The recent warm weather has certainly inspired people to start running more. The increase of knee pain complaints at the office is a sure sign that summer is almost here. Knee pain is by far the most common running injury, yet it has many possible sources. Conventional wisdom suggests that since the knee is a joint, then any knee pain must be a joint problem. Patients often claim that their pain is due to a partially torn ACL or meniscus from an accident which occurred years ago. Recent research, however, indicates that muscular strain or weakness is a common cause of knee pain. Even muscles that don't directly attach to the knee can be a problem. In fact, numerous studies have shown that hip strengthening exercises greatly reduces pain on the outside of the knee (iliotibial band syndrome).
A quick look at the anatomy shows how some of the hip muscles are connected to the knee. The iliotibial band does exactly this. It is a thick band of fascia. Fascia is very strong connective tissue which does not contract. In fact, fascia also runs through your entire body. It is better thought of as a super strong spiderweb (or matrix) that permeates the entire musculoskeletal system. That's a fancy way of saying it goes through and connects muscles, tendons, ligaments, and even bone.
So, if fascia permeates and interconnects all muscles, tendons, bones, and joints, AND the source of anyone's knee pain can be far from the actual knee, one could theorize multiple other muscular scenarios where the problem is muscles other than the hip ones described above. A thorough check of strength and flexibility of all possible offending muscles is best done by a skilled specialist. However, one could make attempts to stretch or strengthen these areas with no real repercussions if they were wrong. The worst that would happen is that their muscles would get more flexible, or maybe stronger.
If your pain is on the outside of the knee, it is likely due to weak hip muscles. A side laying leg raise is a good exercise to start with, just like the ones Jane Fonda would do. (Wow, I am dating myself with that reference.)
If your knee pain is on the inside part of the leg (medial), there is a good chance one of your groin muscles (hip adductors) is tight and short. Stretch'em.
If your knee pain is just underneath the kneecap (patella) in the front, there is a good chance that your front shin muscle (anterior tibialis) is either overused (usually from steel toe shoes), or it might be short and tight. Keep in mind that pain in this area could also be due to TMTS (Too Much Too Soon). Back off on the distance of your training by 2/3 and progress your mileage no more than 10% per week.
If your knee pain is under the kneecap (patella), but more to the inside of the leg (medial) it could be the posterior tibialis. This muscle is largely responsible for maintaining the arch of the foot. Have you been told you "pronate" too much? Strengthen this muscle by doing heel lifts while standing on one leg. Hold on to a chair or wall until you develop enough balance.
If your knee pain is in the back of the knee, it could be one of the hamstring muscles (biceps femoris) or tight calf muscle (gastrocnemius). Check to see if you are able to fully straighten your knee. Many people CAN'T do this, and usually blame previous knee injury. Yet they have never tried stretching the muscles BEHIND the knee. Try this stretch: stand with both feet pointing straight at a chair. Put one heel on the seat of the chair. That's all. Just keep in mind that your body will try to cheat the movement by twisting out out the supporting foot, or twisting the pelvis to the side of the supporting foot. Look at your foot on the floor to make sure that it is still pointing forward. Also look at your belt buckle to make sure that it is still pointed forward. If you can do this with a straight knee and no difficulty, then bring your toes toward you, and push your chest up. DO NOT TOUCH YOUR TOES!
Seeing a specialist for your knee pain is also a good idea. Finding one with experience in running is extremely helpful. Finding one who also runs themselves is better yet. Unfortunately, there are many "orthopedic specialists" who will focus solely on the knee. This is unfortunate because, as stated previously, often times the problem is starting somewhere OTHER THAN THE KNEE. It is true that many people with kne pain do have meniscus tears or other damage. Keep in mind that an MRI, X-ray, or CT scan can show where damage is. But it is no guarantee that the pain is coming from that damage. If the focus is only the knee, and no other changes are made to surrounding structures, it is just a matter of time before the pain returns.
If you have any questions about this blog, or any questions regarding running injuries, you may come to our class "Running Injuries and How to Avoid them". It will be held on Tuesday, May 21 at 6pm. There is no fee, but if you think you may be coming, let us know. Give us a call at (616) 301-3000. Or personal message us on our Facebook page here.
