Forums >Health and Nutrition>Runner's Knee..
I stand corrected... by you and by my chiropractor. That is indeed my diagnosis. Posterior right pelvis tilt + lots of recent hard, long races = very tight right vastus lateralis + relatively stronger vastus lateralis vs. vastus medialis = imbalance pulling on the patella. The good thing, in my case, is that the treatment seems fairly clear, and there's no reason to think there's any long-term problem that needs addressing by altering my stride or shoes. Though I may work on strengthening that VMO. But damn, it really sucks to not be able to go more than 3-4 miles without pain. I am ready for this to be gone.
I stand corrected... by you and by my chiropractor. That is indeed my diagnosis. Posterior right pelvis tilt + lots of recent hard, long races = very tight right vastus lateralis + relatively stronger vastus lateralis vs. vastus medialis = imbalance pulling on the patella.
The good thing, in my case, is that the treatment seems fairly clear, and there's no reason to think there's any long-term problem that needs addressing by altering my stride or shoes. Though I may work on strengthening that VMO. But damn, it really sucks to not be able to go more than 3-4 miles without pain. I am ready for this to be gone.
I have yet to see any peer-reviewed literature or research that conclusively proves that VMO isolation and targeting is even possible. You are strengthening your quads.
(Which isn't to say the exercises wont help; particularly if one is doing something like squats or similar which involves far more than one muscle group.)
And unless you are racing around a race track, why is it that most often times, the other leg is fine? Would the contralateral quad muscles not be exhibiting similar imbalances and presumably result in similar painful symptoms?
Just some food for thought.
I posted twice accidentally, and am trying to remove the duplicate message. Hopefully this works.
tomatolover
Dr. Bob?? and others...
Are there specific hip strengthening exercises that you believe are most effective?
My runners knee (?) seemed to move from an issue with my ITband after a 1/2 marathon....On the outside of the knee one day, on the otherside of the knee the next...Is this common?
Consider modifying your stride. I had runners knee and switched to barefoot running, which requires you to land on the ball of your foot. You don't have to go barefoot/minimalist to do this though, just find some shoes with a relatively low heel to toe drop that will allow you to land either mid-foot or on the ball, not the heel. This allows all of those muscles and tendons in the foot to act as a shock absorber. It also uses the calf muscle and when you land, your knee is bent, allowing it to flex and not absorb any impact. If you land on your heel with a relatively straight leg, the only thing absorbing that impact is bone and cartilage in your heel, knee and hip, none of which are very good at it.
Consider modifying your stride. I had runners knee and switched to barefoot running, which requires you to land on the ball of your foot. You don't have to go barefoot/minimalist to do this though, just find some shoes with a relatively low heel to toe drop that will allow you to land either mid-foot or on the ball, not the heel.
This allows all of those muscles and tendons in the foot to act as a shock absorber. It also uses the calf muscle and when you land, your knee is bent, allowing it to flex and not absorb any impact.
If you land on your heel with a relatively straight leg, the only thing absorbing that impact is bone and cartilage in your heel, knee and hip, none of which are very good at it.
You could try running on your hands...
Know thyself.
Dr. Bob?? and others... Are there specific hip strengthening exercises that you believe are most effective? My runners knee (?) seemed to move from an issue with my ITband after a 1/2 marathon....On the outside of the knee one day, on the otherside of the knee the next...Is this common?
(Definitely not Dr. Bob, but rather a physio...who in truth, is no longer working with an athletic population.)
If one Google's "Glute medius exercises" or "Glute medius strengthening" there are a few sites that provide some pretty good info. There are some pretty good explanations as to WHY the glutes (especially med.) are so important when considering the cause of knee pain in runners. (They are included way down below this message.)
With respect to exercises, here is an article published in the Journal of Orthopaedic and Sports Physical Therapy (JOSPT):
(It is a link to a pdf file from the JOSPT site.)
http://www.google.ca/url?sa=t&source=web&cd=14&ved=0CC4QFjADOAo&url=http%3A%2F%2Fwww.jospt.org%2Fmembers%2Fgetfile.asp%3Fid%3D4482&ei=WNkDTs3fOuTy0gHBsrC1Cw&usg=AFQjCNE8pq3pGvtA-6RAJQ_k_yst9Pf1ow&sig2=ueaTZmXgeUt2xWLVzsm9pA
That article details a bunch of glute ex's. It lists them according to muscle activation. Their research suggests that side-lying abduction works the glute med. best, which makes sense. The problem with that is that runners need to use these muscles while running, not side-lying. I believe you need to train muscles in a manner similar to how they will be used.
With that being said, I was a little surprised that they didn't include unilateral hip hiking. There are a few ways to do it. Some suggest bending the knee, others keep it straight. I like to do it standing on a step or curb (with knee slightly bent), but will often do it brushing my teeth in the bathroom on a level floor. Works for me.
I don't do a lot of different exercises. If I feel some knee/ITB pain creeping in, I basically do that exercise to fatigue before bed, take a day off and run again.
Something like this:
http://www.youtube.com/watch?v=3OwttGWEOB8
(And in theory, if you are straining the lateral structures surrounding the knee, it makes sense that the medial side could be subjected to compressive forces...plus if you are running sore, you may be compensating without even realizing it. Slight changes to running gait could explain the newer medial knee pain, especially if you think about how many times you would be repeating that during the course of a long run.)
(That being said, I have not seen your knee. Be leary about getting cure-all exercises online or elsewhere. If it worsens, seek appropriate medical advice.)
