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Within a one-year period, one out of every three runners will have an injury. Out of every three of these injuries, one will involve the knee. Of all the injuries that occur in the knee, those affecting the kneecap are the most common. A variety of names have been given to this injury, most commonly chondromalacia or runner's knee Runner's knee pain usually comes on gradually. Unlike a skiing injury where symptoms occur abruptly, the runner's knee pain occurs gradually over a period of weeks or even months. The pain is difficult to localize. However, it is usually in the front of the knee around the kneecap.
Clues A feeling as if the knee will give way, pain when getting in and out of a car, particularly if the left knee is affected. Visualize getting into a car. When sliding into the driver's seat, all of your weight is on your left leg. Getting out of the car, the left leg is placed on the street and the weight of the body is raised on the left leg and knee. The lower the seat, the more the stress on the knee. Those with runner's knee who use a clutch will also notice that the left knee is uncomfortable when depressing the clutch. Stiff or achy knee after prolonged sitting discomfort when squatting, kneeling or hopping (Doing squats or leg extensions in the gym may be the cause of the knee damage.) pain when walking downstairs; occasionally when walking upstairs pain with lateral thrusting movements such as those used in racquet sports or aerobics All of the factors which precipitate knee pain are those where the knee is bent and there is pressure placed on the foot or when doing leg extension exercises on machines with a bar across the front of the ankle.
Show and TellThe runner can look at his knee and find a few things, which could suggest the existence of runner's knee as the cause of pain. 1. I look at the quad muscle just above the knee on the inside of the leg known as the VMO. Frequently with runner's knee, there is poor development or weakness of this portion of the quad muscle. 2. While sitting in a chair extending the leg, watch the patella move. Often with runner's knee pain, when the leg is almost fully extended, the kneecap will move toward the outside of the leg. Patella movement is the result of a tracking abnormality of the patella, which predisposes to runner's knee pain. Patella tracking to the inside causes the same syndrome in a few runners. 3. X-rays are rarely abnormal but can offer evidence that other knee problems are not causing the pain. X-rays of the patella may show that it is deviated to the outside.
TreatmentAccurate diagnosis of the runner's knee can be made quite readily. The general principles of treatment include strengthening the VMO, or inner portion of the quad muscle, while stretching the outer knee structures such as the iliotibial band ITB. VMO strengthening can be accomplished with (a) leg lifts, (b) leg extensions, or, more preferably, (c) short arc quad extensions. A leg extension regimen developed at Michigan State University is to contract the quad for 60 seconds, rest for 60 seconds and repeat three times. Although this regimen does not seem to be very vigorous, its proponents endorse the technique. Regardless of the strengthening technique used, it will be six to 12 weeks before significant improvement in VMO strength will occur. ITB stretching will be reviewed in a later issue. No discussion of the runner's knee pain would be complete without some mention of the hamstring muscles. In many runners with knee pain, the hamstring muscles are tight. Hamstring tightness will often worsen kneecap pain. Thus, hamstring stretching is an important adjunct to treatment. Orthotics and proper shoes will help excessive pronation. Finally, there are runners whose knee pain is recalcitrant and resistant to treatment. For you, a kneecap stabilizing brace is available. In a number of runners, the brace has made a big difference in pain and the capacity to run. In conclusion, runners with knee pain should ride the elevator, avoid scrubbing floors, drive cars with automatic transmissions and stretch their ITB's and hamstrings."

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Knee Pain, Knee InjuryCarpal Tunnel, Wrist PainAnkle Pain, Ankle InjuryArthritisWrist Pain, Carpal Tunnel1CarpenterAthletic PerformanceEpidemiologicalFemoralFishingFootball