Knee pain in runners: the 2 most common causes

Knee pain running is common. With the marathons in London and Brighton we’ve seen an increase in people coming into our clinics with knee pain associated with running. The 2 most common causes of knee pain in runners are “Runners knee” and ITB syndrome. In this posting we’ll talk about runners knee pain, what it is and how to treat it. Next we’ll do the same for ITB syndrome.

Runners knee

“Runners knee pain” is more correctly termed patella femoral syndrome and can affect as many as 1 in 4 runners. The symptoms are typically pain under the knee cap and around the front of the knee and used to be called chondromalacia patella.

Anything where the leg is bending and straightening can become painful, particularly when weight bearing, and there may be creaking or cracking under the knee cap, a symptom termed crepitus. Of course running, particularly once milage when training for a longer distance event is increased is a common cause. Aggravating factors also include going up and down stairs, running, in particular up or down hill, leg extensions/quad strengthening in the gym, often sitting for a prolonged times at work or in the car for instance.

Cause of Runners Knee Pain

The causes of runners knee are related to the anatomy of the area. The underside of the patella (kneecap) has a ridge which slides along a narrow groove in the femur (thigh bone). Every time you bend and straighten your knee the patella slides up and down the groove. Trouble can start when your kneecap moves out of its track or groove and rubs up against its sides causing friction. This is called patella misalignment or maltracking. That it becomes painful when you run is not surprising when you realise that there are on average nearly 1000 steps per mile.

Common things that can cause misalignment and how to fix them are:

  • Quadriceps imbalance: This is perhaps the most common cause of runner’s knee. The quadriceps muscle on the front of the thigh is made up of four parts and running strengthens the outer part more than the middle part, thus the patella is pulled out of alignment. This usually resolved with some specific rebalancing exercises for the muscle group.
  • Foot instability: Often your feet imbalanced every time they hit the ground, and you’re feeling the constant pounding and repetition of this mistake in your knee. Over pronating, which means your foot is rolling in too much when you run, is the most common type of this, something that is often associated with fallen foot arches. A combination of orthotics (these are special insoles; at Sundial we use Superfeet orthotics) for your running shoe and exercises is usually enough to rebalance and stabilise the foot. You should also have your running analysed to make sure your shoe is the suitable for you. For more on orthotics and running go here.
  • Tight muscles at the back of the calf or thigh: If the calf muscles are tight the foot will have to pronate further when running or walking causing an increase in rotation at the lower leg bones, if the hamstrings are tight when running or walking the knee is not fully straightened, this also means the foot has to roll more into pronation. Both of these can cause patella misalignment and are treated with specific stretches and rebalancing exercises.
  • Gluteus medius weakness: One of the muscles that make up the buttock, it often relatively weak in runners. If the gluteus medius is not strong enough the upper leg rotates inwards and causes an unequal pull of the patella over its groove. Again, some specific strengthening and stretching exercises usually resolve this.

In addition to the specific treatments for each cause there are a few other things which also help resolve runners knee.

  • Ice: Wrap a cold packs around each knee, with the pack at the front for about ten minutes, a few times a day to bring down the swelling. Make sure the cold pack is wrapped in a thin cover to avoid cold burns!
  • Rest: Not what a runner wants to hear close to an event, but where possible, stopping or decreasing your running will help then problem settle whilst treatment takes effect.
  • Laser treatment: This is useful in reducing the inflammation around the patella and encouraging faster healing
  • Taping: Specific taping techniques, particularly kinesio or Rock taping, something our physio Quentin specialises in, can help straighten the pull of the patella
  • Running/gait analysis: Many running shoe shops offer this and it’s a good way of screening your running for problems and also seeing if your shoes are suitable for you

If you would like a check to see if you have runners knee then call us for our free Runners MOT with our physios or chiropractors.

Free Massage for Brighton Marathon Runners

Physiotherapy leg examIf you are feeling sore after running the Brighton Marathon we would like to offer the first ten callers a free half hour massage worth £30 with Quentin our physio. Congratulations on running and hopefully completing the course. We would like to help your marathon recovery and massage is great for that.

