How to Avoid Runner’s Knee

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Your knees are put under a lot of stress, whether you’re running, playing basketball, dancing, or simply cleaning your house. Just using the stairs can put pressure on each knee equal to four times your body weight.

Functioning simultaneously as a hinge, lever, and shock absorber, the knee is the key to your ability to stand up, walk, climb, and kick. Yet it depends almost entirely on soft tissue—ligaments, tendons, and muscles—for stability. Because of its complexity and the great forces to which it is routinely subjected, the knee is susceptible to a host of injuries.

Of all chronic knee injuries caused by overuse, runner’s knee—more accurately called patellofemoral pain syndrome, or PFPS—is the most common.

Prevention is the key

PFPS typically occurs when a misaligned kneecap (patella) irritates the connective tissue supporting the knee. Characterized by dull pain in or around the kneecap, it is most noticeable when you go down stairs, run, or squat.

Nearly 30 percent of runners eventually develop this disorder. Skiers, cyclists, soccer players and people who participate in any high-impact activities are also prone to it.

Research has shed light on a variety of underlying factors that can contribute to PFPS. These include biomechanical problems such as a kneecap sitting too high or tilted in the groove in which it rests on the thighbone (femur); knees that turn in too much; feet that are very flat or very highly arched; and various muscle-related issues that affect how the kneecap moves. Genetics may predispose you to some of these factors.

Women are at greater risk for PFPS than men for anatomical reasons. For instance, they have a wider pelvis, which increases the angle of the quadriceps (the large four-part muscle group on the front of the thigh) to the knee. They also have smaller knees with less restraining tissue and weaker supporting muscle.

The best way to prevent runner’s knee is to strengthen and stretch the muscles that power knee movement, especially the quadriceps and hamstrings, which are located in the back of the thigh. (The exercises below will get you started.) A weakness or imbalance in the quads, hamstrings, and/or hip muscles can contribute to improper tracking of the kneecap.

If you’re a runner, your quadriceps are probably weaker than your hamstrings, so it’s a good idea to alternate cycling (a good way to strengthen the quads) with running. Walking up stairs or hills also helps strengthen the quadriceps.

To protect your knees, avoid the following:

  • Deep lunges or full squats
  • Downhill running
  • Cycling with the seat too low or in too high a gear
  • Taking large steps on the stairs or a stair-climbing machine
  • Full leg extensions with heavy weights and locked knees

In addition, do not exercise in worn-out shoes; don’t suddenly increase the intensity or length of your workouts; and don’t run on very hard, very soft, or hilly terrain. Don’t wear high heels, except on special occasions.

Treatment: what’s right for you?

If you have knee pain for more than a week or two, see your doctor. If you have PFPS, you should be referred to a physical therapist. There has been much debate about which treatments are best for PFPS.

Taping: One rehab technique for correcting a kneecap that doesn’t track properly is called McConnell taping, in which special tape is used to pull the cap into the correct position, thus reducing pain and allowing people to engage in rehab exercises. However, there is a need for large studies on taping techniques, and not all the findings have been positive. In addition, many people have trouble applying the tape properly.

Braces: There are special knee braces or sleeves that are supposed to correct knee biomechanics. The compression also stimulates skin and muscle receptors, thereby improving proprioception—that is, how you perceive the position of your knee in space. Improved proprioception may allow you to modify your movement in a way that puts less stress on the knee joint. A review in the American Family Physicianconcluded, however, that it’s not clear how effective the braces are.

Bottom line: If you have PFPS, it’s crucial to determine what’s causing it and get a personalized treatment plan. A skilled physical therapist—especially one who works with athletes and dancers—can then develop an exercise program to address your specific muscle weaknesses or imbalances and/or biomechanical problems.

Not everyone with PFPS has weak quads, hamstrings or hip muscles, for example. If it’s a biomechanical problem in the feet, you may need special shoe inserts. In rare cases, if nothing else helps, surgery may be an option.

(Originally published on Berkeley Wellness in November 2010. Updated April 2013.)

