Archive | October, 2011

Runners Knee: Part 1

9 Oct

It seems we live in an age where everything has to have an easily digestible name. While it could be argued that certain red top newspapers take ‘dumbing down’ a little too far, I think it is fair game when it comes to Sports Injuries. For example, have you ever heard of Lateral Epicondylitis? Probably not, but you more than likely have heard of its pseudonym, Tennis Elbow. And so it’s no surprise that Runners Knee is another example of this. However, sufferers of Runners Knee – similar to sufferers of Shin Splints (see previous blogs!) – can report a wide variety of symptoms, and so I will look at it in two separate blogs on 2 fairly specific conditions; 

Part 1 – Patellofemoral Pain Syndrome (P.P.S)

and 

Part 2 – Illiotibial Band Friction Syndrome (I.T.B.S) 

From here on in I will refer to the above two injury types by initials only – for sake of your reading sanity and my typing finger! To start with though, a couple of pictures to locate and recognise the soft tissues that are key players in these injuries;

A) Vastus Lateralis. B) Vastus Medialis

 

P.P.S

What is it?

Irritation of the cartilage that helps the kneecap work efficiently, and helps create knee stability. Characterised by pain around the knee cap – primarily on the inside edge –  and sometimes a feeling of pain underneath the knee cap.

 How does it occur?

Running is great for strengthening the outside muscle of your thigh (vastus lateralis) but can neglect the muscle working the inside of your thigh – the vastus medialis (sometimes called the ‘teardrop’ muscle – see picture). The vastus medialis is responsible for the last bit of straightening that your leg goes through at the knee joint, and as running rarely involves fully straightening the leg, the vastus medialis rarely sees any action. This imbalance means that the kneecap (patella) does not ‘glide’ sufficiently across the joint, and if the patella is out of alignment eventually pain will occur. Muscle imbalances and tightness in the calf muscles and hamstrings can also contribute as these can result in the foot and ankle rolling inwards and causing strain on the inside of the knee, meaning ‘pronators’ are very susceptible to these symptoms.

Symptoms?

Pain can go unnoticed during exercise, but post run, as the inflammation sets in, pain will emanate from the underside of the patella. Other common complaints include pain under the knee cap upon going down stairs, running down hill, leg extensions at the gym, or sitting down for a prolonged time with the knees bent, for example at a work desk. Due to hip alignment – and thus thigh bone angle – it is more common in women, but can occur in men.  

Treatment?

At its most basic level, this is an injury caused by an imbalance between the outside and inside of the thigh. To correct this, we need to consider a couple of options. Kinesio Taping can correct the tracking of the knee cap and help in retraining the body to initiate the vastus medialis muscle (see www.dc-injuryclinic.co.uk/indexabout for more information on K-Tape, or see previous blog entry).  Deep tissue massage will aid the ineffective vastus medialis muscle and help it to begin working. The opposing vastas lateralis muscle would benefit from some attention due to being overworked. Because running is very one directional, muscles that bring the leg out to the side and rotate the leg outwards at the hip are often very weak, and so most people suffering with P.P.S will benefit from prescribed strengthening work in and around the hips and glutes too. 

Self help?

A very simple exercise to carry out at home is to get a rolled up towel and place it under your knee with your leg out straight in front of you. Then, push the knee down into the towel, and really focus on tensing the vastas  medialis muscle (see picture) to start re-training the muscle into – essentially – doing its job!

Squeeze the knee into the towel – focussing on the Vastus Medialis muscle.
 
 
 
 
 
 
 
 
 
Part 2 to follow! 
 
N.B. There are no ‘one size fits all’ style quick fixes in most injury scenarios, so these article shouldnt be seen as such. They are merely guides to a better understanding of how our bodies work.