Home' Trinidad and Tobago Guardian : May 24th 2013 Contents A56
Guardian www.guardian.co.tt Friday May 24, 2013
The reality is that most runners deal with con-
stant, nagging pains, twinges, aches...a tight ham-
string, an "iffy" knee, a hurting foot.
This is particularly so when mileage is high and
there is no cross-training involved---but that is another
discussion all by itself. Runners World Magazine has
so accurately described the typical runner s situation
as a spectrum. At one end, which they call the red
zone, there are the potentially career-ending, full-
blown injuries like stress fractures which require time
off from running. At the other end, the green zone,
the runner is in top form, and perfectly healthy.
However, most runners spend most of their time
in the yellow zone, where they are not completely
pain-free, yet do not have full-blown injuries.
The next few articles in this column will comprise
a series of the most common types of injuries that
keep runners in the yellow zone, and may even take
them into the red.
We begin with one of the most common running
injuries so appropriately called "runner s knee." The
medical term for this is patellofemoral pain syndrome
(PFPS) and it is the irritation of the cartilage under-
neath the kneecap (patella). It is more common in
women because of their body structure. The symp-
toms are usually described as pain underneath the
kneecap that flares up after or during long runs, and
with descending stairs or hills. Prolonged periods of
sitting also exacerbate symptoms, and this is the
reason for the condition s other name, "movie-goer s
The irritation of the cartilage under the kneecap
is caused by poor tracking of the kneecap over the
knee joint as the athlete bends and straightens the
knee. The major causes of this maltracking are fairly
extensive but all are biomechanical stresses that affect
how the kneecap glides over the joint. These stresses
include ankles that roll inwards during weight bearing
(pronation). This causes the lower leg to rotate and
puts extra torque on the knee. This can be easily
assisted by the use of orthotics or proper running
shoes, in addition to strengthening the stabiliser
muscles of the hip, foot and ankle.
Other factors that can affect the tracking of the
kneecap include weak hips that can cause poor control
of the pelvis and ultimately, the knee. The hips and
pelvis act as the foundation from which the knee
functions. If one builds a house on a foundation of
mud, the house falls with the first rain. The same
is true for the knee and its pelvic foundation when
it comes to running, and sport in general. If the core,
pelvis and hips are weak, then knee stability suffers
as greater torques are placed through the joint. This
can result in PFPS.
Another problem that can lead to PFPS, and one
which I see often at Total Rehabilitation Centre after
knee surgeries, is an imbalance in the strength of the
quadriceps muscles. Appropriately named, the quadri-
ceps on the front of the thigh is actually a group of
four muscles, and each muscle exerts a different
direction of pull on the kneecap. After surgery, or
because of other factors, the innermost muscle of
the quads usually becomes weak and cannot coun-
teract the pull of the outer quad muscle. As a result
the kneecap tracks outward as opposed to smoothly
over the joint, irritating the cartilage and resulting
in PFPS. However, most of the time these issues
occur together. Very rarely do they exist independently.
Therefore a more holistic approach to the rehabilitation
of PFPS is necessary.
A runner s technique may even need to be altered
to place less stress on the knee.
Physical therapy to address the above issues is of
the utmost importance if the athlete is to return to
Learning to manage 'runner's knee'
pain-free running and avoid future problems
such as early-onset arthritis. It will usually
consist of strengthening weak muscles of
the core and entire lower extremity, releasing
mobility restrictions, foot stability exercises,
running technique correction, possible
orthotic prescription, and even kinesio taping
to coax the kneecap into tracking correctly
and to activate the inner quad muscle.
If you have PFPS, you do not have to stop
running. However, you should reduce your
mileage, avoid running on consecutive days,
and only run as far as you can without pain.
Carla Rauseo, DPT, C.S.C.S. is a doctor
of physical therapy and certified strength
and conditioning specialist at Total Reha-
bilitation Centre Ltd in El Socorro.
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