And I don't think that the importance of REST and allowing recovery to occur can be overstated!
My two cents.
Feel free to disagree. Like I said previously, it all depends on who you ask.
Some other reading that may be of interest for background information.
http://www.sportsinjurybulletin.com/archive/gluteus-medius.htm
http://www.mikereinold.com/2008/12/gluteus-medius-evaluation-strengthening.html
thanks for the links, physio-bob!....
I'm trying the rest+ice+exercises for the next couple of days before I make an appt. with the doc. Appreciate your 2 cents
Whereas I *am* Dr. Bob, so I was a bit confused, but -- as the saying goes -- I'm not that kind of doctor.
+5 for Slytherin.
Reviving a semi-old thread rather than starting a new one, since there's already a lot of good info in here.
Recently got what looks to be a pretty textbook case. Started a week and a half ago when I woke up in the morning and couldn't walk right due to kneecap pain, let alone run (previous day's run was easy and uneventful, so no acute trauma that I'm aware of). It got much better overnight and I only took the initial day completely off before starting to run again. It's been still nagging me since that point, but bothers me least when I'm actually running. I feel it in the morning, but by a mile or two into my run I can still feel it, but it's not what I'd describe as pain or even discomfort, and stays that way for the rest of my run, only returning to discomfort several hours after I'm done.
Basically I'm wondering whether training should be adjusted to avoid turning it into a more serious issue, given the fact that at the moment the issue is minimal enough during running to not really affect anything. I did 20 miles this morning including several miles of steep uphill and downhill (significantly longer and harder than my usual LRs), and even then didn't have any significant discomfort after the first mile or two -- I felt it more on the downhills (unsurprisingly) but even on the steepest parts it never really impacted how I was running. I'm already starting to do the usual things already mentioned (e.g., quad strengthening exercises).
Has anybody ever tried accupuncture for runner's knee? It actuallly crossed my mind yesterday.
not bad for mile 25
“I tried physiotherapy, acupuncture and a chiropractor.”
Biomimeticist
Runner's Knee is sadly a euphemism for a doctor who doesn't want to admit that he can't cure your pain. You're a runner and you have a knee, what can he change medically?
What you can change is how much stress you put on the joint. And that's a matter of technique and how you train.
Experts said the world is flat
Experts said that man would never fly
Experts said we'd never go to the moon
Name me one of those "experts"...
History never remembers the name of experts; just the innovators who had the guts to challenge and prove the "experts" wrong
Reviving a semi-old thread rather than starting a new one, since there's already a lot of good info in here. Recently got what looks to be a pretty textbook case. Started a week and a half ago when I woke up in the morning and couldn't walk right due to kneecap pain, let alone run (previous day's run was easy and uneventful, so no acute trauma that I'm aware of). It got much better overnight and I only took the initial day completely off before starting to run again. It's been still nagging me since that point, but bothers me least when I'm actually running. I feel it in the morning, but by a mile or two into my run I can still feel it, but it's not what I'd describe as pain or even discomfort, and stays that way for the rest of my run, only returning to discomfort several hours after I'm done. Basically I'm wondering whether training should be adjusted to avoid turning it into a more serious issue, given the fact that at the moment the issue is minimal enough during running to not really affect anything. I did 20 miles this morning including several miles of steep uphill and downhill (significantly longer and harder than my usual LRs), and even then didn't have any significant discomfort after the first mile or two -- I felt it more on the downhills (unsurprisingly) but even on the steepest parts it never really impacted how I was running. I'm already starting to do the usual things already mentioned (e.g., quad strengthening exercises).
Z, nice workout on that 20 miler, on a trail even.
I think what you may have is your recent mileage increase catching up with you a bit. Of course I am not diagnosing anything but, If I were you I'd back off a bit for a couple of weeks, a rest day or two in there.
Runner's Knee is sadly a euphemism for a doctor who doesn't want to admit that he can't cure your pain. You're a runner and you have a knee, what can he change medically? What you can change is how much stress you put on the joint. And that's a matter of technique and how you train.
Now, believe it or not, folks, this is one comment I DO agree with jester. I too think the term "Runner's Knee" is created by doctors who have no kdea what the heck is going on with runner's knee when they come in and say that their knee hurts.
I hadn't read the entire thread here--in fact, I thought this was that other thread about "tight knee"--but, with the activity of running, some degree of knee soreness is expected. I know some people who like to make a big deal out of it because then he/she feels like a real runner: "Oh, I got Runner's Knee..." or "I got IT Band Syndrome..." or "I got Plantar Fasciitis..." This "Syndrome" is the best; it's basically when doctors can't figure out what it is, they call it "Syndrome" and people LOVE to hear they have that--"Oh, I got China Syndrome..."
For runners, some degree of strengthening exercise would most probaly cure these initial problems. Running over uneven and undulating terrain would also help if done sensibly and gradually. We've got what we've got. You can't change that much. But our body is designed to run a heck of a lot more than playing football, taking some tackles side-ways, or playing basketball or tennis by moving all over the place, changing every direction. Yet, we manage alright. All of a sudden people started to run and all sorts of problem started to surface.
Hey Nobby,
Thank you for agreeing with me on this.
To me, "Runners Knee" is like "overuse syndrome". Last time I checked, our bodies didn't come with a warranty card telling us how long it would last. So the only way you can overuse something is if its function lasts longer than the warranty said it would...
We can't overuse anything, we can only misuse our bodies, and that defines biomechanic skill.