5 Ways to Stop Knee Pain in Runners

By Ryan Domeyer PT, DPT, CMPT for Athletico

Between 20 to 93 percent of runners suffer from knee pain, making it the most common lower extremity injury.  When knee pain occurs, one of the treatment options is physical therapy. Physical therapists are trained to examine, diagnose and treat knee pain to help patients return to the activities they love.

The majority of knee pain associated with running is not caused by direct trauma butknee-pain rather improper loading. Running requires the ability to absorb the weight of the body when the runner’s foot hits the ground in order to propel the runner forward. Although it might not seem like it, running is actually a complicated skill that most people do not actively practice prior to their recreational run. Knee pain can start during a run, but most commonly is experienced after running longer distances. Research shows the more miles you run the higher risk of sustaining a knee injury. The most common causes of knee pain in runners are iliotibial (IT) band syndrome, chondromalacia patella (runners knee) and patellar tendon pain.

It is common for runners to treat their knee pain with rest and ice and hope it goes away on its own. Although rest can help during the initial stages of knee pain, there are many ways that runners can take load off their knees and prevent future injuries, including the five listed below:

  1. Improve Hip Flexor and Quadriceps Mobility

Americans spend on average 13 hours per day sitting.1 Sitting for long periods of time during school, work or watching TV causes the front of the hip to shorten, which leads to tightness in the hip flexor and quadricep muscles. Stretching or foam rolling are the most efficient ways to improve hip flexor and quadriceps mobility to lessen knee pain. For more information on stretching and foam rolling, read:

Stretching: It’s All in the Hips Part 3

Foam Rolling: 3 Ways to Roll Away Muscle Tension

  1. Improve Hip Strength

Another adverse effect of sitting during the day is the inefficient use of our gluteal muscles. The gluteal muscles are the largest muscles in the body and when trained properly, can lessen the load on the knee. The easiest way to improve strength of the gluteal muscles is with bodyweight exercises including bridges, planks, side planks, bird dogs and hip abduction raises.

  1. Improve Balance

As previously mentioned, running requires the ability to land on one leg repeatedly to propel the body forward. The knee is the middle connection between the ground and the body. A loss in balance can lead to poor force absorption from the ground with each step taken during running.

To test balance, try standing on one leg without using your arms for 30 seconds. If this is difficult, balance can be improved by practicing. To take this balance exercise a step further, try balancing on one leg without holding onto anything with your eyes closed. If balance continues to be a problem, consider scheduling a complimentary injury screening at your nearest Athletico Physical Therapy.

  1. Improve Core Position and Stability

Another way to improve muscle imbalances is to improve core strength and the ability to run with a neutral spine. To do this, begin your run on the right track with a neutral neck aligned over your shoulders, neutral low back without a large backward curve and feet straight forward. Awareness of your low back and core position is important at the start of a run, as it becomes more difficult to maintain as fatigue sets in.

  1. Increase Number of Steps

Running technique is the most significant way to decrease the load on the knee to prevent or improve an injury. A simple way to improve technique is by increasing the number of steps taken. Although it may seem counterintuitive to take more steps, this will prevent a poor foot strike position and set the body in a good position to fall forwardathletico300x250 rather than absorb the force.

If you need help with running technique, request a video gait analysis at Athletico, which provides real-time audio and visual feedback on your running style. This will enable your physical therapist to provide feedback that not only helps improve efficiency, but also helps to prevent injuries.

Click to Schedule a Complimentary Injury Screen

Return to Play After Spinal Fusion

Dr. Frank Phillips, co-director of the MOR Minimally Invasive Spine Institute, conductedgolf-spine a study on return to play after spinal fusion that was recently published in SportsHealth.  Dr. Phillips found that more than 50 percent of golfers return to play within one year of lumbar fusion surgery and some were even sooner. In general, most golfers returned to preoperative levels of performance (handicap) and frequency of play.

Read Full Study

MOR300x250

Snowboarding Ankle Injuries

By Dev K. Mishra, M.D., President, Sideline Sports Doc, Clinical Assistant Professor of Orthopedic Surgery, Stanford University

Key Points:

  • Snowboarders tend to get more ankle injuries than skiers, and skiers tend to get more knee injuries than snowboarders
  • The “snowboarder’s fracture” is unique to ankle injuries in snowboarding
  • A fracture of the “lateral process of the talus” is sometimes missed on regular x-rays and it’s sometimes necessary to use specialized imaging to make a proper diagnosis
  • When treated early and properly this fracture will typically allow full return of sports participation but a missed diagnosis can result in significant problems

In this post I’m going to discuss a particular type of broken bone seen in snowboarding snowboardoften referred to as “the snowboarder’s fracture.” This particular fracture occurs in one of the ankle bones called “the talus”. A fracture in the lateral process of the talus is called the snowboarder’s fracture.

