By Sam Carter, M.D. Orthopaedic Specialist Medical Director, Kentucky Derby Festival Marathon and miniMarathon
The second race of the Triple Crown of Running is now behind us, and what a beautiful day it was for racing. For those of you who completed the race, congratulations and good luck on the final leg, which will be the Papa John's 10 Miler. As I wrote in my last post, I had some pacing problems in the first race, so I paid special attention to that this time and I feel I did a much better job. My pace fluctuated no more than 10 seconds per mile for the entire race, and I felt much better at the end. When I was looking up results on the race's official website, I noticed they had links to race results going back all the way to 2002. It just so happens that the last time I ran the Rodes City Run was in 2002, so I looked up my time and was pleased to find that my time this year was only 9 seconds slower than 10 years ago! They say you're only as old as you feel (and I'm feeling it more during this training than I did 10 years ago, that's for sure). Again, I would like to thank all the supporters who cheered us on from the roadsides and give a special shout out to part of our Norton Healthcare running team, Dan Delph, who was full of energy on the side of Cherokee Road ringing cowbells and passing out drinks.
I wanted to talk this week about a very common condition that plagues runners – so common in fact that it is usually called “runner’s knee.” What is runner’s knee? The medical moniker is patellofemoral pain, or patellofemoral pain syndrome. Patellofemoral pain, or kneecap pain, is characterized by pain in the anterior aspect, or front, of the knee. It is generally caused by irritation of the soft tissues around the kneecap or of the cartilage in the kneecap joint itself. Many factors can contribute to patellofemoral pain, including:
Tightness, weakness or imbalance of the thigh muscles
Flat feet (pes planus)
The symptoms of patellofemoral pain are generally a dull, aching pain under the front of the knee just behind the patella. This generally occurs with flexed-knee activities, including:
Walking up or (especially) down stairs or hills
Sitting for long periods of time with a bent knee
After running (especially hills)
Here are some tips to help prevent patellofemoral pain, especially if you are a runner:
Stretch – Tightness of the quadriceps muscle can lead to patellofemoral pain, so stretching before and after runs can help minimize the chance of developing runner's knee.
Avoid excessive hills – Overtraining, especially excessive hill running, can lead to patellofemoral pain. Pay special attention to running down a steep hill, as this generates immense stress on the patellofemoral joint. Slow your pace, and for very steep hills run in a zigzag pattern, not straight down.
Avoid or modify squats and lunges – Many times I see patients with patellofemoral pain after they have started exercise routines that include squats, lunges, step-ups and/or knee extensions. All of these activities place tremendous stress on the patellofemoral joint, and I generally recommend either avoiding them or modifying them to keep knee flexion at 45 degrees or less.
Stay in shape – Good conditioning, particularly of the thigh muscles, is important in preventing patellofemoral pain. Controlling your weight is a major factor as well. Biomechanical studies have shown that during a full deep squat, compressive forces across the patella approach six times body weight – you do the math.
Treatment of patellofemoral pain syndrome is almost always nonsurgical. In addition to the activity modifications described above, the RICE protocol (Rest – Ice – Compression – Elevation) can be very effective in treating acute symptoms after activity. An anti-inflammatory medication can also be helpful in the initial stages to control the inflammation and swelling of the anterior knee structures that are responsible for the pain. Physical therapy is useful in cases where these treatments do not improve the symptoms.
Occasionally, there is an anatomical cause for the patellofemoral pain. A focal cartilage lesion behind the kneecap or in the groove where the kneecap slides (the trochlea) can lead to patellofemoral symptoms. Large, symptomatic lesions may need to be treated surgically to help restore the cartilage surfaces. Malalignment of the patella can also lead to patellofemoral pain and, in mild cases, can be treated with taping or bracing. In more severe malalignment, especially if the patella actually dislocates out of the trochlea, surgical intervention may be necessary to correct the problem.
Again, good luck with your training, and I hope to see you at the Papa John's 10 Miler.