We are happy to announce a new feature column here at "On the Run Events Northwest" , which we call
The Runners Clinic. This new area of our site is sponsored by The Sports Reaction Center and moderated by physical therapist and personal trainer Neil Chasan. Neil is making time for your questions regarding medical and training needs. He won't be able to answer all the questions he gets, but each month we will publish those questions that will most benefit all Runners. The Sports Reaction Center is a high-performance rehabilitation clinic for athletes of all ages and abilities who want to take their personal game to a higher level. The Center was founded by Neil Chasan, PT, MMT , a licensed physical therapist who specializes in human performance and the biomechanics of sports.
You may submit your question to Neil Chasan here.
Neil Chasan, PT, MMT
I am a runner who has struggled with knee pain for the last 18 months. I
tried everything and finally opted for surgery last Christmas. My knees were
debrided and I have osteoarthritis. I am now running twice a week and living
with a mild dull ache in my knees. Has anyone had this problem and made a
successful return to running? I want to race again but don't want to ruin my
Tom in Canada
Tom, here is the short answer:
The knee lives between the foot and the hip. The function of the knee is largely controlled by the biomechanics of the foot at one end, and the ability of the hip rotators to decelerate the femur at the other end. The knee cap - (patella) lives in a groove between the epicondyles, and pretty much goes where the condyles go, like a train on a track. For different reasons both excessive pronation of the foot on one hand, and a severely supinated foot on the other can cause the knee to travel further with each step, and the patella spends more time than it would like to moving against the lateral epicondyle. This leads to inflammation, and eventually chondromalacia patella, or a softening of the subchondral bone on the underside of the patella. So if pain in the knee is a function of biomechanics, the first consideration must be corrective orthotics. The orthotics bring the ground up to the foot so that the foot is in good alignment at heel strike and foot flat In turn, the knee doesn't move so far in the frontal plane, and the patella is relieved of the burden of compression by the lateral epicondyle.
So that said, Tom, my first suggestion is that you ice your knees daily. Second, have orthotics made that are aggressively posted to reduce the medial frontal plane moment at the knee. Third, you should reduce your running training, and instead, introduce a low impact training regime, such as in-line skating, which will keep your cardiovascular work rate high, and also work your legs in the frontal plane (Great cross training tip!!!). This "causative -cure" concept is important as you gradually increase the tolerance of the patella toward loading. Emphasis on the word "gradually". This way, you can reduce your actual running training leading up to a race, and still post surprisingly good times! Let pain be your guide in determining how much actual road work to do (if it hurts, don't do it - there are good histological reasons for that which will be the topic of an upcoming article). Also, make sure your shoes are in good repair, and that you have good orthotics in all your footwear. Finally, once you have become accustomed to the orthotics, make sure you do a rehab program with an emphasis on rotational butt work with your feet on the ground. The reason for this is that the butt decelerates the femur in the transverse plane primarily, and with the femur not traveling as far, the butt must be conditioned to decelerate the femur through a more limited range of motion.
I have been having some "aching" and numbness in my right lower back
extending down the thigh. It is not really a sharp pain, however, when I
drive it is extremely achy. Lately it feels like I'm dragging my right leg.
Sometimes while running, the numbness makes me wonder if my leg will support
me. I run 6-8miles three times a week and do cross training on two other
days. I'm wondering if I should continue running or let it rest. I have taken
up to 4-5 days off with no effect. Any suggestions? I've been running 15
years basically injury free.
Vickie in , Beaverton OR
Vicki...not good news.
The sense you have of dragging your right foot suggests that you have motor nerve compression leading to weakness, which is why you feel as if the leg won't support you. The aching and numbness that extends down your thigh is suggestive of a disc protrusion, which is supported by the increase in pain that you experience while sitting and driving. Go and see a physician, preferably a Physical Medicine and Rehabilitation specialist who can order such tests as an MRI, and an EMG should the physical examination warrant it. My bet is that you have a disc herniation, and the question is weather or not you will require surgery. If so, let me know, and I will give you a list of questions to ask. If not, seek out a physical therapist who has attended a Gary Gray workshop titled "The Chain Reaction Festival". They will have the tools to get you back on track. In the meantime, reduce your running, but more importantly, reduce your prolonged sitting, bending and lifting, and static postures in general. Keep up your aerobic work through an alternative activity like swimming, where the buoyancy will reduce the strain on your back. Ice your back for at least 30 minutes each day until the issue is resolved. Good Luck.
I have been in physio for months, trying to work at weak glute medius and
glute maximus muscles, and a rectis femoris muscle that dominates- The psoas
muscle is getting stronger, but all these imbalances have made recovery slow
and frustrating. Muscle imbalance cannot be corrected by passive stretching.
Any insight you can give me?
Joe - Kanata Ontario
You pose a series of complicated questions Joe. To answer the last question first. Stretching will not resolve any so-called imbalance. Stretching cannot increase a muscle length per se, because the resting tone of the muscle is set neurologically by the quick stretch receptor called the muscle spindle. To increase a muscle length you have to exercise it into greater ranges functionally.
Now the first part of your question is a bit confusing to me because the gluts and the rectus have completely different functions. The rectus femoris primarily decelerates knee flexion at heel strike, while the gluteus medius decelerates hip adduction, and the gluteus maximus decelerates hip internal rotation. Granted, they work in synergy, but the rectus femoris is going to have a hard time dominating the glut maximus - compare their origin and insertion points, and also their cross sectional area, and the orientation of their fibers. So if you indeed have a week gluteal complex, look at that as a separate issue. Probably you have biomechanical problems of the foot, which in turn results in increased forces of medial rotation acting at the hip, leading to "stretch weakness" of the gluteal complex. Orthotics are the first line of defense. While we put orthotics in the shoe, we really make them for the butt! Correctly aligning the foot will make each step therapeutic for the butt, and with a functional exercise program, you can increase the strength of your butt to kick in at the right time. Muscle imbalances...not a theory I support very much.