Ignoring knee pain places you in a position where crippling , sometimes even permanent damage can take place. Ensuring you take early advice from the appropriate specialist professionals can usually stop the trauma fairly quickly. Professional biomechanical evaluation of the knee, lower extremity can often pinpoint the true cause of a knee trauma. Overuse training, running on hard ‘unforgiving’ road surfaces and wearing inappropriate or worn-out footwear are usually amongst the leading culprits.
A primary cause of chronic knee pain in adolescents is a condition called PFPS, which stands for Patellofemoral Pain Syndrome and a fairly common cause in adult physiologies too. Biomechanical knee problems are not exclusively caused by actual mal-alignment of the knee joint, but often the lower extremities are also responsible, relayed up by over pronation of the foot. Abnormal amounts of over pronation in the subtalar joint of the foot in running, specifically during the stance phase, generates excessive levels of rotation in the lower leg, significantly inhibiting normal knee joint function. Knee joints ride on three millimetre thick cartilage ‘cushions, which during any run, have to absorb impact velocities three to six times the body weight.
The knee joint being one of the body’s most unstable articulations hardly helps matters, especially when it’s subjected to twisting motions as well as impact velocity. The foot doesn’t just roll inwards with over pronation, in addition, this condition mis-aligns the knee too with each and every stride. Biomechanical imbalance in the form of patellofemoral stress syndrome is the unfortunate result or ‘runner’s knee’, as it is more generally known!
Remedial methodologies for PFPS are numerous. Important aspects for biomechanical consideration is the knee to pelvis correlation and the lower leg and foot relationship, which is professionally referred to as the Q-angle. High Q-angle combined with excessive pronation can cause a "pendulum swing" at the knee if excessive pronation is unfortunately combined with a high Q-angle. Cartilage damage will then certainly take place over a period of time, via elevated localised stress factors and increased loading on the articular cartilage itself, all caused by the demon of patellofemoral imbalance.
Other causes of PFPS are wasting (atrophy) or structural weakness of the medial quadriceps. ANOTHER is wearing shoes where the outer soles are worn down, causing the runner to roll outwards (supinate) excessively during heel strike, then roll in (pronate) excessively. Changing shoes every five hundred miles or every six months is a helpful rule of thumb. Choosing a shoe with good stability and proper motion control is another tip to help avoid this injury.
The use of prescription orthotic devices has been shown to significantly reduce excessive pronation, establish more of a neutral subtalar joint, and allow the foot to function more effectively. The body will then require less forward propulsion, and provide for improved shock absorption. The Q-angle (one of the measures of lower extremity alignment we described) will be altered with a foot orthodic. It has been shown that by altering the Q-angle, a prescription orthodic allows for more normal loading and contact pressure. By affecting the rotations of tibia on the femur, the pressure in the knee joint is more easily distributed between the condyles of the femur. This creates a more normal alignment. Thus, the runner is more biomechanicaly "correct," and with the entire lower extremity (femur, knee, tibia, foot) in more proper alignment, the runner suffers less risk of injury.
A less expensive soft orthodic can often work just as easily as the harder prescription device. For the runner who needs minimum control for pronation, the softer device may be all it takes. However, the softer device will eventually break down, and could cause a resumption of symptoms. Therefore, a trial period of at least four weeks is necessary in order to evaluate whether the runner should progress to a more permanent foot orthodic.
Strengthening exercises, particularly of the quadriceps muscle group, is essential. Cross-training exercise - i.e. swimming, aqua-running, cycling, and, later, stair-stepping and roller-blading - can maintain training effect and conditioning, while allowing for rest and recuperation of the knee joint. Another suggestion is taking extra time off between running days. The compulsion to run a marathon, especially two to three a year, can have its destructive affects upon the body, its muscles and joints. When we run every day, we do not allow the body to enjoy the rest it deserves. Often we do not observe the rule to keep weekly mileage increases to 10 percent or less; runners training for marathons often try to boost there mileage during the weekend after too many inactive weekdays. Use cross-training during alternative days to keep in shape, and, simultaneously, give overused muscles and knees a much deserved rest.
The next time your client experiences a twinge of knee pain with no previous injury, think of overuse runner's knee and get them to a sports medicine specialist. Don’t let them continue to "run through" knee pain, as prompt treatment and corrective measures now could prevent greater and more chronic problems later on.
