Knee Joint Conditions
ITB Syndrome (Ilio-tibial band syndrome), which causes pain at the lateral border of the knee joint and sometimes the side of the thigh is common. We also see a lot of Runners knee, or patella-femoral tendonitis, which causes pain below the knee cap. There’s also a condition called chondromalacia patella, which is best described as wear and tear on the back of the knee cap. Lots of runners get these conditions, but don’t hang up your Asics Gel Kayano just yet, there are several treatment options to help reduce the pain and eliminate the cause of your condition.
There’s a lot more to this knee joint story too, such as arthritis and meniscal issues. We really need to see you in the gait lab / clinic to assess you and offer a treatment plan.
Case Study – Knee Pain
Knee pain in a recreational runner by Karl Lockett – Sports Podiatrist.
A female runner, 32 years of age, presents to the Sports Podiatrist complaining of knee pain in both legs. She is a fit and healthy lady who runs each morning before work, covering approximately 7k’s in 35 minutes. On weekends, she will cover a distance of 12k’s and then take one days rest. She informs the Sports Podiatrist that she has never experienced chronic knee pain before but has felt some sharp twinges in and around the knee cap, although these were very rare and short lived. The pains this patient feels are sharp pains below the knee cap during the first few minutes of running, which get worse as she attempts inclines, declines and stairs. The knee pain does come and go during the run, when training on a flat surface. She had 4 visits with her physiotherapist and reports feeling much better following treatment, but no real improvement overall. The physio would massage the quads and release tight muscle groups as well as assisting the patient with a range of stretches. She was also advised to perform exercises to strengthen the thigh muscles, Vastus Medialis in particular, to support the knee cap. After a month of compliance, she was still feeling pain in the knee so she stopped running and decided to ice and rest her knees. The knee pain would feel better after applying the ice packs, but the soreness was still there the following day. 3 weeks on, she decided to have her running shoes assessed and was advised to see a Sports Podiatrist by a friend.
Physical Examination for Knee Pain
The Sports Podiatrist carried out a physical examination to determine which part of the leg was causing the knee pain. The joint is complex and there are several conditions that can cause this soreness. All ligaments were tested and were found to be pain free and stable. Tests were done for meniscal tears and no pain or crepitus was found. Muscle tone was good and comparable on each side. The patient did not demonstrate symptoms of arthritis and her age would suggest this to be unlikely.
The patient reported pain when pressure was applied to the patella tendon, the tendon that runs from the knee cap to the shin bone. Pain was reported at the tibial tuberosity also, where the tendons attach. The patient was asked to lie down with her knees flexed and while the Sports Podiatrist applied pressure against her ankles, she was asked to try and extend her legs. This proved a challenge for the patient as it reproduced the knee pain that she feels when running. She was informed that she had Patella Tendonitis, which is an inflammation due to irritation, of the tendon below the knee cap.
Running Shoe Assessment by Sports Podiatrist
The wear pattern on this patient’s running shoes was uneven across the out sole. The outside of the heel was badly worn which indicated a heavy heel strike on the lateral side of the shoe. Through the forefoot, the medial side of the sole was worn away, through the tread, under and around the ball of the big toe joint. Wear patterns were indicative of an externally rotated hip / foot and an over pronated foot type.
Bio Mechanical Assessment
The Sports Podiatrist drew bisection lines on the patient’s feet and legs and asked her to walk and run on the treadmill, without running shoes. Her gait cycle was recorded using HUDL technique on an iPad. It was clear from the slow-motion replay that the patient had a heavy heel strike, due to a long stride, and was slightly out –toed. Bisection lines on the heels were everted and the medial side of the ankle protruded as the foot pronated. Throughout mid-stance and just prior to toe off there was further pronation, which allowed an excessive amount of collapsing through the foot and excessive internal rotation of the knee. One of the causes of knee pain is over pronation in the foot which leads to unnecessary internal rotation of the leg and knee joint. The Sports Podiatrist explained that her foot function could have led to her Patella Tendonitis.
Running Shoes and Knee Pain
The Sports Podiatrist explained that she had been mismatched with her running shoes. She was running in a lightweight, neutral running shoe, when in fact she needed more support than this. She was advised to purchase new running shoes as part of her treatment for this ongoing knee pain. A Nike Structure, Brooks Adrenaline or Asics Gel Kayano were suggested.
Running Style
This patient had a long stride and a heavy heel strike, and although she only weighed 67 Kg’s, it was important to reduce the force with which she hit the ground. The Sports Podiatrist explained that there is approximately 4 times body weight that strikes the floor when we run, and this causes a ground reaction force. In other words,x the ground hits back at the foot with the same force. The greater the GRF the more likely we are to develop injury and fatigue. Her knee pain would subside much more quickly if she were to shorten her stride and reduce the GRF. A detailed explanation on running style was delivered and noted.
Treatment Summary for Knee Pain
This patient was asked to purchase new running shoes and to disregard her existing neutral shoes, with immediate effect. In order to ensure a speedy recovery from this chronic knee pain she was also asked to shorten her stride and modify her running style. The application of ice packs to the affected area on a daily basis would reduce inflammation and also reduce the pain in the knees.
This patient was reviewed at 4 weeks and again at 8 weeks. At the first follow up she reported a slight improvement. She was able to run without excruciating knee pain over a 7k distance, describing occasional and mild soreness when running on the flat. Inclines, declines and stairs were still a problem and there was pain when the Sports Podiatrist applied pressure to the tendons. The patient was asked to run on alternate days so as to reduce the load slightly but still remain active. She was asked to reduce the weekend run to 7 K’s.
At 8 weeks, there was further improvement and minimal knee pain. The Sports Podiatrist applied pressure to the tendons and there was mild soreness but no pain. She had been compliant with running style and the application of ice packs. The patient was happy running in her new Brooks Adrenaline and there were no foot problems to report. Inclines, declines and stairs caused mild pain but this was improving with time.
The patient was asked to maintain this training programme for a further 4 weeks and return to the clinic for further assessment. She would be given advice on increasing her running load in due course.
PLEASE NOTE: This case study should not be taken as general medical advice. If you have knee pain or any form of running injury you may benefit from the advice of a Sports Podiatrist.
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