Patterns of injury are a bit different in snowboarding compared to skiing. Skiers tend to get more knee injuries than ankle injuries, and snowboarders tend to get more ankle injuries than knee injuries. One proposed reason for this difference is due to the less rigid boots used in snowboarding, which provide minimal protection to the ankle joint.

Most ankle injuries in snowboarding affect the lead leg. And about half of all ankle injuries in snowboarding are fractures. The “snowboarder’s fracture” occurs because of sudden upward movement of the foot, combined with the foot turning inwards. This injury typically occurs when landing from a jump. Pain is present on the outer side of the foot and ankle, and is often associated with swelling, bruising and significant tenderness to touch. Unfortunately, this injury is often missed, because regular X-rays don’t always show the fracture very well. If I’m suspicious for a snowboarder’s fracture and the x-rays look normal, I’ll often order a CAT scan as this can be a much more accurate way to diagnose this fracture.

Treatment of the snowboarder’s fracture depends on how big and how displaced the broken fragment is. For a small fracture that is in normal alignment, we can treat these without surgery. This typically means about 4 to 6 weeks of having the foot and ankle in a cast and no weight bearing on the leg. Large and displaced fractures are typically treated with surgery—the fragment is moved back into its normal position and screws are inserted to hold it in place. Recovery after surgery also includes a period of non-weight-bearing, followed by gradual restoration of motion, strength, and function of the ankle joint.

ssd.bannerOutcomes of snowboarder’s fractures are typically good if the injury is diagnosed early and appropriately treated.

Most athletes are able to get back to normal physical activity within 4 to 6 months. However, significant problems can result if this fracture is missed and appropriate treatment is delayed. These include non-healed bony fragments causing pain and poor function, as well as early arthritis of the joint, which can significantly limit movement of the foot. When a snowboarder presents with acute pain on the outer side of the foot or ankle after an injury on the slopes, it’s very important to see a skilled physician for a proper exam and appropriate diagnostic imaging to avoid missing this injury.

Dr. Kathleen Weber Featured on BullsTV Pre-Game Live

Dr. Kathleen Weber, sports medicine primary care physician and team physician for theMORGif-180x150-link Chicago Bulls joined BullsTV host Steve Kashul during Bulls Pre-Game Live on December 19th, 2016. Dr. Weber discussed the NBA’s new Concussion Protocol and the efforts being made to protect all players from returning too soon to the court.

Kashul and Dr. Weber also talked about how the physicians at Midwest Orthopaedics at Rush all work together in treating the Chicago Bulls players.

 

How Exercise Shapes You, Far Beyond the Gym

By

When I first started training for marathons a little over ten years ago, my coach told me something I’ve never forgotten: that I would need to learn how to be comfortable with being uncomfortable. I didn’t know it at the time, but that skill, cultivated through running, would help me as much, if not more, off the road as it would on it.

It’s not just me, and it’s not just running. Ask anyone whose day regularly includes a hard bike ride, sprints in the pool, a complex problem on the climbing wall, or a progressive powerlifting circuit, and they’ll likely tell you the same: A difficult conversation just doesn’t seem so difficult anymore. A tight deadline not so intimidating. Relationship problems not so problematic.

Maybe it’s that if you’re regularly working out, you’re simply too tired to care. But that’s probably not the case. Research shows that, if anything, physical activity boosts short-term brain function and heightens awareness. And even on days they don’t train — which rules out fatigue as a factor — those who habitually push their bodies tend to confront daily stressors with a stoic demeanor. While the traditional benefits of vigorous exercise — like prevention and treatment of diabetes, heart disease, stroke, hypertension, and osteoporosis — are well known and often reported, the most powerful benefit might be the lesson that my coach imparted to me: In a world where comfort is king, arduous physical activity provides a rare opportunity to practice suffering.

Few hone this skill better than professional endurance and adventure athletes, who make a living withstanding conditions others cannot. For my column with Outside Magazine, I’ve had the privilege of interviewing the world’s top endurance and adventure athletes on the practices underlying their success. Regardless of sport, the most resounding theme, by far, is that they’ve all learned how to embrace uncomfortable situations:

• Olympic marathoner Des Linden told me that at mile 20 of 26.2, when the inevitable suffering kicks in, through years of practice she’s learned to stay relaxed and in the moment. She repeats the mantra: “calm, calm, calm; relax, relax, relax.”

