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Monday, August 28, 2006

Runner's Knee

"Hi Gary
I was hoping you could help me. I did the XYZ Half Marathon last year and I finished it feeling great however I thought I would then go on and help a friend of mine finish the marathon (just the last km) however I suddenly got a bad pain in my left knee – since then I have had physio, acupuncture, pediatrician, I even had my leg measured and found my left leg was 4mm longer than my right leg so I had orthodics put in. I did rest for awhile (about a month) however it seems that when Im running I can get to the 10k mark then the pain starts and gets worse as I go along – going up hill seems to help it but its going down hill or on the straight that it is really bad. The physio said that it was runners knee however not sure what that problem is. The pain seems to start on the outside of my knee then goes further under my kneecap and sometimes above my knee. Im usually sore for the rest of the day and depending how far Ive run it may even be a bit sore the next day. I am trying to strengthen it up at the gym by using weights and sometimes even swimming or cycling to help.

I am at my wits end and I love my running and Im sick of this problem, do you have any other idea as to what my problem could be or what I should try next.
Gary Moller comments:
You can now see why marathons and 1/2 marathons are a huge windfall for therapists of all persuasions - even pediatricians! The aftermath can be both financially and emotionally expensive.

If the injury is what you have described and what your physiotherapist says, then you have damaged the very delicate under surface of the knee cap. This is not good; but the good news is you will recover – eventually.

First of all, I think you can throw away the orthotics and replace them with a good quality innersole like Formthotics. I have never in 28 years seen an athlete benefit, other than briefly, from these and you are unlikely to be the exception. Your feet are shock absorbers; if they are not allowed to do their job properly, the energy gets transferred further up the legs to structures like the knees. They can actually cause worse problems down the track by accentuating weaknesses and imbalances. You need strong feet - not weak ones. And do the exercises that you see in the last few pages of the Guide – the ones that stretch and open up the runner’s hips. Do these every time before and after a run. Tight hips throw huge strain on the knees, especially when running downhill. If you have a short leg (most of us do), (or is it a long leg??) the cause is most often in the pelvis and not the leg itself. The attention of a chiropractor might be beneficial along with regular practicing of the hip stretches recommended here. Consider purchasing a new pair of running shoes if the ones you have are worn, or are in any way uncomfortable.

When you go for a run
When you go running, keep the knees warm before, during and after. A long hot bath and a self massage about the knee caps is wonderful and will help healing.
  • Stay off hard pavement, especially during winter. Run on trails, that twist and undulate, thus eliminating the relentless pounding monotony of running on pavement.
  • Keep close to home by running in circles rather than out and back. Murphy's Law dictates that you will seize at the most remote point far away from Home!
  • STOP running before your knee hurts and gradually build minute by minute, run by run no matter how long it takes to fully recover.
  • Do not run every day. Have a rest day between runs (rest days can be active - go and swim or lift weights).
  • Do fartlek and intervals that stretch, strengthen and get the run over and done with quickly; rather than your runs being a sucession of bland drawn out plods.
  • Before you do your next marathon, or anything over 15 km, do a proper buildup of at least 12 weeks, as outlined in our marathon training guide along with plenty of races over short distances no longer than 10km. Join a running club, so you can do their race programme, even if you consider yourself a completly social runner (You will not be alone).
Doing strength work in the gym might help; but you must be very careful with the weights exercises not to stir the injury up. Make sure that you get instruction from an experienced instructor who has the appropriate qualifications. The key is to eliminate ongoing harm and to assist your body’s healing processes - not to stir it up.

You need to do the exercises in here whether you have weak feet or not and take a good, long look at your posture – how you place your feet, how you stand and how you walk and run and sit. If necessary, go do a few sessions with a posture expert like a person qualified in the Alexander Technique.

Go and see a sprint running coach who you can find via your local running club and get some lessons at the running track on doing running drills including bounding. Learn how to run tall, lightly and strong. Even if you consider yourself a social runner, this is one of the best actions any runner can take to have a long, enjoyable and injury-free time running life.
Nutrition to assist the body with healing itself
  • Purchase some joint food here and take 6 teaspoons per day until finished.
  • Also take 3 teaspoons of this daily until finished.
  • And take 2 per day of these until finished.
These will help your body get its healing processes ahead of the ongoing damage that is happening. Take all of these with food and spread throughout the day, rather than all at once.
  • Take a course of magnesium – one daily until finished.
Low magnesium may cause the muscles to be slow in relaxing, causing the thighs to pull on the knee cap when they should be relaxed. This is one reason for the painful seizing up towards the end of long, hard runs.


Wayne said...

I"ve found it better doing lots of shorter runs and the occasional long run to build up for half marathons. too many long runs even with rest days can knock the body back especially for heavier builds whereas the shorter runs can be recovered from far quicker enabling you to keep your mileage up. i listen to my body rather than stick strictly to a training regime. and never do a long run when i'm tired or sore beforehand

Wayne said...

i see there are a couple of sports shoe chains that offer video evaliation of your stride to fit you to the right shoe, sounds like a good concept although i've never tried it, I did try one where you walk over a plate and it evaluated my arch and my stride telling me I was "neutral" and that i didnt have to worry too much about getting the more suportive shoes.
i have found shoes that are too soft in the mid sole let my ankles roll too much causing knee pain.

Gary Moller said...

Dead right Wayne!
In Wellington we are blessed with running tracks all over the city. Short hard runs on undulating terrain are much better on the knees than slogging out the miles run after run.

Gary Moller said...

With regrds to having the video analysis in a shop is concerned, this is helpful to a point. The problem with feet is they might look nearly perfect posturally until well into a run when the muscles of the feet and calf begin to tire and the feet consequently begin to fail in their work. I look for tell-tale signs by examining the feet and calves and this can be supported by observation about 30-60 minutes into a run; but this is usually unnecessary.

Wayne said...

yeah mate start the auckland wellington war again he he he,

Anonymous said...

Hi I have been reading a number of articles about runners knee.
I can run for about 1Hr.15 min before pain kicks in. as soon as I stop and relax the pain is no longer there and I have no swelling or pain later or the next day. I suspect I am getting these warning signs, to say if I don't change what I am doing then it will get worse. I have done two marathons this year and my training at the moment is to stay fit and get ready for another marathon early next year. I probably should cross train more, say cycling and gym work to give my knee the time to recover, I am a neutral runner, my feet are pretty strong, but it's hard to tell if it's because of a weakness somewhere else that is causing this problem. I always train on the road or pavement so this could be the problem. I do between 40-60 km a week. I have read your article already but if you have anything to add let me know.

Gary Moller said...

Raymond. Can you contact me direct about your injury.
Contact details here: