I know the feeling. Been running along and then BAM…who just whacked the side of my knee with a baseball bat?? Oh, wait…there’s no one around…
Knee pain is one of the classic issues that can befuddle runners. The problem is that not all knee pain is created equal. Saying “knee pain” can mean any number of things, and quite often the problem is far away from the knee. Sure, we need to calm down the pain if we want to start moving normally, but long-term progress requires us to search a little deeper. The purpose of this guide is to help you as an athlete navigate what can seem like an unsolvable puzzle, especially when you’ve been trying to find a solution for weeks, months or even years.
Personally, I remember several instances in which I suffered from IT band syndrome. First was in college, my sophomore year. On the Saturday before Thanksgiving, there was a school turkey trot in the park on campus on a hilly course. I finished the race with no problem however, Five days later on Thanksgiving, I returned home to Maryland and ran the local Turkey Trot. Upon returning to school, during my first easy run back, I remember running in the Quad on campus and felt a level of knee pain I hadn’t felt since my youth when I was diagnosed with osteochondritis. What made it even more frustrating was I couldn’t even cross train on the elliptical or do any lower body strength training because those things hurt too.
Eventually, I went to see the athletic trainer (which made me feel like a “real” college athlete, hanging out in the training room with all the basketball players…this was before golfers trained as athletes!) who put me on the schedule to see the sports medicine doc who came to the clinic twice per week. I even saw an orthopedic surgeon, that’s how bad the pain was! I purchased a set of expensive orthotics, which actually seemed to help a bit. This was also around the time that motion control was a new thing in running, so I got myself into a pair of heavy motion control shoes (Nike Structure Triax). Between orthotics and heavy motion control shoes, my foot wasn’t going anywhere! Later I understood how excessive motion control can create its own set of problems, but fortunately I did not suffer from any. Eventually, I got over the injury and didn’t have any problems with that knee again.
Fast forward about five years. I had just run my fourth marathon, the Philadelphia Marathon. Still a race that, relative to my fitness level at the time, I consider to be my best race performance in my life, even though I eclipsed the time by more than four minutes several years later. After the race, I took my obligatory week off and with this being early December and cold/icy, I made my first run back on the treadmill. One problem..I only lasted about five minutes before some excruciating pain hit my left knee. At first I chalked it up to a little stiffness and stretched it out, then hopped back on. Again, about five minutes later, the same debilitating pain. Of course, being only a week removed from a PR and my best race ever, I was determined to get my planned run in for the day, albeit at an easy pace and with a few interruptions.
This cycle persisted for a few weeks, marked by experiments such as a knee strap and daily visits to the physical therapy office for (gasp!) ultrasound! Now, I was exposed to several basic exercises which I had not seen before along with the key concept of hip strengthening to improve hip function and distribute stress away from the knee. This was also my first experience with a foam roller, which at the time was a new curiosity in the sports world, unlike now where you see athletes toting them everywhere, and some scholastic athletic departments issuing them to all student athletes. For traveling across the country, I even had a giant “hockey goalie” duffel bag to fit the foam roller, as this was years before the half roller was on the market.
Some key lessons
1 The knee is often a “victim” of what happens at the ankle and the hip. Both of those joint systems have a far greater capacity for movement, and our bodies expect a lot more from these joints to help us navigate the environment. They’re all “coworkers,” and while the knee can absorb some extra work if its colleagues aren’t doing their jobs, they can’t take the extra burden indefinitely. Eventually, they get cranky from having to do extra work.
2 Running isn’t bad for your knees. In fact, as a whole, runners have a lower rate of osteoarthritis as compared to sedentary people. There are plenty of things more damaging to knees than running…such as not running. In fact, one of the factors most associated with knee pain is carrying excess weight.
3 Pain is a signal. Part of what makes knee pain persistent is that brain can become conditioned to “fear” movement. One reason pain develops is if the body senses a threat. This threat can be something traumatic, like an ACL tear, but it can also the body getting irritated from doing too much. A key part of overcoming knee pain is, once healing has taken place and the threat has resolved, is to reteach the brain that the previously painful movement is safe.
4 Complete rest is rarely the best medicine. Some post-operative patients, whether for total joint replacements or ACL reconstructions, will enter physical therapy the SAME DAY as their operation! They obviously aren’t going to be doing very much, but enlightened providers recognize the value of movement in any circumstance. Even if the knee itself isn’t part of the treatment session that day, there are still many valuable things to accomplish in other areas of the body.
5 Most adults over the age of 30 have some form of “degeneration” in their knees….regardless of whether they are in pain or not. In other words, don’t rely on an Xray or MRI for definitive answers, unless we’re talking about serious injuries such as tears or fractures.
6 Treat the person, not the condition. Two people can have identical conditions but have entirely different causal factors. One person might lack mobility; one person might need more strength; another might need to modify their training plan.
7 Medication is neither good nor bad. If you only take medication and do nothing else, you are less likely to achieve long term resolution, though some people certainly do experience long term relief. Rather than vilify medication, I prefer to see appropriately dosed and timed medication as something to allow you to engage in the activities that DO result in long term change. In other words, if you’re in too much pain to meaningfully exercise, it will be hard to make the changes you need to make. But if medication calms your symptoms and allows you to move in ways that facilitate healing (with the alternative being not moving at all), then we’d consider that a highly effective use.
Allan Phillips, PT, DPT is owner of Ventana Physiotherapy