Ways to Treat Knee Pain Conservatively

Knees

Many individuals suffer from pain in their knees as a result of arthritis, over exertion or knee malalignment. Although a visit to a physician can be costly, there are several over the counter treatments that can bring relief. Using one or several of the following products can reduce the pain and discomfort of knee ailments.

Analgesic/anti-inflammatory: The knee is held in place by a series of strong ligaments. When these ligaments become torn or stretched, it can result in extreme discomfort. Analgesics can help ease the pain, while anti-inflammatories can reduce the swelling of the ligaments.

Brace: It can be tricky to determine which is the best brace for knee pain, as this is determined largely upon what has caused the pain. When ligaments in the knee become strained, they may need to be immobilized to give them a chance to heal. There are many braces available that will immobilize the joint to prevent it from bending while the healing process takes place.

For those who suffer from pain due to excessive physical exertion, a hinged knee brace may be of benefit. These hinged knee braces help to stabilise lax ligaments around the knee while allowing flexibility.

Supplement: Glucosamine is a chemical compound naturally found in the body. Its main purpose is to keep cartilage in the joints healthy. As we age, this compound begins to decrease, which can lead to pain in the knees. Taking glucosamine supplements for knee degeneration helps to rebuild this cartilage, providing more cushioning within the joints.

Medicated cream: Many athletes, gardeners and labourers suffer from pain in or around the knee as a result of over worked muscles or ligaments. There are many medicated creams for knee pain that contain anti-inflammatories and pain relief ingredients to help increase blood flow to the area where it is applied, which in turn releases tension around the knee area.

Pain doesn’t have to keep you immobilized.  It is still advisable to see an Orthopaedic Surgeon for a proper diagnosis and recommended treatment.

 

 

What Happens When You have an Anterior Cruciate Ligament (ACL) Tear and What are the Proper Methods to Treat it?

 

What is the ACL?

The anterior cruciate ligament (ACL) is just one of four main ligaments that are located in the knee. This ligament prevents movement of the shin bone forward relative to the thigh bone, but unfortunately is a common knee injury among athletes and active individuals.

An ACL tear or sprain will occur when direction of the body suddenly changes and the knee is locked in place. Typically, a pop sound will occur and then swelling and pain begins almost immediately. A complete ACL tear usually requires surgery while other times it can recover on its own if it is a minor or partial tear.

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What Are the Non-Surgical Options? 

If a partial tear or sprain has occurred, it can be helped with rest, use of knee braces and physiotherapy. Sometimes if the problem persists, surgeries such as ACL repair or reconstruction can help with this condition. Depending on the age of the patient and their level of activity, this will determine whether or not orthopaedic surgery is necessary.

What are the Orthopaedic Surgical Options?

If there is a complete tear of the ACL, a surgical option such as ACL arthroscopic reconstruction should be considered. While surgery is not always necessary for an ACL Tear, most injuries will require surgical intervention. The purpose of an ACL reconstruction procedure is to restore stability of the knee. Without long-term stability of the knee, it can lead to weakening of other muscles in the knee and leg. It may cause arthritis and meniscus tears due to misusing the knee and putting weight on the wrong areas of the knee joint.

ACL Repair versus Reconstruction-

ACL Repair: When a repair of the ACL takes place this involves a surgeon suturing the torn ends of the ligament back together again.

ACL Reconstruction: ACL Reconstruction has become a far more popular procedure as it is more effective for complete tears. Part of the hamstring tendon will be harvested from either the patient or a donor and is then used to replace the torn ACL.

While there are different options available when it comes to an injury of the anterior cruciate ligament, it is often recommended that some sort of treatment takes place in order to bring back stability in this region. This is especially true in active individuals and athletes as this could result in further damage to the knee if this injury is not taken care of properly. For most patients who receive treatment, activity and normal life can begin again approximately six to nine months after reconstruction or treatment.

Do you have flat foot?

Flat foot

Flat foot is a.k.a fallen arches or pes planus. Most adults have an upward curve on the inside sole of their feet. This is called an arch. However, if you place your feet on a flat surface and you see a complete imprint of your feet, then you most likely have flat feet.

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Common Causes

Flat feet arise from many causes. Some common factors are abnormality from birth, stretched or torn tendons, broken or dislocated bones and rheumatoid arthritis. Other factors that can increase your risks are obesity, aging and pregnancy. People with flat feet tend to notice that their shoes wear out unevenly.

