Among the many inhibitions of runners, one that tops their worry chart is- knee pain!
According to studies, almost 40-50 % of runners get knee pain due to running. The physiotherapy department is full of such cases. Hence the term “runner’s knee” is coined medically for cases of runners developing knee pain.
The scientific name is patellofemoral syndrome (just in case if you’re curious).
What Causes Knee Pain?
In patellofemoral syndrome, there is irritation of the tendons, cartilage, fat pad beneath the patella or other tissues around the kneecap. The reasons can be muscle overuse, muscle imbalance, wrong running technique, too much force, misaligned kneecap, foot problems, natural misalignment of muscles, tendons, cartilages, etc.
Another syndrome associated with knee pain is called iliotibial band syndrome. The iliotibial band is a ligament that stretches from pelvis to shin along the outside of the thigh.
It helps to stabilize knee while running. In this syndrome, the ligaments become tight causing knee pain.
As the statistics in the study implicate a higher rate of runners falling into knee pain category, runners are usually concerned regarding this matter.
But you need not worry. We have got you covered!
By following the below techniques and method, you can happily go about your running and training and not worry about knee pain!
Note: In case you’re experiencing knee pain, it’s best to consult a doctor. the technique covered in this article are all pre-emptive and would help you avoid any knee injury or pain in the future.
Running Form Correction Technique
According to Danny Drever, author of ChiRunning, it’s the way people run that causes pain and injury and not running itself.
He advises correcting the running form, where there is minimal impact or undue stress to your knees.
Never overstride and let your feet get ahead of your body. The step of your feet should never be ahead of your knees. Always let your feet land beneath your body rather than ahead the body. When we don’t do this what happens is with every step we are hitting brakes with the help of heels and this sends a major impact on the knees causing knee pain.
Never lift up your knees. This will cause you to land your feet ahead of your body. Instead, keep heels up in a swinging motion. Keep your knees swinging low. Bend your knees and let your heels float up behind you.
Lean your body forwards so that your steps land beneath you.
Aim for a midfoot strike.
According to Christopher power, co-director of a musculoskeletal biomechanics research laboratory at the University of Southern California, when you lean forward, it reduces the torque in the knees and puts the weights into the hips.
Flex more at the hips and allow the torso to come forward seven to ten degrees.
Keep your knees soft and bent. Do not straighten your knees. Straightened knees give a strong impact to the knees and heels.
Draw an imaginary center line between your feet in the direction you are running. Rotate your entire leg inwards towards the center line. This will make your feet parallel and will help to keep your feet pointed in the direction you are heading. If your feet splay, it creates pain in knees as one is torquing the knee with every step.
One way of achieving this is by practicing inward medial rotation of the legs. It will take time and patience but persistence will eventually pay off and your legs biomechanics will also change, helping the knees to hinge in the direction they were designed to.
Increase in stride rate method
According to doctor Williams, director of RUN LAB at Virginia commonwealth university, stride rate is the most important factor we know of right now that is easily changeable and reduces the load on the knee.
Shorter steps that encourage a faster pace to decrease the force on the quadriceps place on the knee cap.
According to a study in the journal of orthopedic and sports physical therapy, when the study participants ran faster, they reduced the overall stress on their knees by 30% compared to their normal pace.
There is no single number guideline but if you’re running below 160 steps per minute, you should try to increase it by 5-10 %.
To determine the number of steps, it is a good idea to step on a treadmill and ask someone to track how many times your right (or left) foot strikes the ground in 1 minute.
Now double that number. If it’s above 160 it is great but if it is below that, calculate a 5 to 10 % increase. With gradual practise, you will be able to increase the number.
Fix your shoes
Feet is made up of 26 bones and 33 joints.
Everyone has different natural alignments of bones, muscles, ligaments, and tendons in the feet. Do a gait analysis and find out which shoe design is suitable according to your feet. Good shoes diffuse the impact shooting up the rest of the legs.
Go for a low profile neutral shoes as the added cushion on the knees is actually harmful. Run with shorter strides to minimize the impact and help achieve a soft landing.
