A little bit about knee pain

At our run session on Tuesday night the topic of conversation turned to knee pain. With the London and Brighton marathons approaching knee pain is likely to dominate many conversations as people’s training loads increase and some athletes will push themselves just a little too far. The three most common causes of knee pain associated with running are patellofemoral pain, iliotibial band syndrome and patellar tendinopathy.

Common knee injuries

I will briefly explain each of the injuries above and then give you my thoughts on the most common contributing factors. Patellofemoral pain is pain that arises from the joint between the patella (knee cap) and the femur (thigh bone). The iliotibial band is a thick band of connective tissue that runs from the hip to the knee. Iliotibial band syndrome is due to excessive compression of the iliotibial band over the outside of the knee. Patellar tendinopathy is due to reversible degenerative changes in the patellar tendon that connects the patella to the tibia (shin bone).

Contributing factors

The cause of all three of these injuries is multifactorial. It is a combination of many factors that leads to the development of such an injury. Training errors are a common cause. Too much volume, too much intensity, too often, insufficient recovery or a combination of two or more of these variables. I know you have heard it before but these kind of training errors occur frequently and some people never seem to learn from their mistakes. Not increasing your training load by more than 10% per week is a guide only. We are all unique, for some this will be too much while others can get away with more and remain injury free. Increasing your training load by 10% week after week, without having a scheduled recovery week, may also lead to injury. You will only realise the benefits of your training if you have adequate recovery. At the very least, the 10% rule should make you think about your training load from week to week. 

We could talk all night and write an entire text book about the biomechanics of running and the risk factors associated with the above injuries. The most common faults we see in terms of running biomechanics lead a repeated increase in tissue stress.  Our  tissues are designed to cope with only so much stress, this can be altered with correct training so we can tolerate more, but sometimes it is too much and this is when injury occurs. We must remember at this point that some tissue stress is vital to our tissue health e.g. some impact loading is vital to maintain bone and cartilage health.

A frequent fault that we observe in the injured runner is a lack of appropriate control around the hips and pelvis. This can occur for a number of reasons such as habitual postures, muscle imbalances, a lack of body awareness and previous injury just to name a few. The result is a number of faulty movement patterns with the most common observation being a tendency, during the stance phase of running i.e. when the foot is on the ground, for the pelvis to drop on the side of the swing leg and the hip of the stance leg rotates inwards and adducts (move towards the midline). This has consequences in terms of abnormal loading all the way down (and up) the kinetic chain i.e. from the pelvis to the foot. Again I am simplifying things here as we observe many abnormal movement patterns in injured runners but this one is common. 

How can we address this?

First you need to see if this is something that you do when you run. Some simple video analysis is all it takes. You can pick this up with the naked eye but there is nothing like a little slow motion video analysis to really highlight faulty movement patterns. Then you need to work out why you do it. This is a little more tricky and probably requires someone with the necessary skills to put you through a few tests to determine, for example, if you have any muscle imbalances, lack body awareness or perhaps have insufficient muscular endurance. Gail’s yoga on a Monday night targets these kinds of issues and Karl incorporates an element of technique and strength in his Sunday morning run sessions to address these faults also. My job is to keep you informed! A combination of corrective exercises, running drills and frequent running form checks using video analysis is a good start. But everyone is different and ultimately what is needed is a holistic approach to running injury prevention that addresses the risk factors specific to you.

Remember to sign up for the Kingfisher Aquathlon on 13/04/2014, the Ful-On Duathlon on 27/04/2014 and the Thames Turbo Sprint Triathlon on 05/05/2014 to help LFTC get a off to a good start in the London League. Just a reminder that Tuesday night’s run session will be at Mile End Stadium. Make sure you bring along £3 to enter the track. Also check the club calendar to see what is going on at training. See you Sunday, Tim (LFTC Coach).