OrthoVirginia Blog

Virginia 10 Miler Running Tips: Week 6

Let’s talk about your knee. It’s not your meniscus!
Knee pain is one of the most common running injuries and one of the most common reasons people seek orthopaedic care. But, when is the right time to seek medial attention? Knee pain behind the knee cap, around the knee cap, below the knee cap, beside the knee cap, and sometimes behind the knee are usually safe to treat without seeking medical attention.
What is it? You may have a diagnosis or heard of a diagnosis called “Anterior knee pain”, “Patellofemoral Syndrome”, “Chondromalacia patella”, “Patellar instability”, “Patellar maltracking”. All of these terms involved the knee cap (patella) and the thigh bone (the femur). Symptoms can be anywhere from mild to disabling. The femur forms part of the hip joint at one end and part of the knee joint at the other end. The patella is a small round bone which sits in a groove on the bottom end of the femur and is embedded in a tendon which runs from the femur to the large lower leg bone (the tibia).
All that anatomy lesson to say that there are many things that need to be working right to avoid to prevent and treat this type of knee pain. Commonly, there 2 muscle groups that must be working correctly to stabilize this region- the glutes (buttocks) and the quads (top of thigh). The glute muscles attach from the back of the hip to the femur and control rotation forces. The quadriceps muscles attach directly to the patella through a common tendon and help to stabilize the patella within the groove on the femur. These muscle must work in balance for proper knee mechanics.
It’s like a railroad and the railroad car. The railroad is the femur, the railroad car is the patella. If the railroad is constantly moving back and forth (lack of glute stability/balance) underneath the railroad car there is risk for developing knee pain. Similarly, if the railroad car is out of balance and pulling to one side of the track (lack of quad strength/balance) it is going to wear out.
What to do?
Straight leg raises to the front, side and back for thigh and hip strengthening. Single leg bridges for glute strengthening.
IT Band Syndrome: The ITB is a tight band of tissue which runs down the outside of the thigh and attaches just below the knee joint. Commonly runner’s experience pain on the outside of the thigh, outside of the knee, outside of the hip, or sometimes all of the above. As discussed in previous posts, the pain appears as a result of too much too soon. Hills training, specifically downhills and speed training add an additional challenges to the body and if one is not proper prepared there is increased risk of injury. Prevention starts with proper training utilizing to 10% rule, proper warm up, techniques such as foam rolling and stretching, to maintain flexibility of the buttocks, quadriceps and hamstrings (thigh muscles) muscles, and proper strengthening of the buttock muscles. 

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Mark Henry, DPT, PT, ATC
Lynchburg Physical Therapy