Knee pain after running is not uncommon, but a very topical problem for a large number of people who are interested in running. Our correspondent Anna Inkova contacted osteopathy doctor, sports physician of PHC CSKA Vladimir Demchenko to find out not only why my knees hurt after running, but also what to do to avoid it.
Runner’s Knee, Jumper’s Knee and Biker’s Knee
“Runner’s knee” is a collective term that hides various diseases. This is not a medical diagnosis. Most often, “runner’s knee” means patellofemoral syndrome. Also, the “runner’s knee” is sometimes called the IT Band syndrome or the orioturbial syndrome.
People running, there are several very common conditions: “jumper’s knee”, or tendonitis of the patellar own ligament, and “cyclist knee”, or goose foot tendinitis. It is with these diseases that runners are most often treated for pain in the area of the knee joint.
In patellofemoral syndrome, pain occurs in the patella area and under it. Not from below, but inside of it – “from below from within”. Sometimes it is a little on the outer or inner edge of the patella. The pain – a rather sharp character – begins during the run, as a rule, right at the very beginning of the workout.
If we are talking about the problem of the patellar own ligament, or the “jumper knee”, this is also a pain in the anterior region of the knee joint, but not in the cup itself, but immediately below, from below. There is a so-called own patellar tendon, practically a continuation of the quadriceps tendon.And she will be ill under the knee cup, the pain will be during training and the next day. They become quite intense during accelerations, running down and the next day when walking up the stairs.
The characteristic place of pain in the syndrome of the oriothibial tract is in the middle of the knee joint outside. Pain (not even in the knee itself) arises due to friction of the so-called or tibial tract on the lateral condyle of the femur. The pain will be on the side. Very characteristic pain, appearing closer to the end of the workout. The pain increases with acceleration. It is important that the next day it will be painful to walk down the stairs.
Similar symptoms in goose foot inflammation (“rider’s knee”): especially noticeable pain the next day;gain near the end of the workout. Sometimes the pain occurs at the beginning of the run, after warming it decreases – but towards the end of the workout it still returns. The next day will also be painful to walk. But localization of pain from within. That is, the place of pain in the “rider’s knee” is the inner surface of the knee joint. And it happens both at the level of the knee joint, and slightly below it on the inner surface, because the goose foot attachment extends for about 5 centimeters below the flexion level in the knee joint.
Causes of pain in the knee after running
Running injuries in the overwhelming majority of cases are injuries of overuse (“overuse”). Normal tissues, anatomically unchanged, respond by an inflammatory process to a strain that they cannot cope with. Most often, the pain will come from the tendons and ligaments, and she will always behave in approximately the same way. Pain from the “overuse” will initially appear only at great distances or during acceleration, the next day everything will pass. If the situation worsens, the pain will appear already at earlier stages and linger after training for 2–3 hours. And the next period – the pain appears at the very beginning of the workout and lasts 3–5 days. The most extreme stage – when the pain does not go away at all, can last up to one and a half to two weeks, even with a complete rejection of training. The nature of pain is inflammation of the ligament,
What mistakes lead to knee pain?
The first mistake – running in the wrong shoes. Quite a common situation: a person engaged in running, going on vacation, to the country or somewhere else and goes for a run in what he has – in sandals or something else completely unsuitable.
The second point is the incorrectly chosen load plan. People, for example, prepare for competitions according to the plan of preparation, but violate it with some unplanned races. For example, there is a preparation for a marathon, there is a certain weekly volume; it is performed and, for example, from above a person participates in “Running Hearts”. It would seem, why not run 10 km? But it turns out that people completely fulfill the volume of their training plan and from above they cover 10–15–20 km with additional races, which eventually become redundant. It turns out “overuse”.
The next error is insufficient recovery. Especially often this sin lovers. Professionals are all very warm up, knead, stretch, go for a massage. Nonprofessionals love to run and do not like recovery activities: stretching, rolling on a foam roller, massage, restorative swimming. Thus, the muscles remain clogged longer, and in this state they are more prone to injury.
The first is people with high weight, more than 90 kilograms.
The second – people without any sports past, starting to run too sharply (or there was a sports past, but several years passed between the last physical activities and the return to sports). Let’s just say, in the risk zone, all office workers who suddenly decided to run a marathon. A much more rosy picture of someone who, for example, went to the gym, ran there as a warm-up, but at some point decided to make the run the main load.
At risk are people with orthopedic problems – with longitudinal, transverse flatfoot. Also at risk are runners who have had problems with the musculoskeletal system, including people with fractures or knee surgery.
