Friday, March 1, 2013

I'm a runner & I have runner's knees!

Runner's knee....or more jargon-ly known as Patellofemoral Pain Syndrome.

What izzit?

Well....most simply put, it's that annoying pain you get at the lateral side of your knees, just beneath the knee cap due to it rubbing against the lateral femoral condyle.

And guess what.....I have it....just like every other runner out there who complains of the annoying knee pain that occurs when one increases one's mileage carelessly.

In fact I've been tackling this issue since before TMBT last year.
But with some proper strengthening exercises and common sense of adequate REST and appropriate icing, I managed to get it under control and completed quite a few running events, on and off road.
However with Vibram HK100 training, I've been a bit lazy with my own rehab and physio that the knee pain sorta came back.
Anyway training for the 100km had me hiking and climbing stairs a lot more. It wasn't too much of an issue for my knee pain, fortunately.

Besides, I had more pressing issues of the occasional twisted ankle and was actively working on my proprioception and ankle strengthening instead. Therefore my VMOs were sorely neglected.

Can't exactly say my knees were too happy about competing in Vibram HK100.

But since that ultra, I've not been doing much running and instead been cycling a whole lot more.
I kinda forgot about the knee pain completely.

Only recently, I started dusting the dirt off my road running shoes and hitting the pavement again.
Been building up mileage rather less than 15km of road running per week (which breaks down to about 5km runs, 3x per week). I spent most of my remaining training hours on bike or in trail....or in pool.

A couple of weeks ago (I blame the CNY hols), I ramped up the mileage to about 30-35/week. Not much in comparison to what I used to do....but it was a rather huge relative increase.....definitely more than the conservative (and advised!!!!) 10% mileage increment per week.

Then the pain started. 

Not so severe that it left me limping at the end of the run....but annoying nonetheless.
And I'm not gonna be the one that will take this lying down!
I'm attempting to actively deal with this issue while still maintaining my (some-what half baked) training schedule.
(I'm not quite sure what exactly I'm training for....a little bit of this and a little bit of that....and somehow at the end of it, I find that I have loads to train for!!!! And here I was complaining that my life is dull and boring....hmmm)

And since I'm actively dealing with it.....I might as well actively blog about it.

Not gonna dwell to much about what exactly is this condition about.....coz I'm sure Google does a much better job at describing all the causes, risk factors and what-nots.
Besides...this ain't that sorta blog. This blog is a venue for me to whine and talk about bullshit and so the trend shall remain.......

Anyway.....if one complains of lateral knee pain just behind the patellar.....a runner/cyclist/hiker/anything-that-involves-a-lot-of-repetitive-knee-flexion-and-extension-over-a-period-of-time.....and on physical examination does not offer anything much other than some lateral joint line pain or positive on patellar grinding....or maybe some swelling or so....I'd proceed with some radiological investigations.....cheapest and more readily available would be the plain x-rays.

And please tell whoever that is writing you your xray request form that you'd like weight bearing AP and lateral skyline/merchant's view.
(I'm starting to do these xrays routinely for almost all physically active patients coming in complaining of knee pain....)

And below are mine....

Skyline view of both knees. Take note that the patellar bilaterally are deviated laterally, with the left knee being at a more acute angle. Of course it doesn't surprise me considering my left knee is more of a bother at the moment than my right.

For comparison sake....

AP view, weight bearing. Yes I'm very aware of the early osteoarthritic changes seen at both knees. Thankfully when compared to similar xrays taken 2 years ago, nothing decline in joint spaces or increase in osteophytic changes. 

Left knee, lateral view. Yes...already noted the osteophytes at both poles of the patellar. Sigh. dealing with can deal with it via the short term manner (which is popping some painkiller and hoping it'll go away) or the long term manner.....which is proper rehab and physio.

As common as common sense go....employing the R.I.C.E. ( techniques does wonders, although for some it also test one's patience.

Secondly....find out where's the imbalance.

Mine (as shown on radiographs) are due to VMO weakness in relative.
VMO, by the way, stands for Vastus Medialis Obliquus.

