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Runner’s Knee

Expert Panel Question???

“After a run my knee begins to hurt fairly badly. It hurts a little during the run but mainly after. Is there a certain type of shoe that would help with my knees or is the only solution not to run?”


Knee pain is probably the most common injury complaint in runners and has a variety of causes. The most common, Patellofemoral Syndrome, actually also goes by the lay name “Runner’s Knee”. It is more common in women but can occur in men too. It is characterized by pain in the front of the knee, is worse going up and down stairs, during squats or lunges and often results in a deep ache in the knee after a prolonged knee-bent position (such as sitting in a class, movie, car or on a plane). The fact that your knee pain is not so bad during your runs but afterward makes this the most likely problem although it can get bad enough to become an issue during runs too. It is thought to be an injury that occurs to the under surface of the knee cap (the patella) when the knee cap and the bone below it (the femur) are not in alignment.

The under side of the patella has a small ridge running vertically through the middle of it and the femur below has a corresponding groove. These two should remain lined up as the knee bends and straightens. A misalignment between the patella and the femur can be due to genetic factors, biomechanical problems or the result of muscle imbalances. Since we can’t do much to change our genetics, the focus is on the muscle imbalances and biomechanics. As a one directional sport i.e. straight ahead, even elite runners are notorious for developing muscle imbalances.

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IT Band Syndrome

As an L.M.T at this time of year I see many clients with multiple running over use injuries (plantar fasciitis, shin splints, patellar tendinitis, IT band syndrome, SI pain/ dysfunction). As runners increase mileage and intensity to reach performance goals it is common to create myofascial irritation leading to compensation pain patterns that inhibits bio-mechanical function. Pain in a single workout that heals with rest and change of training tends to be a simple acute strain and a normal effect of being a hard training athlete. But continued or increasing discomfort with training may lead to a substantial soft tissue injury and should be evaluated by a health care professional.

Sports specific massage therapy can be a good tool to help recover from or even prevent an over use myo-fascial pain or guarding response. Myo-fascial manipulation breaks up adhesions and areas of congestion in muscle bellies and along tendon and ligament attachments. Soft tissue work opens pathways of circulation to help with ischemia (lack of oxygenated blood) and allow drainage of chemicals of inflammation (a byproduct of muscle metabolism) and the stretching of connective tissues to decompress pressure and pain receptors in the nervous system. A skilled sports massage therapist can sculpt myo-fascia along muscle compartments to improve bio mechanical function, increase range of motion at joints, free adhesions of scar tissue and improve tracking of muscles as they contract and expand.

When I work with athletes, I evaluate posture, alignment, passive and active movement, tissue health and areas of tenderness on palpation. Even with a specific diagnosed injury I will treat the whole structure to prevent secondary compensations that form with favoring the injured area.

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