If you are having more serious problems after the marathon then we suggest seeing Quentin for a more in depth assessment and treatment. Treatment including our laser is wonderful at rehabilitation from the pulls and strains associated with running.

To book in give us a call but be quick, the 10 free ones will go soon.

7 Steps to Combat Lower Back Pain in Pregnancy

Looking for top tips to prevent back pain in pregnancy or treat pregnancy pain? We may just have the answer.

1. Improve your posture during pregnancy

If you are getting back pain in pregnancy the best advice is to try and maintain the best posture that you can. The change in your centre of balance will be throwing you off just that. So the trick is to keep your ears and shoulders in line with one another to work as a harmonious, loving power couple. Neither is ahead of the other and both keep the other in line. The best way to check that is to catch yourself in the mirror to the side, or ask someone to keep an eye on you. The most common fault is to throw your head forwards. It is true that you head weighs the same weight as a bowling ball so imagine how that will pull your whole body forwards and put huge strain on your back.

2. Avoid standing up

Push to the front of queues. Well not literally perhaps but try to avoid standing for too long. Your postural muscles are already working overtime aggravated by the hormone Relaxin. As this flows through your body and causes your muscles and ligaments to relax through pregnancy your support system is not at its best. And make the most of grabbing those priority seats on trains and buses.

3. Use a pelvic support belt

Before you were pregnant I am sure that Gok Wan coached you into buying those belts to cinch in your waist  and create that elusive hourglass figure. Well now you won’t give a monkey’s about an hourglass but may still be picking up a belt – namely a specific maternity support belt. These support your bump in the later stages of pregnancy to relieve the strain through your back and now you can even get them for post-partum to continue the support until you regain your physical strength.

4. Sleep with a pillow between your knees

As odd as that may sound, straddling a pillow between your knees when lying on your side in bed may well be the support that you need to your bump and enough to relax the muscles of your pelvis, which will be having a tough time of things with all these changes going on. Ideally, if you are planning on going through more than one pregnancy I would absolutely recommend investing in one of the pregnancy pillows which you can buy from any good maternity store. Compare prices as they can vary tremendously and they may not look attractive but they are long enough to stretch along your whole body which minimises the chance of them slipping or being expelled from the bed during the night.

5. Computers make back pain in pregnancy worse

Your desk and workstation set up at work is incredibly important during your pregnancy so if your company has an internal occupational assessment team then now is the time to rope them in. Other problems can occur too. Not only does your desk height, angle, and distance matter to your back but so too does your keyboard and mouse use. Carpal tunnel syndrome is all too common during pregnancy (thanks to fluid retention) a wrist support is important for use with a keyboard and many women prefer to switch from a conventional mouse to an upright one which requires the arm to be at a more favourable angle of sideways; or else use a roller pad. Everyone has a different preference but it is worth bearing it in mind.

6. Have a bath to ease a bad back

A warm bath can help back aches. Enjoy lots of warm baths during pregnancy to help to relax your muscles as well as your mind but make sure that you can happily dip your toe into the water without jumping from the heat. The water should never be more than warm during pregnancy as it can be stressful for the baby.

7. Go shoe shopping

Finally an excuse to get the credit card out and hit the shops – this time however it won’t be for glamorous purchases. During pregnancy it is a good idea to banish the stilettos and kitten heels and opt for sensible lace ups. It isn’t the height of the heel that is important but the support of the shoe to the foot, and therefore rest of your body. As pregnancy progresses the foot arches can flatten and contribute to back pain. Imagine that your feet are the foundations of a house and that your pregnancy is akin to planning an extension on the property. You wouldn’t start without assessing that the foundations are excellent or the rest of the house would be under strain. Your body is the same, particularly during pregnancy where your centre of gravity is changed and your supporting tissues are less…well, supporting. And it is for this reason that cheap ballet pumps are also out I am afraid as they offer zero support to your feet.

If you would like an appointment to see if our chiropractors or physiotherapists can help you with pregnancy related back pain or leg pain then give us a call and we can book you in.