While a runner is wearing shoes and running, he/she strikes heel to toe while hitting the ground. If you wear normal sandals or are barefoot, you won’t hit the ground with heels as they will hurt a lot.
Shoes provide a cushion to heels whereas heels were never meant to be cushioned and neither were our heels meant to be hitting the ground first. We are supposed to hit the toes. Toes have shock absorbers which act like a spring which go down a bit and then up the air and then hit the ground again.
This method protects the knees and protects the ankles. While wearing shoes one first hits the ground with heels and then toes or midfoot. So although the heel is cushioned and one doesn’t feel the pain, but the heel gets damaged and the damage goes all the way up to the knees. This causes pain.
Related: Best Running Shoes
Strength training and cross-training (strengthen hips and core)
A study done on 400 female runners published in medicine and science found that, over two years, women who developed runners knee had greater pelvic instability meaning weakness in their hips.
Another study in the Journal of athletic training found that runners who strength trained with a focus on their hips and core reported less three pain in three to four weeks.
When we are only running, we are only strengthening the muscles on the back of the thighs that hamstring. To strengthen the muscles in the front of the thighs (quadriceps) and also hips and buttocks, we need to cross train.
According to a physical therapist, Pamela kopfensteiner, during running, there comes a point in time when the body is not in contact with the ground.
While the body is in mid-air, it is the core’s job to control the rate at which legs return to the ground. Now when the core is strong the control is increased and the force shooting through the joints when the leg lands decrease and in this way injury to the knee is prevented.
Strength training/cross training should be done twice or thrice in a week. It includes planks, squats, medicine ball rotations, jumping lunges, single leg landings, squats with weights, resistance bands, etc.
Strengthening of glutes should be done with foam rollers. Rolling of golf balls or frozen water bottles can be done to relieve the irritation under the foot.
According to John Henwood, mile high run club coach, elliptical, Stairmaster, swimming, cycling, and spinning class increase strength and flexibility. He suggests running 3-4 days in a week and cross-train & strength train the other days with one day completely off.
Running on different terrains
Running uphill increases the strength and stability of the legs and joints. It is a good idea to use a variety of movements by running on different terrains at least once a week. The muscle contraction is different on different grounds and in areas where one has to pay attention, it contracts quite a bit for stability.
This leads to shorter strides and controlled steps.
Off-road, running improves overall body coordination and boosts running motor skills.
However, runners tend to overstride or reach out when running downhill. It’s important to remember to take shorter steps and stay in control
Stretch Before Running
Don’t forget to stretch before and after running.
According to Dr. Kevin Plancher, an orthopedic surgeon and sports medicine specialist stretching prevent knee injuries as it gets the blood flowing and makes the joints flexible. It also helps runners prevent hip injuries, shin splints, and foot cramping.
Dynamic stretches strengthen the lower leg muscles. Some examples are down dogs with calf raises, reverse lunges with overhead reach and cross body knee hugs.
Slow and steady method
According to USA track and field coach Ian Sharman, it takes time for the body to adapt to training. Ligaments and tendons take more time than muscles to adapt as they get less blood flow.
So even if your body and muscles signal you to take on more and more, do yourself a favor and go slow to allow enough time for the support around the joints to catch up.
A healthy intake of nutrients
To maintain healthy knee joints and legs, one needs to eat the right nutrients. Dr. Kevin Plancher, an orthopedic surgeon and sports medicine specialist recommends 1000-1200 milligrams of calcium each day.
They can be taken as supplements or in food form from dairies and dark green vegetables. He also recommends 1500 mg per day of glucosamine and 1200 mg per day of chondroitin sulfate.
Glucosamine is an amino sugar that has a role in cartilage formation and repair. Chondroitin sulfate is a complex carbohydrate that helps cartilage retain water and maintain elasticity. According to Dr. Kevin, taking the two together helps provide relief for osteoarthritis patients.
A balance and adequate requirement of carbohydrates, proteins, amino acids, and antioxidants should be consumed. Remember lack of good fuel within a body cause stress and injury to all joints in the body.
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