VMO is part of the Vastus Medialis, which is part of the Quadriceps. 

A larger, more detailed picture of where exactly is the VMO.

Sometimes is could be due to tightness of your ITB. So please do as necessary and stretch that bloody band. Although come to think of it, no harm stretching that (and also strengthening your Gluteus Medius as part of working out your ITB) and working your VMOs at the same time.

I love THIS site in its explanation on isolating the VMOs. In fact the below photos are from PhysioAdvisor website.

Pressing the knee down against a towel lets you isolate your VMO.....once you're used to identifying which bulge is the muscle you're trying to work on, you can progress to other exercises.

This is the one I usually use to tackle the VMO. It is the easiest (for me, anyway) and the least hassling.  Using a resistant band (I prefer theraband), I hook it to the affected side at the ankle and extend knee, focusing on contracting the quadriceps. Then I externally rotate the same foot, and lift the whole leg upwards (hip flexion) while isolating the VMO. 

Let's say I'm having a bit of pain but I kinda have this race coming up this weekend and I just wanna run it with the least amount of pain....but I'm kinda worried about taking painkillers coz someone told me it'll totally kill off my kidneys.....(btw, it'll take more than a couple of painkillers to kill your bloody kidneys.....I'm just saying!), then I'd tape my knees. It's kinda like buying insurance when you already have had a heart attack and still having frequent anginas.

You can simply Youtube how to tape your knees.....but for the heck of it, I'm gonna show you how I do mine....with the minimal amount of tape used....(I'm kinda cheap that way)

Currently am using Rocktape. I don't get any incentives from mentioning this particular brand but by means of experience with different brands of tapes, I find Rocktape does the job best. It has the stiffest "consistency" and if you get their H2O line, the best in terms of stickiness!!!! And if you're all about looks, it has the best patterns on them, hands down!!!

Measure the length of tape needed. For most people, you can get away with cutting just 10-15cm of tape.  My rule of thumb being that when measured, it should cover the vertical length of knee with a couple of centimeters extra at both ends.

I usually just cut 10cm. I told you, I'm cheap...Rocktapes don't come cheap!!!

Round the edges........

Tear at the middle of the tape.....

Relax the knee on extension.....palpate for the patellar.  The aim of taping is to try and shift the patellar medially.

Adhere the center of the tape to the center of the length of patella, at the lateral side of knee. 

As I pull the lower edges of the tape, curving around the patellar.....I'm gonna flex the knee. The aim is to put pressure to the tape, applying tension inwards/medially. Do the same for the upper edges of the tape. Do remember that the aim of this taping is to manually shift the patellar medially. 

In the end, it'll look something of a C-shape. It may take a few attempts to get it JUST RIGHT. Take it out for a short test run to see if the pain has been relieved with taping. I find that some people, to be on the safe side, will tape both sides of the attempt to really keep the patellar in position. My advice would be....try and see what suits you!

Anyway, since I've no issues with cycling and swimming....I so guess I'll take more rainchecks with my running.



Sue's Ramblings said...

Try strength training to build up the glutes, quads and hammies.

Anonymous said...

Hai Dr Pui San,

Need advise regarding this runner knees. I have it.

My question is:

1.Can I still run with runner's knee?

2. I didn't train much but I want to run for full marathon this April, is that possible?

Puisan said...

it depends...
how painful is it when you run?
coz if it comes on off then, I'd continue to run but cut back on my mileage.

and about running a full marathon in depends on you....whether you've been doing full marathons quite a bit prior...coz I have not train for a full in a very long time and just end up running it but keep a modest expectation of your timing. Also are you physically fit....have you been partaking in other physical exercises?
if you've done nothing of the sort...and this is your first few marathon attempts....I'd say give it up for another day.

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Carol said...

(Wow, you got a lot of spam comments on this post!) Thanks for posting this detail. I rarely run (just a few sprints) but I do have kneecaps that are migrating outward. My knees swell like softballs after any impact exercise and I can feel my leg isn't hinging correctly when I try to do lunges.
I'm going to try your taping method and the VMO exercise.
Thanks much!