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Runner's Knee

Sixty percent of runners experience an injury severe enough to sideline them from activity. Because the best way to avoid injury is to prevent it, and running shoes are the only protective only protective equipment runners have to safeguard themselves from injury, choosing the correct running shoe is important.

However, choosing the correct shoe is only one variable to consider when trying to prevent running injuries. Several other variables, including flexibility, strengthening, and training schedules, also need to be considered. Running injuries may be acute or chronic, and they all must be managed within an appropriate time frame to assure optimal healing.

Types of injuries

Injuries may be acute or chronic.

Acute

Acute injuries are sudden, somewhat violent injuries. These include broken bones, sprains, and lacerations.

Proper first aid for acute injuries
  • Stop the bleeding.
  • Apply ice to the injured area.
  • Immobilize the injured extremity.
Seek assistance if:
  • There is immediate swelling.
  • There is persistent, severe pain.
  • You are unable to use the injured part.
  • You hear or feel a tear, crack, or pop.

Overuse (or chronic)

Overuse injuries are due to a low-grade, abnormal force being applied repeatedly over a prolonged period of time. These are the most common injuries in runners. The following variables contribute to overuse injuries:

  • Terrain
  • The condition of running shoes
  • Individual foot anatomy (such as flat feet)
  • Decreased strength
  • Decreased flexibility
  • Improper running form
  • Training that lasts too long or is too intense. Overtraining is a leading cause of overuse injuries.
  • Poor running form/biomechanics
  • increasing weekly mileage too quickly
  • Too quick of a transition from treadmill to outdoors.
Symptoms of overtraining include:
  • Weight loss
  • Persistent feeling of fatigue/soreness
  • Sleep disturbances
  • Morning pulse increased by 10 beats per minute
  • Recurrent sore throat or cold symptoms
  • Persistent aches and pains
  • Headaches
  • Increased incidence of injury
  • Aversion to exercise
Proper first aid for overuse (chronic) injuries
  • Reduce training, using pain as a guide.
  • Apply ice to injured area 15 to 20 minutes, three to four times per day.
  • Use compression to decrease swelling.
  • Elevate injured area if possible.
  • Take aspirin or ibuprofen as directed on package instructions.
  • Determine cause of injury (e.g., tight muscle or weak hip muscles) and fix it.
Seek assistance if:
  • Pain continues despite decreased training.
  • Pain persists beyond 10-14 days.
  • Pain medications are needed in order to train.
  • Pain resolves with rest, but recurs once you resume training.

Specific types of injuries

Plantar fasciitis

The primary symptom of plantar fasciitis is pain in the bottom of the foot, from the heel into the arch. It is especially painful when you get up in the morning and after you have been sitting a long time. The discomfort may be present at the start of a run, subside during the run, and then recur later. Causes of plantar fasciitis include:

  • Feet with a high arch (supinator, or a person who rolls his or her feet too far outward while running)
  • Flat feet (overpronator, or a person who rolls his or her feet too far inward while running)
  • Shoes (excessive wear)
  • Incorrect shoe type (cushion versus motion control)
  • Tight calf muscles
  • Training errors (increasing mileage or intensity too quickly) Poor running form/biomechanics
  • Too quick of a transition from treadmill to outdoors.

Treatments for this condition may include:

  • Decrease running (cross train with biking and/or swimming)
  • Apply ice for 20 minutes two to three times per day
  • Stretch calf muscles
  • Massage arch of foot
  • Take anti-inflammatory medications
  • Replace running shoes every 400-600 miles
  • Get fit for shoes at specialty store to find the correct type of running shoe for your foot mechanics, looking at cushioning, stability, and motion control
  • Use appropriate devices, such as arch supports, heel cups, or customized orthotics (devices to correct biomechanical problems)
  • Get a cortisone injection, which may be prescribed by a doctor

The best method for preventing plantar fasciitis is stretching. The plantar fascia can be stretched by grabbing the toes, pulling the foot upward and holding for 15 seconds. To stretch the calf muscles, place hands on a wall and drop affected leg back into a lunge step while keeping the heel of the back leg down. Keep the back knee straight for one stretch and then bend the knee slightly to stretch a deeper muscle in the calf. Hold stretch for 15 seconds and repeat three times.

Achilles tendonitis

Achilles tendonitis is characterized by pain with heel strike, pain when the foot lands on a curb, when running up the stairs, or with a sudden change of direction. Pain may be more prominent in the morning with the first few steps out of bed. This is because the calf muscle in shortened in sleeping positions. Causes may include:

  • Excessive hill running or stair climbing
  • Tight calf muscles
  • Flat feet (overpronator)
  • Incorrect shoe type
  • Overused running shoes
  • Change in shoes or running surface
  • Training errors (increasing mileage or intensity too quickly)
  • Poor running form/biomechanics
  • Increasing weekly mileage too quickly
  • Too quick of a transition from treadmill to outdoors.

Treatments for this condition may include:

  • Modification of training schedule
  • Stretching calf muscles
  • Ice
  • Using appropriate devices, such as heel lifts, insoles, or arch supports
  • Massage
  • Anti-inflammatory medications
  • Avoiding hills

To help prevent Achilles tendonitis from occurring, proper stretching—such as leaning into a wall with your back leg straight or knee slightly bent—as well as proper shoe maintenance should be employed.

