With marathon season just around the corner many runners will be increasing both the intensity and duration of their sessions in preparation. And with that step up in training comes an increased risk of knee problems.
The knee is the largest, most complex joint in the body and its function is heavily influenced by the foot and ankle below and the hip and pelvis above. Pain at the knee can be due to acute sporting injury, wear over time and almost anything in between, and can require careful management and rehabilitation to correct. Here are a few of the more common knee issues along with some tips for self care until you can see your osteopath.
Some of the common issues experienced by runners and sports people are:
Pain at the front of the knee
Patella tendinopathy
A common cause of pain at the front of the knee is patella tendinopathy. Pain is typically felt just below the kneecap. It is also sometimes referred to as jumper’s knee and is common to sports where there is repeated loading of the tendon followed by energy release, especially with jumping – athletics, football, basketball and tennis for example. As it is usually a reaction to increased physical activity it is often possible to manage the condition by unloading the tendon, ideally by stopping activity placing the highest load on the tendon such as jumping or fast changes of direction, followed by controlled rehabilitation and graduated return to sport. Your osteopath will be able to help with this and help you to maintain fitness during your recovery.
Bursitis
Bursa are like fluid filled sacs which protect other structures, such as bone, tendon and muscle, by allowing them to glide over each other rather than rubbing. The knee has a number of bursa, due to the complexity of the joint, any of which can become inflamed and sore. Impact to the front of the knee, repeated kneeling or increased activity can all be causes of bursitis, as can infection. The front of the knee may feel inflamed and typically painful in the bursa is compressed. Rest and avoiding application of direct pressure on the bursa (kneeling for example), along with use of ice can be effective in controlling the symptoms, as can the use of NSAID’s (eg Ibuporfen - please speak to your pharmacist before taking (or your osteopath if he is also a pharmacist 😊)) with avoidance of kneeling activities can help reduce recurrence.
Pain at the back of the knee
The back of the knee is complex and has nerves and blood vessels running through the dip that can be felt there. The dip itself (known as the popliteal fossa) is formed due to the attacement of muscles which cross the knee, controlling the flexion. Due to the nature of the lower leg the calf muscles which influence knee movement also control ankle movement. Similarly the hamstrings at the back of the thigh influence both knee and hip movement. In many cases pain felt at the back of the knee is due to a strain of one or more of these muscles. Your osteopath will also consider the hip and ankle/foot complex when examining you as issues in these areas can lead to pain at the knee. Once again treatment with graduated, controlled rehabilitation is the best approach for this kind of injury.
Acute injury
Acute injury is usually due to trauma of one sort or another such as a twist or impact. With this kind of injury there is risk of damage to ligaments as well as the muscles and tendons surrounding the knee. Sudden twisting, jumping, landing or change of direction can cause a tear of the anterior cruciate ligament (ACL). You may well have heard of this with footballers and skiers in particular but it can happen with other sports as well. The ACL prevents the lower leg sliding too far forward on the femur. With this kind of injury you may hear a ‘pop’ at the time of injury and due to the anatomy of the knee joint there may also be damage to the medial meniscus and medial collateral ligament as well and your knee will feel unstable. Your osteopath will be able to assess your knee and advise on a course of action. They may well suggest referral for imaging in this scenario and advise you on the most appropriate course of action dependant on the outcome.
Osteoarthritis
Osteoarthritis (OA) is associated with an increased wear of the joint surfaces. Although it can happen in any joint the knee can be affected due to the load that is placed through it during normal activity. It is more common with advancing age, because the rate of repair reduces as we age, OA can also be present in younger people, particularly those who have had a previous knee, leg or foot injury which can alter the function of the knee. With OA you may notice stiffness in the joint and difficulty and pain with some activities, such as climbing the stairs. It is important to maintain fitness and a healthy lifestyle with OA and a healthy diet and regular physical activity, such as walking , are important in managing OA. Osteopathic care can be very helpful in controlling the symptoms of OA, especially if started early, and can help address imbalances elsewhere in the body which can contribute to the progression of OA.
Whilst this is by no means an exhaustive list of knee issues it does give an idea of the type of presentation I regularly see. If you are experiencing knee pain I would advise you to see a professional healthcare practitioner, such as an osteopath, as early intervention can be beneficial in most cases.
Of course it is best to avoid knee problems in the first place. I would advise getting any small niggles looked at sooner rather than later, especially if you wish to maintain or increase training intensity as doing so with a knee not functioning as intended could well exacerbate the problem.
So the 4 key tactics for avoiding knee pain
1. Do a comprehensive warm up before your main training, each and every session. This will prepare your body for the hard work to come and reduce the chances of sprains and strains affecting the knees, either directly or indirectly.
2. Increase your training load gradually. If you are used to running for 30 minutes, going straight to a 2 hour run is likely to lead to overuse injuries such as muscle strains. Instead increase gradually.
3. Incorporate specific strengthening exercises to your routine for the muscles surrounding the knee and influencing the knee. This will help give the maximal support to the knee joint during activity, reducing the risk of injury.
4. Improve your balance. Spending time on balance exercises will improve the feedback from the feet and the control of the muscles around the joints. Single leg balancing exercises (be close to something you can grab if you need to!) are a good place to start and these can be progressed as your balance improves.
If you would like any advice about an issue you have or how you can manage or prevent knee pain then please do give me a call.
If you find this useful or have an suggestions of topics you would like me to cover then please leave them in the comments.
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