess is as good as mine and my physical therapist, as to the why and exactly where. As to whether it’s running related or not  is also unclear. It certainly isn’t one of the more common runner’s problem so it’s quite possible the cause of my running hiatus has nothing to do with running at all.  It could be a complex mix ranging from issues arising out of my overly active lifestyle, a weak core, or something as basic as utilizing poor form when lifting at the gym and performing other strength exercises. You would think I have a strong core? Me too! Clearly, not strong enough is what I’m learning.

Getting sidelined with an injury is no fun for a runner and certainly no fun for anyone. When I’m caught off guard and something bothers me, right away I’m on top of it and want to know the why and wherefore whether it’s a pesky hamstring or a troublesome ankle. Knowledge is power and while we cannot be in control of, or even responsible for, every injury that befalls us, there are those we can beware of and guard against and even be quick to take care of if and when we encounter them.  Armed with knowledge of the possible injuries we face, we can make more informed decisions and run smart.

Most common running injuries occur in the knees, ankles, shins, and calves. Secondary muscles such as the back and hip muscles can also be affected. For the purposes of this post, I highlight the knee injuries most common to runners. They are: Runner’s knee, IT band syndrome, Patellar tendonitis, Miniscus damage, and Knee osteoarthritis. I’ve fallen victim to a few of these so that qualifies me to talk. Right? Bragging rights and all that. Lol. But seriously, I’m not a doctor just a runner with a personal account of running issues that I’ve either faced myself or known of others who have.  So I speak from a place of familiarity and not authority.

In a peer reviewd article titled, Common Running Injuries, Knee Pain Andrew Cole MD states that both walking and running exerts extra pressure and weight on the knee that far exceeds the body’s weight: 3 times the body’s weight when walking and 5 times the body’s weight when running. No surprise then that the knee is the most susceptible joint to injury in the body.

  • Runner’s Knee – according to Dr Michael Khadavi, Pain in the front, or anterior, part of the knee is often due to an abnormality of the patellofemoral joint and called “runner’s knee.” While runner’s knee has many underlying causes, the hallmark symptom is pain at front of the knee, around or behind the kneecap, particularly during movement such as running or squatting, or with prolonged sitting. It is most common in individuals who repetitively stress the patellofemoral joint through sports that involve running. Some causes and risk factors of runner’s knee are: sudden increase in the volume or intensity of training; overuse and overtraining of the knee; injury to the ankle, hip, or knee; weak or underdeveloped hip or thigh muscles; excessive body weight; tight quadriceps, calf, illitobial band, or hamstrings; and gender. Presumably, women are more prone to runner’s knee due to having wider hips and different knee alignment.

Some symptoms of runner’s knee include: pain in the front of the knee, a grinding or crunching sensation within the knee, pain that worsens with movement (excess friction), knee swelling, and stiffness after a period of rest or while riding in a car or sitting. Treatment is usually the RICE method: rest, ice, compress, and elevate. If symptoms extend beyond 2 weeks then it’s recommended to see a sports doctor.

  • Iliotibial (IT) band friction syndrome. The IT band is made of fibrous tissue that connects the buttocks muscles to the upper portion of the tibia (shin). A root cause of this injury is weak gluteus (buttock) muscles. (Yale Medicine.org) Treatment involves stretching and/or foam rolling the IT band, employing specific stretches and strengthening exercises to lengthen and strengthen the gluteal muscles, the IT band itself, and the hamstring.
  • Patellar tendinitis, commonly referred to as jumper’s knee, can cause pain at the front of the knee, at the lower kneecap or the bony bump at the top of the shin. The pain may be minor and felt only when exercising, or it may be severe enough to affect a person’s daily activities, such as going up stairs. Along with pain, a person may notice swelling, redness and warmth writes Andrew Cole, MD in his article “Common Running Injuries” in SPORTS-health. Jumper’s knee is common in athletes whose sports require rapid jumping or stopping from high speed, and is more common in male athletes than in women. Risk factors include: insufficient training preparation, prior injury, and being overweight. Some symptoms include: pain during athletic motion, swelling, bruising or redness, and discomfort during daily activities. It is advised to stop all athletic activity even though you may feel you can proceed to avoid a worsening of the condition. Immediate treatment include pain medications and the R.I.C.E. method for minor cases but may include prolonged treatment and even surgery depending on the diagnosis (Terry Gemas, M.D)
  • Miniscus Damage. The meniscus is a C-shaped pad of cartilage that separates the tibia and the femur and provides cushion and stability. It can be damaged in a single traumatic injury or degrade over time through mini-traumas. People who are older, who run on uneven surfaces, or who make sudden turns and hard stops (e.g. soccer players) are at the greatest risk for damage to the meniscus. A person with a torn meniscus can experience knee pain, swelling and stiffness. In addition, the knee may give way or lock if a piece of the torn meniscus prevents joint movement. Surgical repair is sometimes, but not always, recommended. (Andrew Cole, MD) The severity and location of the tear will be vital factors in determining a treatment regimen. Common non-surgical treatments include: R.I.C.E., antiinflammatory medication, physical therapy, electrical stimulation, and injections (Terry Gemas, MD).
  • Knee osteoarthritis – achy, stiff, and possibly swollen knees may be signs of osteoarthritis. Scientists have not determined definitively whether regular running or exercise causes knee osteoarthritis. Cole says that some argue against but state that if one already has it and runs, you may accelerate the wear and tear on the knee while others say that running regularly has added health benefits that outweigh arthritic damage to the knees. Some symptoms include: aches in the knee during and post workout, stiffness and pain when squatting, climbing stairs, and prolonged inactivity. Garrett Human, MD, MPH, writes that, In most but not all cases, the symptoms of knee osteoarthritis come and go, becoming worse and more frequent over months or years. It is easy to dismiss early knee arthritis symptoms, but symptoms may worsen if left untreated. The most common symptom is knee pain. Other symptoms include: swelling, stiffness, redness and warmth, reduced range of motion, worsening symptoms w inactivity, popping or crunching, and buckling or locking up.

Garret Human, MD, MPH, writes that the earlier knee arthritis is treated, the more likely knee pain can be relieved and the less likely it will get worse. Knee arthritis treatment may include nonsurgical treatments, injections, and surgery. Typically, nonsurgical treatments are tried first. Surgery is not usually necessary and recommended only when other treatments have been tried and have not adequately relieved symptoms. A combination of physical therapy, gait and posture training, and topical medications are usually used in early treatment.

Elizabeth Gardner, MD, a Yale Medicine orthopedic surgeon who specializes in sports medicine, recommends getting fitted for sneakers at a store that specializes in running shoes, and balancing running with other workouts like swimming or yoga that don’t involve pounding the pavement. “Cross-training and stretching go a long way toward avoiding running injuries.” As a believer in cross-training myself that’s sound and practical advice right there. Additionally, as a runner, I cannot overemphasize the importance of warming up prior to runs and stretching post workout and even rolling wherever and whenever you feel any tightness. It’s the little things my friends that make a big difference.

In a subsequent post, I’ll continue with a look at other common running injuries beyond the knee. Safe running friends!

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