Runners’ knee

When a person has runners' knee, the pain builds up gradually and is usually located beneath or around the kneecap. The pain is aggravated by squatting and going up and down stairs. Stiffness in the knee after prolonged sitting is also a symptom of this injury. Causes may include:

  • Weak thigh and hip muscles
  • Flat feet (overpronator)
  • Tight hamstrings and quadriceps muscles
  • Change in shoes or running surface
  • Overused running shoes
  • Incorrect shoe type
  • Poor running form/biomechanics
  • Increasing weekly mileage too quickly
  • Too quick of a transition from treadmill to outdoors.

Treatments for this condition may include:

  • Avoiding painful activities
  • Applying ice
  • Taking anti-inflammatory medications
  • Stretching calf, hamstrings, quadriceps, and hip flexors
  • Strengthening quadriceps, hip abductors, and hip extensor muscles
  • Correcting foot and/or shoe issues
  • Replacing running shoes every 400-600 miles

Efforts to prevent runners' knee from happening begin with strengthening. Hip strengthening is very important for runners in avoiding injury.

To strengthen the hip abductors, lie on your side, keep your hip and knee in a straight line and kick leg up towards the ceiling keeping leg in line with the body. To strengthen the hip extensors, lie on your stomach, squeeze your buttock muscles, and lift your leg off the ground.

A runner should perform strengthening slowly and with good control. Repeat 15-20 repetitions and do three sets.

Iliotibial band syndrome

This type of injury is characterized by pain on the outside of the knee while running. A runner may also experience pain on the outside of the hip. With this injury, a runner may notice the pain more on slower runs than fast runs, running hills, or going up or down stairs. Causes of this condition include:

  • Running on a banked surface or changes in running surface
  • Flat feet (overpronator)
  • Training errors (increasing mileage or intensity too quickly)
  • Overused running shoes
  • Weak hip abductor and hip extensor muscles
  • Tight hip muscles (especially iliotibial or IT band muscle)
  • Incorrect shoe type
  • Poor running form/biomechanics
  • Too quick of a transition from treadmill to outdoors.

Treatment of this condition may include:

  • ;Modifying training schedule
  • Strengthening hip abductors and hip extensor muscles
  • Applying ice
  • Taking anti-inflammatory medications
  • Massaging lateral (outside) knee
  • Stretching hip muscles (IT band)
  • Replacing running shoes every 400 to-600 miles
  • Getting fit for shoes at specialty store for correct shoe type

Stretching of the IT band can help prevent this injury. To stretch this muscle, stand with the affected leg towards a wall, cross the unaffected leg in front of the affected leg, place arm on wall and drop hips towards the wall. You should feel the stretch on the side of the hips or side of the knee. Hold stretch for 15 seconds and repeat three times.

Shin splints

As the name suggests, a shin splint injury is typified by pain in the shin while running. The pain first starts after running, but then progresses to a persistent pain. If you continue to have pain, you should visit your doctor. Causes of this condition include:

  • Insufficient control of foot mechanics (incorrect shoe type)
  • Change in running surface or banked surfaces
  • Overused running shoes
  • Flat feet (overpronator)
  • Tight calf muscles
  • Training errors (increasing mileage or intensity too quickly)
  • Weak hip muscles
  • Poor running form/biomechanics
  • Too quick of a transition from treadmill to outdoors.

Treatments for this condition may include:

  • Get rest
  • Decrease mileage and cross train with biking or swimming
  • Apply ice
  • Take anti-inflammatory medications
  • Get fit for shoes at specialty store for correct running shoe type for your foot mechanics (cushion/stability/motion control shoes)
  • Replace running shoes every 400-600 miles
  • Stretch calf muscles
  • Strengthen hip abductors and hip extensors
  • Modification of training schedule: avoid hills

The best way to help prevent shin splints is to practice good shoe maintenance. Most importantly, a runner should wear shoes that are appropriate for his or her foot type and training intensity. You may need prescription orthotics if the foot mechanics cannot be controlled with a shoe alone (e.g., to correct for overpronation). A running shoe needs to have good shock absorption in order to decrease the stress on the shins. Running shoes lose 30% to 50% of their shock absorption ability after about 250 miles. Shock absorption is greatly reduced when running in wet shoes. To assure adequate shock absorption when running every day, a runner should alternate shoes. Running shoes need to be replaced every 400-600 miles to help prevent injuries like shin splints.

Stress fractures

Stress fracture injuries cause persistent pain, most commonly in the shin, but at times in the foot. In rare cases, the thigh or pelvis may be affected. Causes and treatments for stress fractures are similar to the ones that apply to shin splint injuries. However, stress fractures are more severe than shin splints and require more conservative management. Some runners may be immobilized in a walking boot or be required to use crutches to allow the stress fracture to heal. Cardiovascular training must focus on non-weight-bearing activities like swimming. The best approaches to preventing stress fractures are proper training, proper shoe maintenance, and not running on excessively hard surfaces.

References

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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/24/2013…#8765

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