• World-champion big-wave surfer Nic Lamb says being uncomfortable, and even afraid, is a prerequisite to riding four-story waves. But he also knows it’s “the path to personal development.” He’s learned that while you can pull back, you can almost always push through. “Pushing through is courage. Pulling back is regret,” he says.

• Free-soloist Alex Honnold explains that, “The only way to deal with [pain] is practice. [I] get used to it during training so that when it happens on big climbs, it feels normal.”

• Evelyn Stevens, the women’s record holder for most miles cycled in an hour (29.81 – yes, that’s nuts), says that during her hardest training intervals, “instead of thinking I want these to be over, I try to feel and sit with the pain. Heck, I even try to embrace it.”

• Big-mountain climber Jimmy Chin, the first American to climb up — and then ski down — Mt. Everest’s South Pillar Route, told me an element of fear is there in everything he does, but he’s learned how to manage it: “It’s about sorting out perceived risk from real risk, and then being as rational as possible with what’s left.”

But you don’t need to scale massive vertical pitches or run five-minute miles to reap the benefits. Simply training for your first half marathon or CrossFit competition can also yield huge dividends that carry over into other areas of life. In the words of Kelly Starrett, one of the founding fathers of the CrossFit movement, “Anyone can benefit from cultivating a physical practice.” Science backs him up.

A study published in the British Journal of Health Psychology found that college students who went from not exercising at all to even a modest program (just two to three gym visits per week) reported a decrease in stress, smoking, alcohol and caffeine consumption, an increase in healthy eating and maintenance of household chores, and better spending and study habits. In addition to these real-life improvements, after two months of regular exercise, the students also performed better on laboratory tests of self-control. This led the researchers to speculate that exercise had a powerful impact on the students’ “capacity for self-regulation.” In laypeople’s terms, pushing through the discomfort associated with exercise — saying “yes” when their bodies and minds were telling them to say “no” — taught the students to stay cool, calm, and collected in the face of difficulty, whether that meant better managing stress, drinking less, or studying more.

For this reason, the author Charles Duhigg, in his 2012 bestseller The Power of Habit, calls exercise a “keystone habit,” or a change in one area life that brings about positive effects in other areas. Duhigg says keystone habits are powerful because “they change our sense of self and our sense of what is possible.” This explains why the charity Back on My Feet uses running to help individuals who are experiencing homelessness improve their situations. Since launching in 2009, Back on My Feet has had over 5,500 runners, 40 percent of whom have gained employment after starting to run with the group and 25 percent of whom have found permanent housing. This is also likely why it’s so common to hear about people who started training for a marathon to help them get over a divorce or even the death of a loved one.

Another study, this one published in the European Journal of Applied Physiology, evaluated how exercise changes our physiological response to stress. Researchers at the Karlsruhe Institute of Technology, in Germany, divided students into two groups at the beginning of the semester and instructed half to run twice a week for 20 weeks. At the end of the 20 weeks, which coincided with a particularly stressful time for the students — exams — the researchers had the students wear heart-rate monitors to measure their heart-rate variability, which is a common indicator of physiological stress (the more variability, the less stress). As you might guess by now, the students who were enrolled in the running program showed significantly greater heart-rate variability. Their bodies literally were not as stressed during exams: They were more comfortable during a generally uncomfortable time.

What’s remarkable and encouraging about these studies is that the subjects weren’t exercising at heroic intensities or volumes. They were simply doing something that was physically challenging for them – going from no exercise to some exercise; one need not be an elite athlete or fitness nerd to reap the bulletproofing benefits of exercise.

Why does any of this matter? For one, articles that claim prioritizing big fitness goals is a waste of time (exhibit A: “Don’t Run a Marathon) are downright wrong. But far more important than internet banter, perhaps a broader reframing of exercise is in order. Exercise isn’t just about helping out your health down the road, and it’s certainly not just about vanity. What you do in the gym (or on the roads, in the ocean, etc.) makes you a better, higher-performing person outside of it. The truth, cliché as it may sound, is this: When you develop physical fitness, you’re developing life fitness, too.

Brad Stulberg is a columnist for Outside Magazine, where he writes about health and the science of human performance. Follow him on Twitter @Bstulberg.