Monday, April 23, 2012

Why Good Knees Go Bad
by Bob Wells, PES


As a trainer and running coach, I see my fair share of knee injuries. The most common of these is patellofemoral pain syndrome (PFPS), more commonly known as runner's knee. PFPS sufferers will usually experience pain beneath the kneecap that is usually at its worst after a workout.

"There tend to be three causes of injury to the knee," says Michael Stuart, M.D., vice-chair of orthopedic surgery at the Mayo Clinic, in Rochester, Minnesota, the highest-rated orthopedic department in the country, according to U.S. News and World Report. "Those stemming from acute trauma, those which are degenerative in nature, and overuse."

In fact, between one half and three quarters of all running injuries are related to overuse. Knee problems dominate overuse injuries, with PFPS leading the pack. According to a two-year study of more than 2,000 runners completed in 2002 by the University of British Columbia, for example, most running injuries treated at the center occurred at the knee, with patellofemoral pain syndrome making up nearly half, 46 percent of those injuries. The next most common knee injuries were iliotibial band friction syndrome, meniscal injuries, and patella tendinitis (see "Where Does It Hurt?").

Diagnostically, PFPS produces minor to severe pain that can be elicited after a short distance while running, while under load (e.g. squatting), while unloaded for an extended period of time in the bent position, such as sitting, or after palpation under the lower corner of your knee cap.

This makes sense, "because bending the knee increases the pressure between the patella and its various points of contact with the femur. Patellofemoral pain syndrome is often classified as an overuse injury", says Mark S. Juhn, M.D., D.O. "However, a more appropriate term may be 'overload,' because the syndrome can also affect inactive patients. Repeated weight-bearing impact may be a contributing factor, particularly in runners. Steps, hills and uneven surfaces tend to exacerbate patellofemoral pain. Once the syndrome has developed, even prolonged sitting can be painful (“movie-goer's sign”) because of the extra pressure between the patella and the femur during knee flexion".

PFPS struck women in the British Columbia study twice the rates as men, and struck those under 34 more frequently than it did those who were older. Females appear to be affected more often than males, because the increased width of the gynecoid pelvis leads to results in an exaggerated Q angle--the Q angle is a measurement of the angle between the quadriceps and the patella tendon--which is believed to cause patella tracking issues.

According to conventional wisdom, PFPS happens when a kneecap has pulled to the side of its track and rubbed something where it should be gliding. The reasons given for this 'patella-tracking problem' have long been a mixed bag: the runner is thought to have poor biomechanics or bad bone structure; the runner followed bad training advice or owns bad shoes; the runner doesn't possess adequate quadriceps strength or exhibits excessive hamstring or lateral-tendon tightness.

"For many runners weak or tight muscles are the culprit," says Jordan D. Metzl, M.D of New York City's Hospital for Special Surgery. " If your upper-leg and core muscles are under conditioned, your pelvis will wobble as you run. This stress the knees and can cause runner's knee."

He suggests the following moves to target the upper-leg and core muscles to help make your knees more stable and less prone to injury. Do these and enjoy your next run, pain free.

1. Quadriceps and Hip Flexor Roll (click for video).  Lie facedown on the floor with a foam roller positioned just above your knees. Place your elbows on the floor for support. Roll your body until the roller reaches the top of your thighs. Then slowly roll back and forth.






2. Squat Thrusts (click for video). Stand with your feet hip width apart. Push your hips back and bend your knees. As you squat down, place your hands on the floor.   Kick your legs backward, so that you're now in a push-up position. Quickly bring your legs back to the squat position. Stand up and repeat the movement. Do for 40 seconds, rest, and repeat.



3.Lateral Lunges (click for video) Stand with feet hip width apart, toes forward. Shift your weight to your right leg as you push your hips back. Your lower right leg should remain nearly perpendicular to the floor, and your left heel should be down. Lunge to the left. Alternate back and forth for 40 seconds, rest, and repeat.



















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