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Whether you're starting to run regularly for the first time or an experienced pro, your knees are one crucial bit of kit. Fail to look after them properly and you can end up with real problems. Giles Gyer of Osteon physical therapy looks at how you can keep your knees happy.
There are many reasons why your knees might hurt, from patellafemoral pain, runners knee, ITB dysfunction, to swelling and bursitis, but let’s look at some sensible steps you can take to prevent some of these conditions happening.
We are also going to look at a few overuse injuries and how you can identify them.
1 - Correct footwear: Make sure the running shoes you have are fitted for you, whether you have high or low arches, and seek advice from specialist running shops. Your footwear will be the first things hitting the floor when you run; it will act as a support to the foot and ankle and help absorb shock.
See Choosing the Right Running Shoe.
2 - Start your training sensibly: Most pain and injury is caused by doing too much too soon. If you’re new to running, then build up the mileage slowly, increase your mileage by 10% per week and let your body get use to the new demands you’re putting on it.
See Running Training for Beginners.
3 - Never train through the pain: It’s your body's way of telling you something’s up, addressing issues early is much better than having to take a long lay off.
Pain when running? See out Running Injuries section.
4 - Stretch: It sounds simple enough, but it's something we could all do more of, work on the muscles surrounding the knee joint, make sure you stretch evenly and consistently, and always both legs!
See Essential Stretches for Runners.
5 - Foam rolling: It hurts but it works. Focus on the Iliotibial tract (ITB); if this is tight it can cause patella mistracking, runner’s knee, and several painful conditions that can literally stop you in your tracks.
See Foam Rollers: Essential Runners' Guide
So you’ve been sensible, your footwear is good, you stretch like an acrobat, and you're foam rolling so much it’s actually stopped making you cry, but you're still having knee pain. Let’s cover knee pain locations and what that can mean to you.
Patella Tendonitis (Jumper's Knee)
This is an overuse injury where the athlete does a lot of twisting or turning at speed, jumping or heavy landing onto the legs. This causes trauma and small tears to the patella tendon. Pain is felt at the base of the knee cap.
Signs of this can be aching and stiffness after training, pain when you contract the quadriceps muscles, the patella tendon is painful to touch and it can also be associated with poor Vastus Medialis Obliquus (VMO) function.
Patellofemoral Pain syndrome
This is a generic term for pain at the front of the knee that comes on slowly and gradually gets worse. General patellofemoral pain syndrome happens when the patella does not move or there is a mistracking when the knee is being bent and straightened.
Symptoms are aching at the front of the knee; swelling sometimes happens after exercise, pain increases when walking up or down hills or stairs, and the knee clicks or grinds on bending. Runners might notice tight muscles, such as the calf muscles, hamstrings and quadriceps.
Runners that over pronate are susceptible to getting patellofemoral pain syndrome and, if you suffer with tight or weak muscles or do a lot of long distance running or hill running, then watch out.
Pes Anserine Tendinopathy / Bursitis
This is a repetitive strain condition can be easily mistaken for Medial Collateral Ligament (MCL) injury do to the close proximity.
In simply terms, the Pes Anserine is the point where the tendons of the semitendinosis (Hamstring), Satorius and Gracilis muscles meet and attach to the tibia on the inner part of the lower knee; this can become painful due to repetitive strain.
In this area there is also a bursa, called the anserine bursa which lies between this combined tendon and the Tibia bone underneath. This bursa may become inflamed due to repetitive friction in sports such as cycling, running.
Some symptoms of this condition are pain over the inner and lower knee, pain on climbing stairs, localised swelling, pain on contraction of the hamstrings, pain on stretching the hamstrings.
Ilio Tibial Band Friction Syndrome (ITBFS) or “Runner's Knee” is a common and painful overuse injury that mainly affects the out part of the knee.
This common problem has many causes, people who have weak hip muscles such as the gluteus medius, or if you overpronate you can suffer from this condition and runners who do excessive training or hill running can be very susceptible.
Common symptoms for ITBFS are suffering from Pain on the outside of the knee, Tightness in the iliotibial band, pain is normally aggravated by running, particularly downhill or during flexion or extension of the knee, made worse by pressing in at the side of the knee over the sore part.
Popliteus Strain, the popliteus muscle is a tiny muscle situated in the back of the knee joint, it assists with internal or medial rotation of the tibia and also helps unlock the knee when a runner initiates knee flexion, or bends the knee from a fully extended position.
This poor little muscle is at risk to over use injuries, and injuries that are causes by muscular imbalances around the knee, also if the knee is excessively hyper extended.
Some signs of a popliteus strain are: if the muscle is tender to the touch; if you get posterior knee pain on resisted knee flexion; if your hamstrings are excessively tight and knee extension is painful or uncomfortable.
Note - This is not an exhaustive list of knee conditions, but a guide to a few overuse injuries that are common in runners. This doesn't address direct trauma to the knee joint such as tears or ruptures as that’s a whole other article. Above all, always seek medical advice from a qualified therapist if pain persists.
Thanks to Jimmy Michael and Giles Gyer at Osteon. For a gait analysis, osteopathy, physiotherapy, sports and remedial massage, acupuncture or podiatry then contact Osteon directly:
email: email@example.com web: www.osteon.co.uk Phone: 020 7043 6025
First of all i am a fairly fit 61 year old (not overweight). In the recent past I have rowed competitively (Gigs). I have just started the 0-5k programme and have developed knee pain. Front inside slightly below/ under the knee cap. I have tried pressing around the area to find the hotspot but cant get at it. From your description I think it may be Pes anserine tendinopathy but you also mention median collateral ligament injury. I cant find anything on this. Can you helpwith diagnosis/treatment?
I have recently started running. Developed pain below the knee on the inner aspect. Refrained from running for approximately a week, it felt slightly better. I went out for a run/walk this morning and the pain has returned. Any advice would be welcome.
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