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Ask the Doctor: Running and Knee Pain

Do you have knee pain when you run? Here's some things to try.

The featured question of the week comes from Nikki—

I have some pain on the outside edge of my knee when I run longer distances. It can be pretty sharp at times, but is usually achy. Any clue what it might be and how to help it?

This is a little tougher question without actually looking at the knee and doing some orthopedic tests. There are a lot of things that could be going on: damaged or strained ligaments, torn meniscus, and arthritis to name a couple things. 

If arthritis and damage to the ligaments and meniscus is ruled out through X-rays and an MRI, what might be the culprit are tight quads, hamstrings, and/or ITB (iliotibial band), or tendonitis of those very same muscle groups.  

I read in an article a few weeks back (and I forget where I read this) that running is similar to hopping on one foot repeatedly. As you run, your entire body is being supported on just one foot and all your joints and muscles, from your neck down to your big toe, should support this activity. If you run hills, trails, or otherwise uneven terrain, the demands required on your body go up - even more coordination is required to achieve the task of running.  

If there is any dysfunction of the joints in the low back, hips, knees, and feet, there will be a lot of increased stress on the dysfunctional part or neighboring areas. Then, because our body is such an amazing machine, all kinds of muscles compensate for the dysfunctional area, which can result in a build up of scar tissue and cause muscle tension/spasm.  

So, the first thing with knee issues is to get it checked out by a healthcare provider. Secondly, make sure you're warmed up before you run and stretch after a run. Depending on what you read, the current recommendation is to do warm up exercises that mimic the activity you're going to be doing. With running, for example, you might want to do some jumping jacks, squats, or some lunges to get things warmed up and blood flowing to the muscles you will be using. If any of these exercises exacerbate your pain, discontinue and seek out a healthcare provider. Stretching after a run, especially long distance, is critical - it prevents muscles from tightening up too much. 

If knee pain is caused by the ITB - which is a soft tissue structure located on the outside edge of the leg from the hip to the knee - this can be a hard area to stretch. So I usually recommend people use a firm foam roller and use it specifically on the ITB. 

I see runners of all kinds - recreational runners, marathon runners, ultra marathon-ers, triatheletes, and ironman competitors - and this type of pain isn't uncommon. It is critical, however, to figure out the cause. Sometimes it can be a misalignment anywhere from the lumbar spine to the feet or it can be a result of tight muscles, ligaments, or tendons. Chiropractic adjustments and Active Release Techniques (ART) can be beneficial for knee pain with this type of cause. I usually get great results in 6-8 visits using ART. Other times, there can be true damage and that doesn't go away or get better without the proper follow up care.

I hope that helps! Thank you for reading, and if you'd like your question featured next week, please leave a comment or email me directly at QureshiDC@gmail.com

David J Doperak May 24, 2012 at 03:32 AM
Interesting how specificity of pre-exercise for running is mentioned yet totally fails to be specific. How do jumping jacks relate to running? Running involves coronal plane knee joint movements and jumping jacks are sagittal plane. Please help me to understand.
Ayesha Qureshi May 31, 2012 at 01:37 PM
You're right about the different planes of movement. Jumping jacks are a good, quick way to elevate the heart rate a little and get the respiratory system going. It's also important to warm up those other directions of movement because stability (or lack thereof) in the hips will affect the knee and can create pain. If you engage in any trail running, you may also be going side to side some to avoid logs and branches, or water. After seeing an ultra-marathon last year run after a full night of rain, people were running up the side of mud banks to avoid running through mud. So, jumping jacks help warm the heart and lungs up, as well as some important stabilization muscles that are required when running. That's my thought process on it! Thanks for the question!

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