April 2020

Running Related Knee Pain

Non-traumatic knee pain is a common issue many runners experience.  When an injury is non-traumatic in nature, it suggests the issue is related to repetitive overuse and that the problem has been building over a period of time.  The common phrase, “the knee is a slave to the hip and ankle” means that the relative health, mobility, and functionality of both the hip and ankle have a direct effect on the health and function of the knee. 

A quick biomechanical analysis of the lower extremity demonstrates that the ankles and hips are made for mobility and move through multiple planes of motion.  On the other hand, the knee is a relatively stable joint which moves primarily through two ranges, flexion and extension, with a very small degree of internal and external rotation.  A decreased range of motion of one joint becomes the responsibility of the adjacent joints.  In other words, a dysfunction in the hip and/or ankle will affect the repetitive load on the knee through increased transmission of forces.  Over time, the increased forces transmitted through the knee can result in acute pain and chronic injury.       

  Some common non-traumatic knee pain diagnoses include:

Osteoarthritis - Degeneration of the joint surfaces of the knee

Bursitis - Inflammation of the bursa of the knee

• Tendonitis- Inflammation of the patellar tendon

Chondromalacia patella - Breakdown of the articular cartilage of the patella

Lateral patellar tracking syndrome - Abnormal movement of the patella

Iliotibial band syndrome - Painful outside aspect of the knee

Ligament injuries - ACL, PCL, MCL, LCL sprain

Meniscus tear - Acute or degenerative tear of the knee cartilage

Plica syndrome- Synovial remnants within the knee

Although the above diagnoses are common, they unfortunately do not tell the diagnositc story of why the runner has developed the problem in the first place.  They are simply diagnoses by symptom location.  There are many factors that can cause knee pain and they should all be considered as part of the diagnositic process. 

The main factors that cause knee pain in runners include:

• High, sustained running volume

• Foot pronation 

• Strength imbalances

• Lack of strength training

• Worn/improper footwear

The main factor in successful treatment of any injury is a proper diagnosis that encompasses both the pain generator and all of the underlying dysfunctions.  The health and mobility of the ankle and hip along with the stability of the knee should be assessed and properly addressed.  The health of the soft tissue structures, both prime movers and stabilizers should also be taken into account.  Scar tissue adhesions in the lower extremity musculature must be removed to ensure proper function and mobility of the lower extremity joints.  Finally, relative strength ratios of the muscles of the hip, knee, and ankle should also be evaluated and properly rehabilitated.

Active Performance Chiropractic focuses on the diagnosis, treatment, and rehabilitation of athletic-related injuries. Treatment is a unique blend of Active Release Techniques, traditional chiropractic therapy, and physical rehabilitation designed to match each patient’s goals and lifestyle.