Location of Pain
Pain around and sometimes behind the knee cap while running.
The knee is essentially made up of four bones. The femur, which is the large bone in your thigh, attaches by ligaments and a capsule to your tibia. Just below and next to the tibia is the fibula, which runs parallel to the tibia. The patella, or what we call the knee cap, rides on the knee joint as the knee bends.
When the knee moves, it does not just bend and straighten, or, as it is medically termed, flex and extend. There is also a slight rotational component in this motion. This component was recognized only within the last 50 years, which may be part of the reason people have so many unknown injuries.
The knee muscles which go across the knee joint are the quadriceps and the hamstrings. The quadriceps muscles are on the front of the knee, and the hamstrings are on the back of the knee. The ligaments are equally important in the knee joint because they hold the joint together. You may have heard of people who have had ligament tears. Problems with ligaments are common.
This is a very common running injury and usually affects those that have just started to increase the distance to 40 miles per week. This condition can produce a crunching or clicking sound while running which can be highly disconcerting. The pain may also increase when running downhill and even after periods of rest.
Runners Knee is a result of a muscular imbalance in the legs and feet. It is not related to the structures surrounding the knee cap. The knee caps need to move up and down in a smooth motion to insure a balanced running stride. When the muscles in the feet and legs are imbalanced the knees go off track causing the cartridge to grind away at the knee cap.
Weak quadriceps are usually caused by the very strong hamstrings overpowering them. This causes the knee cap to be imbalanced as the weaker quadriceps are unable to support the knee cap and prevent twisting and pulling of the knee cap. Foot imbalance (over pronation) can also lead to your knee cap being imbalanced and thus producing knee pain. Sometimes this condition can be aggravated by a sudden increase in mileage, speed and running on uneven surfaces.
Some runners complain of knee pain around the top of thetibia (inside knee).The pain can be so severe that it even affects your feet and putting shoes on can be painful. Popliteus tendon runs behind the knee and attaches to the larger tibia bone. If it is a tendon injury, the injury appears to be associated with the tibialis anterior muscle. Or, extensor digitorun, or extensor hallucius longus since these attach to the tibia. They assist in flexing the foot which could be the source of the pain when putting on shoes.
Recent medical evidence suggests that the quadriceps angle (q angle) increases the likelihood of runners knee. The q angle is an estimate of the effective angle that the quadriceps average its pull. Normal is below 12 degrees, an abnormal q angle is anything above 15 degrees. Some of the mechanical reasons that contribute to the higher q angle are:
Initial treatment should consist of an ice pack. Some runners prefer to use a wet towel that has been in the fridge. We recommend you use commercially available ice packs for focused pain relief. Anti-inflammatory tablets and gels such as Ibuprofen will help to release the swelling. Please note this should be taken with meals and never before running. You can also alternate cold therapy with heat therapy to further increase the healing of soft tissue damage.
It is important to strengthen the quadriceps using quadricep strengthening exercises. Recent sports studies have suggested that “retro-running” can stretch and strengthen the quadriceps and hamstrings to improve stability. Retro-running is walking or running backwards. It is important to start slowly with a slow walk and progress to a gentle jog. Choose a smooth, flat road or you can utilize a treadmill with handrails for support. Alternate your neck position to prevent strains and limit your retro-running to two sessions per week starting from 50 meters and progressing to 500 metes.
Tendons and ligaments are most vulnerable and keep the memory of the previous troubles longer. After them our muscles go who are active memorizers of the problems. The origin of the problem can be incorrect running movement.
Are you a heel striker or a forefoot runner? From this point we can go to a different scenario of treatment.
You need to re-educate yourself into the proper pattern of movement, which will start a healing process. Several rules will help you not to aggravate your problem. Do not land on your heels. Do not land ahead of your GCM (general centre of mass). Do not push off, or straighten your knees on the support. It is already half of the solution to the problem. You need to restore the normal relationships between muscle/tendon work in this area.
We also strongly recommend the use of sports orthotics/ insoles to dramatically speed up recovery time. Knee pain supports provide compression and stability to the affected area to increase the healing phase of the injury.
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