Preventing and managing the most common and annoying running injuries – knee pain

The second most common running injury I see in recreational runners is knee pain, oftentimes also called patella femoral joint pain or chondromalacia patella syndrome. This knee problem very often also involves the patella tendon, whereby there is tendonopathy in the patella tendon – much like what happens in the Achilles tendon (read my blog post on Achilles tendonopathy) and / or irritation of the fat pad that lies underneath the patella tendon.


These problems happen due to muscle imbalance in the lower limb and poor biomechanics leading to the patella not tracking properly over the underlying patella. As the patella is ridged on the underside that corresponds with a grove in the femur, when there is poor tracking of the patella and these surfaces are not well aligned the underside of the patella rubs on the femur. This irritates the cartilage on the underside of the patella and causes pain.


Much like in Achilles tendonopathy, the increased loading (how much running you do) through the patella tendon causes degeneration and breakdown in the patella tendon, new blood vessel growth and pain. Correcting these problems is quite straight forward in most runners as long as they are willing to reduce their ruining volume whilst performing the necessary exercises to stretch and strengthen the right areas.


It is a good idea to see a manual therapists (physiotherapist, osteopath or chiropractor) who can check your biomechanics to make sure your pelvis and spine are aligned and that you have good range of motion in the patella femoral joint, feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury.


As running is a very hip flexor dominant sport, runners become tight in their psoas, TFL and quads. Tightness in these muscles causes the patella to move to the outer side of the knee and weaken the VMO muscle on the inner side of the knee compounding the problem. Therefore stretching and doing self myofascial release for the psoas, TFL and quads muscle whilst strengthening the VMO is warranted. Runners with knee pain have also been shown to have weak glutes, especially the gluteus medius so strengthening this area also helps prevent this condition.


The best ways to prevent yourself from suffering knee pain are:

 

1. Make sure you have a good pair of running shoes such as Asics or Nike. Go along to one of the specialist running shops, such as Sweatshop where they can analyse your feet and provide you with the best running shoes.

2. Get you biomechanics checked by a manual therapists (physiotherapist, osteopath or chiropractor) to make sure your pelvis and spine are aligned and that you have good range of motion and flexibility in the knees, feet and ankles. A quick check up visit is a lot cheaper than a series of treatments after you have an injury. This is how top athletes avoid injuries – they have people assessing and working on them to prevent injury.

3. ALWAYS warm up prior to exercise.

4. ALWAYS warm down after exercise by gently stretching the major muscle groups of the legs including the quads (see my video blog post).

5. Use some self myofascial release on the quads and ITB with a foam roller. See my video blog post where I show you how to do this.

6. Use an undulating periodised training plan to peak before your main run of the season, also make sure you taper your volume leading up to your main event. Don’t just go out and run as far as you can each time you train. This is a sure-fire way to breakdown at get injured.

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