Don’t Knock Your Knees

Running can be great for your heart — but hard on your knees. Experts agree that as many as
70 percent of runners will become injured at some point, and the majority of those injuries will
involve the knees. But running doesn’t have to hurt, and injury is by no means a foregone
conclusion, says Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan

The most common running-related knee injuries are patello-femoral pain, also known
chondromalacia of the patella or runner’s knee, and iliotibial band (ITB) syndrome. Runner’s
knee is created when the kneecap (patella) rubs against the bottom of the thighbone, and can
result in irritation and erosion of the cartilage. ITB syndrome involves irritation to the band of
tissue that runs along the outside of the thigh, which can become irritated from repetitive
rubbing over the outside of the knee.

Both runner’s knee and ITB syndrome can be painful and can leave a runner sidelined for weeks
or longer, says Dr. Plancher. “But just because you’re a runner doesn’t mean you’ll have runner’s
knee — or any other knee injury,” he says. “These problems are typically caused overuse or by a
misalignment of the joint that’s exacerbated by improper running habits — all things that can be

Here is some advice for runners who’d rather skip the knee injuries:

Choose the right shoes: Before you take one running step, be sure you’re using the best shoes
— for you. “Everybody’s feet and legs are different,” says Dr. Plancher, “and every shoe model is
unique.” Shoes vary widely from manufacturer to manufacturer, and can also change year to
year, meaning even if you’ve been running in the same brand since high school, you need to
reassess your shoes every time you buy a new pair (which should be after about 300 miles of
wear, or as soon as the soles start to show signs of breakdown). Consulting a trained
professional for the right shoe fit for you will help protect your knees. Buying shoes with the
right combination of cushioning and stability, which is the shoe’s ability to correct any
irregularities in your stride, such as your ankles rolling too far to one side — that can create big
problems in your knees and other joints, is key to injury prevention.

Train smart: Overtraining — running too many miles without adequate rest between runs — or
trying to increase your distance or speed too quickly can hurt your knees. Be sure to
incorporate one or two days of rest each week, and mix a few “easy” (or short) runs in with the
“hard” (or long) ones. Don’t increase your mileage by more than 10 percent a week. Start at a
slow pace and be sure to stretch before and afterwards, to keep your muscles limber and your
joints flexible. According to Carl Asker, ultra marathoner who just completed a 200 mile run
dedicated to Team Time for Lyme and Lyme disease awareness, “the most valuable tool for
saving my knees while training was to have my feet land underneath my center of mass and
never in front of me which would lead to over striding and a possible knee injury”.
Build strength: Keeping your knees healthy also demands some strength training, says Dr.
Plancher. Many runners do only one thing — run — instead of cross training. That means they’ll
strengthen just their running muscles, and they’ll do it only by running. Quite often, runners are
out of balance when it comes to leg strength, with hamstrings (the muscles that run up the
back of the leg, from the knee to the buttocks) that are much stronger than quadriceps (the
muscles on the front of the thigh). The result: pain and injury. A smarter strategy is to
incorporate regular lower extremity strengthening workouts and core strengthening workouts
into your routine, making sure to work on the big muscles (quads and hamstrings) as well as
the smaller ones, such as hip flexors, adductors and abductors, which attach to the hips and
help move your legs forward and to the sides.

Supplement wisely: Your knees — like the other joints in your body– need the right amounts of
certain nutrients to stay strong and injury-free. Calcium is an essential nutrient, and is used in
the body for several functions, including building and maintaining healthy bones.
Experts recommend that adults get 1,000 to 1,200 mg (milligrams) each day. Food is the best
source of calcium (its plentiful in dark green vegetables and dairy products), but most
Americans can use calcium supplements, as well.

Some runners — especially those who have had cartilage damage or knee pain caused by
osteoarthritis — also take supplemental glucosamine and chondroitin sulfate, which are natural
substances found in and around the cells of cartilage. Glucosamine is an amino sugar that
seems to play a role in cartilage formation and repair, and chondroitin is a complex
carbohydrate that helps cartilage retain water and maintain its elasticity. They won’t help
everyone, says Dr. Plancher, but they might help stave off cartilage damage, and research
shows that a combination of the two can provide relief for people with moderate-to-severe
osteoarthritis pain. The recommended dosages are 1,500 mg per day of glucosamine and 1,200
mg a day of chondroitin sulfate.


Kevin D. Plancher, M.D., M.S., F.A.C.S., F.A.A.O.S, is a leading orthopaedic surgeon and sports
medicine expert with treatment in knee, shoulder, elbow and hand injuries. Dr. Plancher is an
Associate Clinical Professor in Orthopaedics at Albert Einstein College of Medicine in NY. He is on
the Editorial Review Board of the Journal of American Academy of Orthopaedic Surgeons.
A graduate of Georgetown University School of Medicine, Dr. Plancher received an M.S. in
Physiology and an M.D. from their school of medicine (cum laude). He did his residency at
Harvard’s combined Orthopaedic program and a Fellowship at the Steadman-Hawkins clinic in
Vail, Colorado where he studied shoulder and knee reconstruction. Dr. Plancher continued his
relationship with the Clinic for the next six years as a Consultant. Dr. Plancher has been a team
physician for over 15 athletic teams, including high school, college and national championship
teams. Dr. Plancher is currently the head team physician for Manhattanville College. Dr. Plancher
is an attending physician at Beth Israel Hospital in New York City and The Stamford Hospital in
Stamford, CT and has offices in Manhattan and Greenwich, Connecticut. http://

Dr. Plancher lectures extensively domestically and internationally on issues related to
Orthopaedic procedures and injury management. During 2001, 2002, 2003, 2004, 2005, 2006,
2007 and 2008, Dr. Plancher was named among the Top Doctors in the New York Metro area
and to the sports medicine arthroscopy program subcommittee for the American Academy of
Orthopaedic surgeons. In 2007 and 2008 Dr. Plancher was named America’s Top Doctor in
Sports Medicine. For the past six years Dr. Plancher has received the Order of Merit (Magnum
Cum Laude) for distinguished Philanthropy in the Advancement of Orthopaedic Surgery by the
Orthopaedic Research and Education Foundation. In 2001, he founded “The Orthopaedic
Foundation for Active Lifestyles”, a non-profit foundation focused on maintaining and enhancing
the physical well-being of active individuals through the development and promotion of research
and supporting technologies.

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