Knee Injuries in Runners
Sources: Running Injuries by Tim Noakes & Stephen Granger; Clinical Sports Medicine by Peter Brukner & Karim Khan
There are many types of injuries runners can get exposed to and some injuries could be very debilitating. This article will highlight the two most common running knee injuries with the emphasis on prevention and treatment of each condition.
Surveys have shown that the knee is by far the most common site of injury (19-44%), followed by tibial and fibular bone strain (15-18%). The most common knee injury is “runner’s knee”, also known as patellofemoral pain syndrome (PFPS). Since 1970 the incidence of PFPS has risen from 23-44%. The incidence of another common knee injury, namely Iliotibial Band Syndrome (ITBFS) as also increased. This probably reflects the more recent trend towards firmer running shoes with less cushioning.
Runner’s Knee/ Patellofemoral Pain Syndrome (PFPS)
The upper leg (femur) and lower leg (tibia) forms a joint with the kneecap (patella). The patella moves up and down in a groove in front of these two bones when the knees flex and extend. Pain is elicited when the patella runs laterally out of this groove and grinds against the femur head!! This causes a sharp pain, grinding, swelling in/or around the kneecap if sitting for long periods (movie .sign as referred to by medical practitioners), squat, climbing stairs (especially descending), walk or run.
Predisposing factors:· Imbalances in muscle tightness and strength between the inner and outer muscles of the front thigh (quadriceps) and weakness of the external rotators of the hip.
· Walk/run more on the inner area of the foot or flat feet (pes planus, subtalar overpronation and/or forefoot valgus)
· Biomechanical (genetic makeup of your skeleton) problem for ect. knock-knees or bow legs (genum valgus/varus), sway back knees (genum recurvatum).
· Incorrect/worn running shoes.
· Soft tissue tightness in the lateral (outside) structures around the kneecap.
· Incorrect training methods (too hard, too soon)
· Incorrect training surfaces (too hard/too soft/uneven cambered surface) ect.
· When running on only one side of the road where camber of road causes an imbalance in load of the legs.
· When you have a leg length discrepancy due to muscle imbalance.
Conservative Management and Prevention
The treatment of PFPS requires an integrated approach which may involve:
-Reduction of pain and inflammation: Rest or decrease training load and/or intensity. Ice for 10 min every 2 hours. NSAIDS.
-Taping to correct abnormal patellar position to decrease pain and improve muscle balance.
-Rehabilitation: Vastus medialis (inner stabilising muscle of knee) and Gluteus Medius (hip stabliser) strengthening.
-Stretching and Massage Therapy of tight lateral structures in knee.
-Correction of abnormal biomechanics with orthotics or motion control shoes.
-Correction of other possible causative factors such as training modification, alternating sides of the road and by replacing shoes older than 800-1000 km’s or every season.
-Surgery is the last resort.
Iliotibial Band Friction Syndrome (ITBFS)
The Iliotibial Band (ITB)is a thickened strip of fascia (tendon) that extends from the hip across the outside of the knee, to insert into the large shin bone, the tibia, immediately below the line of the knee joint. When the knee is straight, the ITB lies in front of a bony prominence at the outside of the knee, the femoral epicondyle, but as the knee bends, the ITB begins to move towards that bony point. When the knee has bent through 30 degrees, the ITB may make contact with the femoral epicondyle, and it is this contact that is believed to cause the localized pain in this condition. ITBFS accounts for about a fifth to a third of all knee injuries in distance runners. It is the injury most resistant to treatment.
Predisposing Factors
-Training Errors and Surfaces such as increased Downhill running, Longer runs too much and too soon. Running on hard or cambered surfaces.
-Tightness in ITB and other lateral structures in the hip and thigh.
-Abnormal biomechanics such as high-arched rigid feet as well as bow legs (genum recurvatum). Some runners with overpronating, flat feet are also at risk.
-Weakness of the hip stabilizers.
-Incorrect/hard poor shock-absorbing running shoes
-Leg length discrepancy
Treatment and Prevention
-Reduction of inflammation using ice, NSAIDS and electrotherapeutic modalities (eg TENS, Ultrasound ect.) and relative rest from training.
-Avoid downhill running until the injury has healed and alternate the sides of the road.
-Massage therapy to release the excessive lateral hip and thigh structures including the ITB.
-Frequent passive stretching of the ITB and other tight structures.
-Strenghening of the lateral hip stabilisers.
-Replace worn/hard shoes with good shock-absorbing softer running shoes.
-Cortisone injections into the affected area may be considered in those cases that fail to respond to the above measures.