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Symptoms

Most people with flat feet do not have any symptoms. However some might complain of

  • Tired feet
  • Pain over the heel, big toes and/or the arches after long distance walking
  • Lower back pain
  • Swelling along the inside of the ankle

Those usually occur when the connecting ligaments and muscles of the ankles are strained.

Why pain?

The reason why people get pain from running and walking long distances is mainly due to over-pronation. Over-pronation is when the feet roll inwards too much and go past the point for shock absorption. This places stress and causes pain on the ankle, lower leg muscle, knee joints, hips and sometimes the back.

Prevention

Good running shoes are important for people with flat feet. Good running shoes prevent over-pronation and provide stability and motion control while a good insole provides firm support to prevent undue stress to the body. Run on flat terrain to reduce over-pronation. Avoid running shoes with excessive cushioning and little support.

Exercises

  • Sit in a chair with your knees 90 degree to the ground. Lay a towel on the floor. Place your bare feet flat on the towel, curl your toes, gather a ridge of the towel under your toes and pull the towel towards you. Repeat 10 times. Reverse the motion by grabbing the ridges in the towel with your toes and push them away from you. Repeat 10 times.
  • Sit on the ground with your knees bent and your feet positioned flat on the floor. Keep your toes facing forward. Pull your toes slowly toward your ankles while keeping your heels on the ground. This movement raises the middle portion of your foot. Hold in this position for 10 seconds. Relax and repeat 10 times.
  • Sit in a chair with your knees 90 degree to the ground. Place a tennis ball below the soles of your feet and roll it for 10 minutes.

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Treatment

The common treatment will normally be using an orthotic device either over-the-counter or custom made insoles to provide support for the feet. Stretching exercises on the Achilles tendon and posterior calf muscles with proper footwear can help alleviate the symptoms from a flat foot.

In rare cases, surgery is required to alleviate the symptoms of flat feet.

 

Heat Illness

When an athlete exercises, the body’s temperature is elevated and the body sweats to cool itself down. During this process, body fluid as well as critical electrolytes are lost. If the body isn’t replenished with fluids and electrolytes, dehydration may occur and increase the risk of a heat illness such as heat stroke.

Some heat illness symptoms include:

  • Chills
  • Dark colored urine
  • Dizziness
  • Dry mouth
  • Headaches
  • Thirst
  • Weakness

The most effective treatment for heat-related illnesses is prevention, including:

  • Proper training for the heat
  • Fluid replacement before, during and after exertion
  • Appropriate clothing—light colored, loose fitting and limited to one layer
  • Early recognition via direct monitoring of athletes by other players, coaches and medical staff
  • Monitoring the intensity of physical activity appropriate for fitness and the athlete’s acclimatization status
  • If possible, having an athletic trainer on site during events and practices to properly prevent and treat heat illnesses

At the beginning of a strenuous exercise program or after traveling to a warmer climate, an athlete should initially limit the intensity and duration of exercise and then gradually increase it during a period of 7-14 days to allow time for the body to adjust to the new climate and environmental conditions. Athletes with respiratory, gastrointestinal or other illness should be evaluated before exercise, as these conditions increase the risk of heat illness.

If heat illness progresses, more serious symptoms such as difficulty breathing, body temperature increasing to dangerous levels, muscle cramps, nausea, and tingling of the limbs—and even death—may occur.

When you see any signs of heat illness or heat stroke, you may be dealing with a life-threatening emergency. Have someone call for immediate medical assistance while you begin cooling the individual at risk.

Treatment tips include:

  • Getting the athlete to a shaded area.
  • If it is heat stroke, cool the athlete rapidly using cold water immersion. If immersion is not available you may use spray from a hose, cold water sponging or placing cold towels over the entire body.
  • Monitoring body temperature.
  • Providing cool beverages if possible (i.e., if the athlete does not have altered consciousness).
  • Getting medical assistance as soon as possible.

Heat exhaustion is a form of heat illness that can develop after several days of exposure to high temperatures and inadequate or unbalanced replacement of fluids.