Back Pain in Pregnancy: Is it due to hormones?

Back pain in pregnancy can be due to hormone changes.

Haven’t we all been told that hormones are always the cause of every problem known for a woman? Well in this case the hormone in question is ‘relaxin’. This little lovely is produced every month during a woman’s menstrual cycle and disappears if no pregnancy occurs. And if it does this hormone peaks in the first trimester, apparently to encourage implantation, and is then maintained throughout pregnancy to cause relaxation of the body’s soft tissues and so stretch out the joints of the body in preparation for the changes that will be occurring as the baby grows. Hormone changes can lead to lower back pain in early after conception too.

Back in Pregnancy due to Joint Laxity

You know those kids in the playground who are all mouth and who start trouble, only to stand back after it all gets a little too much, and pretend that they had nothing to do with it? Well this may be it. The theory is that this little guy causes the body’s joints to relax (hence the name relaxin) which then reduces the stability of the lumbar spine. And of course he gets help from progesterone and oestrogen with all the relaxation. Add to that the increase in load from the growing baby(s) in that very area and the fact that the abdominal muscles wade in with their stretching to allow for the increasing size of the abdomen and suddenly there is no support in the lumbo-pelvic region. But recent studies have found that relaxin may not be the main fall guy as the evidence is weak overall.

Previous back pain means your at risk

Although there is no definitive proof yet, studies have found that there is an increased risk of suffering from  lumbar spine pain in those of us who have suffered from lower back pain before, most notably during menstruation, those who have had multiple children and whether an individual has had any spinal surgery before.
For PGP the risk increases with increased body mass index, any strenuous activity and as the pregnancy progresses – the latter of which I have certainly experienced to be the case in clinic.

Lower back pain in early pregnancy

This can vary. The general consensus is that pregnancy-related pain can start at any point when pregnant but that most cases occur in the second and third trimesters. If back pain initiates at the start of pregnancy it is often found that it not only continues through until full term but increases in severity as it does so. So something to look forward to then!

If you would like an appointment to see if our chiropractors or  physiotherapists can help you with pregnancy related back pain or leg pain then give us a call so we can book you in.

Next article: 7 steps to combat back pain in pregnancy

References

Aldabe, D et al (2012). Pregnancy-Related Pelvic Girdle Paina nd its Relationship with relaxin

Han, I. (2010). Pregnancy and Spinal Problems. Current Opinions in Obstetrics and Gynaecology. Dec. Vol.22. No.6. pp.477-81

Kovacs, F.M. et al (2012). Prevalence and Factors Associated with Low Back Pain and Pelvic Girdle Pain During Pregnancy; A Multicentre Study Conducted in the Spanish National Health Service. Spine. Feb. No.13. [ePub ahead of print].

Kristiansson, P. et al, (1996). Back Pain During Pregnancy: a Prospective Study. Spine. Mar. Vol.21. No.6. pp.702-9.

Licciardone, J.C. et al. (2010). Osteopathic Manipulative Treatment of Back Pain and Related Symptoms During Pregnancy: A Randomised Controlled Trial. American Journal od Obstetrics and Gynaecology. Jan. Vol.202. No.1. pp.43e1 – 43e8.

Liebetrau, A et al (2012). [Is there a Correlation Between Back Pain and Stability of the Lumbar Spine in Pregnancy? A Model-Based Hypothesis]. Schmerz. Feb. 26. No.1. pp.36-45.

Lisi, A.J. (2006). Chiropractic Spinal Manipulation for Low Back Pain of Pregnancy: a Retospectie Case Series. Journal of Midwifery Women’s Health. Jan – Feb. Vol.51. No.1. pp.e7-10.

Majchrzycki, M et al, (2010). Low back Pain in Pregnant Women. Ginekol Pol. Nov. Vol.81. No.11. pp851-5.

Stuber, K.J. & Smith, D.L. (2008). Chiropractic Treatment of Pregnancy-Related Low Back Pain: a Systematic Review of the Evidence. Journal of Manipulative Physiological Therapeutics. July-Aug. Vol.31. No.6. pp.447-54.