-Surgery to release the ITB and excise the inflamed bursa (bag of fluid) may be indicated if conservative management fails.
There are many types of injuries runners can get exposed to and some injuries could be very debilitating. This article will highlight the two most common running knee injuries with the emphasis on prevention and treatment of each condition.
Surveys have shown that the knee is by far the most common site of injury (19-44%), followed by tibial and fibular bone strain (15-18%). The most common knee injury is “runner’s knee”, also known as patellofemoral pain syndrome (PFPS). Since 1970 the incidence of PFPS has risen from 23-44%. The incidence of another common knee injury, namely Iliotibial Band Syndrome (ITBFS) as also increased. This probably reflects the more recent trend towards firmer running shoes with less cushioning.
Runner’s Knee/ Patellofemoral Pain Syndrome (PFPS)
The upper leg (femur) and lower leg (tibia) forms a joint with the kneecap (patella). The patella moves up and down in a groove in front of these two bones when the knees flex and extend. Pain is elicited when the patella runs laterally out of this groove and grinds against the femur head!! This causes a sharp pain, grinding, swelling in/or around the kneecap if sitting for long periods (movie .sign as referred to by medical practitioners), squat, climbing stairs (especially descending), walk or run.
Predisposing factors:· Imbalances in muscle tightness and strength between the inner and outer muscles of the front thigh (quadriceps) and weakness of the external rotators of the hip.
· Walk/run more on the inner area of the foot or flat feet (pes planus, subtalar overpronation and/or forefoot valgus)
· Biomechanical (genetic makeup of your skeleton) problem for ect. knock-knees or bow legs (genum valgus/varus), sway back knees (genum recurvatum).
· Incorrect/worn running shoes.
· Soft tissue tightness in the lateral (outside) structures around the kneecap.
· Incorrect training methods (too hard, too soon)
· Incorrect training surfaces (too hard/too soft/uneven cambered surface) ect.
· When running on only one side of the road where camber of road causes an imbalance in load of the legs.
· When you have a leg length discrepancy due to muscle imbalance.
Conservative Management and Prevention
The treatment of PFPS requires an integrated approach which may involve:
-Reduction of pain and inflammation: Rest or decrease training load and/or intensity. Ice for 10 min every 2 hours. NSAIDS.
-Taping to correct abnormal patellar position to decrease pain and improve muscle balance.
-Rehabilitation: Vastus medialis (inner stabilising muscle of knee) and Gluteus Medius (hip stabliser) strengthening.
-Stretching and Massage Therapy of tight lateral structures in knee.
-Correction of abnormal biomechanics with orthotics or motion control shoes.
-Correction of other possible causative factors such as training modification, alternating sides of the road and by replacing shoes older than 800-1000 km’s or every season.
-Surgery is the last resort.
Iliotibial Band Friction Syndrome (ITBFS)
The Iliotibial Band (ITB)is a thickened strip of fascia (tendon) that extends from the hip across the outside of the knee, to insert into the large shin bone, the tibia, immediately below the line of the knee joint. When the knee is straight, the ITB lies in front of a bony prominence at the outside of the knee, the femoral epicondyle, but as the knee bends, the ITB begins to move towards that bony point. When the knee has bent through 30 degrees, the ITB may make contact with the femoral epicondyle, and it is this contact that is believed to cause the localized pain in this condition. ITBFS accounts for about a fifth to a third of all knee injuries in distance runners. It is the injury most resistant to treatment.
Predisposing Factors
-Training Errors and Surfaces such as increased Downhill running, Longer runs too much and too soon. Running on hard or cambered surfaces.
-Tightness in ITB and other lateral structures in the hip and thigh.
-Abnormal biomechanics such as high-arched rigid feet as well as bow legs (genum recurvatum). Some runners with overpronating, flat feet are also at risk.
-Weakness of the hip stabilizers.
-Incorrect/hard poor shock-absorbing running shoes
-Leg length discrepancy
Treatment and Prevention
-Reduction of inflammation using ice, NSAIDS and electrotherapeutic modalities (eg TENS, Ultrasound ect.) and relative rest from training.
-Avoid downhill running until the injury has healed and alternate the sides of the road.
-Massage therapy to release the excessive lateral hip and thigh structures including the ITB.
-Frequent passive stretching of the ITB and other tight structures.
-Strenghening of the lateral hip stabilisers.
-Replace worn/hard shoes with good shock-absorbing softer running shoes.
-Cortisone injections into the affected area may be considered in those cases that fail to respond to the above measures.
-Surgery to release the ITB and excise the inflamed bursa (bag of fluid) may be indicated if conservative management fails.
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