Don't Let Pain Stop You!

The sun is out and the warm weather calls many of us to go outside to run, but any new activity means using muscles in ways they haven’t been used and can lead to injury. We were "wearing" these muscles all winter long but haven’t used, trained, or conditioned them to turn on at the right time and be strong for running. These overuse injuries creep up on us one day and can prevent us from running for weeks and that won’t be fun if the sun continues to shine without you!

The most common injury is called Patellofemoral pain, otherwise known as "Runner's Knee."
Symptoms include: Pain in your knee when running, going up or down stairs, squatting, when sitting for prolonged periods of time, and sometimes walking. Xrays reveal no structural damage and may show your kneecap, or "patella" is mal-tracking, which means it is not in the correct position and improperly aligned during movements. MRI is not immediately necessary and your doctor will send you to physical therapy instead.

Diagnosis: A physical therapist will ask you for a detailed history of your knee pain. Then, with a thorough evaluation of your hips, knees, ankles, feet, core, and running form, the cause of your knee pain will be confirmed as patellofemoral pain vs. other knee injuries. Your PT will also analyze the movements of your trunk, hips, knees, and ankles to see how they are contributing to your pain.

Causes of patella mal-tracking: Muscle imbalances (tightness and weakness in the muscles that control the hip, knee, and ankle) cause the soft tissues around the patella to get irritated with repeated motions. This leads to mal-tracking of the patella. Excessive wear and tear of the patella will cause the cartilage to break down, leading to pain. Muscle imbalances are caused by inadequate stretching, repeated vigorous activity using muscles that are not conditioned, improper running form (which can also be caused by foot abnormalities such as flat feet), and/or improper footwear.

Treatment with Physical Therapy

Joint mobilizations: your PT will perform specific hands-on techniques to mobilize any joints that are stiff or improperly aligned, which are affecting your body mechanics during movements.

Exercises: A stretching and strengthening program will be designed specifically to meet your body’s needs based on the findings from your evaluation. You will learn how to stretch the muscles that are tight and how to strengthen the weak muscle groups, which are contributing to your painful runs.
Pain management: modalities, such as ice, may be applied to sore areas in order to alleviate pain.

Injury Prevention

• General conditioning - Keep all major muscle groups surrounding your hips, knees, and ankles in good condition through regular strengthening exercises 2-3x/week. Don’t forget to keep your core strong too because that is the foundation of your body.
• Warm up - Before running, walk briskly for 3-5 minutes.
• Increase miles gradually - Avoid sudden increase in the duration and intensity of your running.
• Proper footwear - Run in shoes that are right for YOUR foot type, not any sneaker that sounds promising in TV commercials.
• Use proper running form - Ask your P.T. to assess your running form to correct any improper movements in the trunk and legs that can lead to injury and pain.
• Stretch - After your run, spend at least 10 minutes performing a stretching routine for every muscle group that has just been used.

 P.T. is extremely successful in treating this problem. However, prevention is the best way to have a healthy, fun, and active lifestyle this summer, so before you start a new activity, consult a physical therapist so you won’t have to come face to face with pain.

Helen Nam, DPT