By Jordan Hicks, PT, DPT, OCS
Running is an excellent activity to improve physical fitness and reduce the risk of chronic health issues such as diabetes, high blood pressure, and heart disease. Running continues to enjoy widespread popularity, with people participating in various running events from 5k’s to ultra-marathons.
Given the number of people running and the mileage logged, the frequency of injuries associated with running is also on the rise. Most runners, especially those training for longer events such as marathons, will have some type of injury during training or competition. The most common area that runners will develop pain/injury is the knee.
Many times [running pain] symptoms will improve with a period of rest from the aggravating activity, but once the activity is resumed the pain returns.
Proactive education with these athletes is key to avoiding injuries, and then directing them to the appropriate early intervention when an injury does occur. The purpose of this commentary is to discuss a few tools to help healthcare professionals reduce risk of chronic knee injury, to help differentiate which patients need a referral to physical therapy, and to describe what physical therapy can do to manage these issues once they occur.
Knee pain that develops with running is typically a result of decreased muscular control in the leg during weight bearing, either at the foot and ankle or at the hip. Patients may also have some restriction or imbalance of muscles in the thigh, or limited mobility in soft tissue structures around the knee. The problems mentioned above can cause issues with patellar tracking, which then causes stress to the surrounding tissues and the patellofemoral joint, resulting in pain. This is typically referred to as patellofemoral pain syndrome or PFPS. This term encompasses any dysfunction of this joint and its surrounding tissues. The most commonly involved structures will include patellar tendon, distal quad M-T junction, bursae, fat pad, distal IT band, and patellar ligaments. There can also be pain that is a direct result of referral from muscles in the thigh and hip.
Pain usually occurs during activities such as running, walking, squatting, and is typically worse with things like going down stairs or down hill. Many times the symptoms will improve with a period of rest from the aggravating activity, but once the activity is resumed the pain returns. There is rarely a specific injury/instance, such as a fall or a pop in the knee that patients will attribute with this pain. This indicates a movement dysfunction or motor control issue, and not necessarily an inflammatory process, so the problem will not subside with rest and medication alone.
At Results Physiotherapy, we provide a hands-on approach for all patients. Our examination will focus on identifying involved tissues, assessing joint mechanics, and discovering limitations in mobility and changes in motor control. Treatment provided by a Results PT will involve the application of specialized manual therapy techniques to assist with pain reduction and reduce abnormal tissue stress. Treatment techniques will include taping to help facilitate proper PF joint alignment, soft tissue and joint mobilizations to assist the healing process and increase the patient’s tolerance to specific exercises.
Exercise is a key component to restoring function and reducing risk of further injury. There is significant benefit to having a PT perform a detailed movement assessment and provide an individual exercise program that fits the specific needs of each patient. This will also allow adequate time for personalized education regarding risk reduction. Results PT’s are able to give information based on current best evidence for reducing risk through proper periodization of training for current runners, as well as a structured and individual training program for new runners.