Runners Can Leave Knee Pain Behind

For Immediate Release

Runners Can Leave Knee Pain Behind
Leading sports orthopaedist discusses how to avoid and treat common running injuries

NY, NY and Greenwich, CT, October 2007 With close to 40 million Americans calling themselves runners, sports orthopaedists generally see plenty of sore knees. In fact, about 60 percent of all runners will be injured in an average year, and about one-third of those injuries strike the knee, meaning one in five runners will hurt their knees in the course of an average year.

What’s going on? Are runners and their knees — doomed to suffer? Not necessarily, says
Kevin Plancher, MD, a leading sports orthopaedist in the New York metropolitan area and an official orthopaedic surgeon for the U.S. Ski & Snowboard teams. True, running puts stress on the knee, which is the largest joint in the body and one of the most easily injured. But running doesn’t necessarily mean trouble for your knees. The key is to understand your bodys mechanics and pay attention to any signs that your knees aren’t moving properly, Dr. Plancher explains.

The knee joint comprises three bones: the thighbone, or femur, the shi bone (tibia), and the kneecap (patella), which slides in a groove on the end of the femur. It also contains large ligaments, which connect the bones to each other and hold them in place to help them move correctly. There are also tendons, which connect bone to muscle, and cartilage, which cushions the knee and helps absorb shock.

Most knee problems in runners can be traced to a few factors:
Overuse (and under-recovery). Any repetitive activity can fatigue your muscles and lead to what the experts call excessive loading of your joints, a kind of stress that creates inflammation and damages tissue, Dr. Plancher explains. If you don’t rest enough between workouts to allow your body to recover, that never-ending cycle of inflammation and damage puts you at increased risk of injury.

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.

Mechanical problems. Having certain structural abnormalities, such as a malalignment of your knees or flat feet, leave you more prone to knee problems.

Being overweight. Carrying around even a few extra pounds increases stress on your knee joints, during ordinary movements like going up and down stairs as well as more strenuous activities. It also puts you at increased risk of osteoarthritis by accelerating the breakdown of joint cartilage.

Being female. Unfair as it may seem, women are more susceptible than men to ligament injuries and chronic problems involving the patella and cartilage, says Dr. Plancher. A womans pelvis is wider than a mans, creating a sharper angle at the knee and, in many cases, misalignment of the kneecap. Women’s ligaments are also more lax — and the muscles that support the knee are not as strong as they typically are in men.

Wearing the wrong shoes. Running in shoes that don’t match your bodys need for cushioning and support can put your knees at risk, says Dr. Plancher. Wearing shoes that are just plain worn out is also a no-no. You should replace your running shoes regularly (about every 250 to 500 miles of use) to keep your steps cushioned.

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. You also can use nonsteroidal anti-inflammatory drugs (NSAIDs), such as Motrin or Advil, to reduce pain and inflammation under the guidance of your doctor. If you don’t notice any improvement in a week or so, see an orthopaedic 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.

Four most common knee problems that runners face and how to manage them. 
Patellofemoral pain syndrome (or PFPS). This condition, also known as runners knee, occurs when the patella moves improperly and is characterized by pain at the front of the knee, behind or underneath the kneecap. The pain may be in one knee or in both, and generally gets worse when you run, go up or down stairs, or sit with your knee bent for a long time (as you do when you’re watching a movie or driving a car).

In most cases, runners can beat PFPS by taking a break from training, putting ice on the knee after exercising and, if necessary, following a physical therapy program that includes strengthening the surrounding muscles and making them more flexible. Taping the knee or using shoe inserts, or orthotics, can also be helpful.

Tendon injuries. By far the most common tendon injury in runners is Iliotibial Band Syndrome, or ITBS, which strikes many long-distance runners, as well as cyclists, tennis players and other athletes who put active, long-term stress on their legs. The iliotibial tendon runs along the outside of the upper leg, from hip to knee. In runners with alignment problems, such as overpronation (in which the ankle rolls too far inward with every step), the tendon will rub against the knee joint, causing inflammation and pain.

ITBS in characterized by pain on the outside of the knee (or hip) that typically starts a few miles into a run. Once it starts, the pain will continue and may even get worse as you keep going and will often feel worse if you run downhill. The discomfort will often go away if you stop running and begin to walk slowly, a phenomenon that has led many runners to try to run through the pain.

To treat ITBS, you should cut back on the intensity and volume you’re your training and use ice and NSAIDs to reduce discomfort and inflammation. You also should incorporate exercises to stretch and strengthen the ITB.

ITBS is often called an overuse injury, but the truth is that runners who log as little as five to ten miles a week can get it, says Dr. Plancher. The real source of ITBS is a lack of strength and flexibility in the iliotibial band and the surrounding muscles, although it can certainly be exacerbated by overtraining, increasing running duration and/or intensity too quickly, running on excessively hard or uneven surfaces, or running in the wrong shoes.

Other tendon problems include tendonitis, which is simply irritation and inflammation of one or more of the tendons in the knee. Runners are particularly prone to inflammation in the patellar tendon, which connects the quadriceps muscle on the front of the thigh to the tibia, in one or both knees. Tendinitis often causes pain and swelling at the front of your knee and just below your kneecap, which usually flares up when you jump, run, squat or climb stairs.

Osteoarthritis. This is a wear-and-tear condition that occurs when the cartilage in your knee deteriorates. It usually develops gradually and is characterized by pain and swelling when you run and stiffness, especially in the morning and after you’ve been active.
Osteoarthritis may be caused by joint injury or being overweight. It most often is associated with aging and typically begins in people age 50 years or older.

If your doctor determines that you have osteoarthritis, you’ll probably be told to use NSAIDs to manage the pain and inflammation. In some cases, you may be given injections of corticosteroid medications, hyaluronic acid substitutes or the nutritional supplements glucosamine and chondroitin sulphate directly into the knee joint.

Ligament injuries. Although ligament injuries most often occur in athletes who jump, twist or change direction rapidly or who participate in contact sports, some runners do injure their anterior cruciate ligament (ACL), medial collateral ligament (MCL) or posterior cruciate ligament (PCL). Ligament injuries are typically accompanied by sharp pain and should always be treated by an orthopeadic professional.

Despite the knee problems that some runners face, the sport is nonetheless a great choice for most people looking to improve their health, says Dr. Plancher. It delivers a terrific cardiovascular workout, strengthens muscles, incinerates calories (and thus speeds any weightloss efforts) and delivers endorphins, the bodys own feel-good chemicals.