Tuesday, March 26, 2013

Runner's Knee

A new course record was set at the Chicago Marathon last year.  With a time of 2:04:38, Tsegaye Kebede became the first Ethiopian man to win on Chicago’s flat course.  Thousands of first-timers and other runners followed the elite runners this morning.  For these endurance athletes, training is essential to reach the finish line, but overtraining or overpacing can easily lead to injury.  One common running injury is known as runner’s knee (patellofemoral pain syndrome) which is associated with pain behind the kneecap.  It is an overuse injury often seen in runners and cyclists, but it can also be seen in sports which require repetitive jumping or cutting.  While this pain can be cause by a direct impact injury, it is typically caused by repetitive bending of the knee.
The major symptom is pain which usually begins as a dull ache or stiffness behind the kneecap (patella).  The patella is attached to the thigh by the quadriceps muscle and tendon and to the leg by the patellar tendon.  Injuries or weakness of these supporting structures can lead to improper alignment and tracking of the patella as the knee  bends and straightens.  This results in irritation and pain.
Conservative treatments for patellofemoral pain syndrome begin with reduced training, ice, and anti-inflammatory medication.  Incorporate stretching and strength training of the quadriceps and hamstrings to improve stability around the knee.  In addition to these therapies, custom arch supports (orthotics) may be considered.
Recent studies have provided evidence that orthotics reduce patellofemoral pain by improving the tracking of the patella during the bending motion of the knee.  Although orthotics have been generally thought to benefit individuals with excessive collapsing of the arch (over pronation), these studies have shown that people of all foot types have reduction in knee pain with orthotics when compared to flat inserts.
Patellofemoral pain syndrome is a degenerative condition that can progressively get worse over time.  Proper training and conditioning can help prevent this and other lower extremity injuries.  Following any injury, the goal of returning to activity as quickly and safely as possible can be achieved with proper evaluation and treatment.  Custom orthotics casted by a podiatrist can be an important addition to the standard treatments for runner's knee.

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