I was given your e-mail address via a running web-page.
I have a question about a recurring knee injury of mine. I hope you
can answer it.
I have a sharp pain in my knee-cap that begins to hurt about 2 miles
into my run. (If you were to put a clock on my right knee, my shin
would be at the 12 o'clock and my thigh is at 6 o'clock) The pain is
right at the 8 o'clock position.
It does not hurt while walking--usually. And it stops when I stop
running. Rest does not help....I want to RUN! Motrin helps, but I
suspect that it will eventually stop helping.
Since I want to run the USMC Marathon, is there an exercise I can do
to counter-act the pain? Or is there an exercise I should NOT do that
would aggrivate it?
I am 38 years old and have been running on and off for over 20 years.
I am not very flexible but I am working on that. I am lifting weights
and that helps to a point.
First off, the knee is usually not the cause of knee pain..rather, the knee is
the joint that is irritated by either biomechanical problems of the foot, or
weakness of the hip rotators. Imagine a train on a track, if the train became
derailed, you would not fix the train, you would fix the track, right? Same
thing with the patello-femoral joint of the knee. Why you have your pain is
unknown, but some considerations are as follows: First consider your feet.
Are you a proanator or a supinator? Actually, either circumstance might cause
you to develop chondromalacia patella - Another consideration is the relative
position of your knees - are you knock kneed or bow legged? Again, each might
give rise to a patello femoral syndrome, but the effect of each can be
modified through the use of orthotics in your shoes.
Usually, we start our evaluation of knee pain with a complete biomechanical
evaluation of the lower quadrant, feet, ankles, knees, hips and lower back.
More often than not, we build orthotics for the feet as a startting point.
Then, once the biomechanics are improved, we put the athlete on a dynamic butt
strengtyhening program. The reason for this is that the butt muscles control
the femur - especially the rotation of the femur. Butt muscles that are long
and weak (we call the condition a stretch weakness) can't decelerate the femur
in it's new imporved position, so once in the orthotics, changing the dynamic
response of the muscle is key. Rarely is the butt strong enough in our knee
patients. Most runners are concerned about the strength of their quads, and I
hear a lot of talk about the ratio of quad : hamstring strength. Try to
picture the leg and thigh. How many muscles insert on the patalla? The
answer - just one. In contrast, how many insert on the femur? The adductors,
the hamstrings, the quads, the hip rotators, the iliopsoas, the gluts - more
than 20 (i just counted 21 off the top of my head, and I'm sure I forgot a
few!) - The point is that the emphasis must be on butt strengthening rather
than quad or hamstring strengthening.
Single leg squats, slide board, roller blades, transverse plane lunges are
strategies to employ .
So in summary - first consider biomechanics, then look at your training
routine, and make sure your cross training includes isolated weight bearing
butt strengthening activities. Finally, ice is your friend - in fact I would
go further and call it your new religion! 30 minutes once or twice each day.
Also, talk to your physician about using NSAID's - musculoskeletal injuries
respond well to a short course of these drugs.
Over the long term, however, we strongly urge our osteoarthritis patients to
take a nutritional supplement called glucosamino sulfates. The product we
sell in our clinic is made by a Interior Design Nutritionals, and is called
Cartilage Formula. It contains several antioxidants, and herb extracts as
well as the basic building block of articular cartilage. It costs about $30 a
month, and if you take such a product, you need to use it for several months
before you decide if it will help or not. The book The Arthritis Cure is a
good reference about this type of suppliment. A word of caution though.
Every one is selling the "best suppliment on the market today". The issues
are ultimately related to the "bio-availablity" of the substance you take.
The reason I like IDN's products is that they are natural, they are water
soluble, and they are made to a very high standard with respect to bio-
availability. What ever suppliments you use, make sure you are getting what
you pay for. One consideration with respect to Cartilage suppliments is that
the molovule Chondroitin Sulfate is a macro molocule with poor absorption
characteristics - less than 2% gets absorbed - so make sure you are not using
a product with this molocule included.
Enough said - good luck with your rehab Bob.