knee (muscle) pain

[katrina]

Art,

I am doing the beginning training program (walk/run).
I am doing the 5 minute warm up (walking) and then this week, run for 90 minutes, walk for 2 1/2 mins.

After finishing 6 sets (walk/run) I am getting a pain at the inside of my knee, not quite in the bend and not on the knee itself.
Could this just be a muscle that is getting used to the workouts?
(I did not run before this "challenge").
Instead if finishing all 8 sets with running I walked faster (did not hurt as it did when I was running but I was aware that it is sore)
Will cold packs or heat help? or just keep training?

Thanks so much,
Katrina

[Gene Zeitler DC MS ART]

Hi Katrina,

I apologize for the delay in my response.

Based on your description of the location of the pain and the fact that you don’t indicate any history of trauma, it sounds like you have a case of runner’s knee. Runner’s knee is pain around or under the knee cap and can also be located on the inside of the knee.

Causes of runner’s knee include:

· Excessive Q angle-this is the angle that the femur (upper leg bone) creates with the tibia (lower leg bone). The greater the angle the more the quadriceps muscle pulls the knee cap towards the outside of the leg causing abnormal stresses at the knee.
· Wide hips
· Flat feet (pronation)
· Tight hamstrings
· Tight calf muscles
· Weak VMO-this muscle is a small portion of the quadriceps muscle on the inside of the knee that makes sure that the knee cap glides properly. If this muscle is weak the knee cap will glide towards the outside of the leg eventually causing pain
· Weak hip muscles

Treatments for runner’s knee include:

· RICE-rest, ice, compression and elevation of the affected knee. Always use ice within the first 24 to 72 hours of an injury to bring down any swelling.
· Make sure you do a proper warm-up and cool down. Go to my post regarding calf injuries for links & more information.
· Discontinue running or run slower to see if you can eliminate the pain. If you still get the pain start to walk and see if you can walk without pain.
· If you can tolerate running without pain make sure you don’t run downhill as this will increase the compressive load on the knee cap causing greater irritation.
· If you have flat feet you can get inserts-I like Spenco. They cost $25-$30. You can also consider custom orthotics. They are better than over the counter inserts, but they cost significantly more it they are not covered by insurance.
· For tight hamstring and tight calf muscles watch the video links under the calf injury post for dynamic range of motion stretches and static stretches.
· Weak VMO-straight leg raises and ¼ squats work well. It is believed that the VMO is most active during the last 30 degrees of leg extension (straightening the leg), therefore, doing body weight squats only going down a ¼ of the way works to strengthen the VMO. With straight leg raises you can lay of your back and keeping your leg straight lift it up towards the ceiling about 30 degrees off the floor. Don’t do exercises that bend the knee as this increases the compressive load on the knee cap potentially causing greater irritation.
· To strengthen the hip muscles you can perform the clam shell exercise (for a description you can go to the hip post). Hip abduction exercises are also effective (lie of your side with the involved leg facing up, lift the leg up towards the ceiling as high as you can without flexing at the hip or rotating the foot up towards the ceiling). Perform all of the exercises 3 sets of 10, 3 times per day.

If these self-treatments don’t work then you need to consult a sports medicine expert. I work the affected muscles and joints more aggressively then you can on your own. Manual therapy can be extremely effective at making sure the joints and muscles are working biomechanically properly. Taping of the knee can be very beneficial and allow you to exercise while reducing or eliminating the knee pain. Supervised exercises ensure that the exercises are being performed properly.

Other causes of medial knee pain can include, but are not limited to:

· Sprain of the medial collateral ligament
· Medial meniscus tear
· Muscle strain
· Pes anserine bursitis

Hope this helps!

Gene Zeitler, DC, MS, ART