I did not notice that people of a certain gender are subject to knee injuries. According to my observations, if a man comes to the reception, it means that he already has a running case. Men are more prone to self-healing, to suffering, to run across. Women are more anxious about their health.And soon a woman will come with a not very pronounced injury than a man. Therefore, in general, it may seem that women are more susceptible to diseases of the knee joint.
If the pain is in the process of training or competition
If the pain is in the competition, then the most reasonable thing is to go the distance.
A more subtle point is what to do if your knee gets sick before a competition or you just know that you have knee problems. First, it is advisable to consult a doctor to make sure that this is not some kind of creepy thing. If the pain is light, then it is permissible to drink some NSAID tablet – and run, for example, on ibuprofen. This is relatively permissible: nevertheless, first the doctor must eliminate the possibility of serious pathologies. Most likely, then you will have to recover longer, take a longer break, somehow take longer to undergo treatment, but if this is a competition for which you have been preparing for a whole year, then taking the pill is acceptable. But if this is some kind of serious pathology, if the pain is quite intense, then it is advisable to go the distance. I often see people who endure to the finish line, die, and then get treated for half a year, for a year.
What can be done immediately after the competition? To mitigate the effects of running injuries, I always recommend to freeze the painful area. Ice, wrapped in a thin cloth, apply three times for five minutes.
Does the knee hurt?
The pain is different: there is good pain, sometimes pain is bad. Good pain is a pain in the muscles, it is familiar to many. Muscle pain associated with lactic acid, “runs up”, from training to training your condition improves – in this case, the pain can be sustained.
There are also adaptation pains that occur in people just starting to run or master new volumes. How to recognize this kind of pain? It should not be in any particular place. The pain must be “spread” over the entire knee – and always from two sides. Should take place no more than 2 days after training.Better – during the day. These are the pains that can and must be tolerated – this is just an adaptation of the joints.
But if the pain is one-sided, there is a pronounced point of pain, then you can not tolerate it. Chance pathology. Most likely, it will not be possible to cross, but it is easy to worsen the situation. And then you have to be treated for a long time.
What is the treatment?
90% of the treatment is to identify the problem. If your knees hurt after running, you need not just to find an inflamed ligament – it is important to understand why it is inflamed. And often how? The doctor sees inflammation – and all therapy is directed to its removal. We have pain and inflammation. Here is a pill for pain, now for inflammation.
But the most important thing that I am trying to do is to understand why this situation occurred. And then the treatment will be individual. Someone will be enough to correct the training schedule, for someone – to fix the technique. One will be recommended to choose the right sneakers, the other – to make insoles. And for someone will be selected exercises that strengthen the muscles, the weakness of which gives the load to the inflamed ligament. Or maybe the problem is that some of the patient’s muscles are shortened, not stretched, then stretching exercises will be selected, to relax specific muscles. In general, you need to analyze what is happening, understand why this is happening and continue to work with the cause. But the treatment of the pain zone itself is in last place. Looping on the treatment of the place that hurts
Limitations for knee pain after running
If things are really bad, then I try to limit running or physical activity for a while.
If the matter is going on mediocrely, and the person clearly has a running injury, then I ask him to switch to cyclic types of activity not related to shock loading for a while: bicycle, swimming, ellipsoid. It often happens that the knee hurts a lot when running, but it doesn’t hurt when doing other sports.Such a change of physical activity will allow not losing the heart, to keep a good “prick”.
When a person recovers, my most frequent recommendation is to remove accelerations and runs from the mountain in the early stages of restoring running practice. It is worth starting to run about 30% of the normal volume. In general, I try to return a person as soon as possible to the training process, I try to limit his physical activity as little as possible.
Bandage with pain in the knee
In some cases, bandages are useful. But, first, he must be chosen by a sports doctor. Secondly, the bandage should be only a means to help in the restoration, and not a permanent element. If you use it in a constant mode, the muscles start to weaken very quickly, addiction occurs and, unfortunately, people start to run only in a bandage. Therefore, the bandage is worn only for the time it is being restored and only if it is really necessary. Let’s just say, if you take 100% of people who came to me with a knee joint, then I will advise the bandage in 2-3% of cases.
Can the runner’s knee be cured once and for all?
Yes of course. If you understand the causes of pain, identified the “trigger factor”, then, naturally, the cure will be complete.
What will happen if you do not treat the “runner’s knee”?
If we take patellofemoral syndrome, then the cartilage can completely stow there, we can bring it to the replacement of the knee joint, the replacement of cartilage by metal. If the pain is caused by the syndrome of the oriotibial tract, then there, most likely, it comes to that (if we take the extreme case, and the pain in a person lasts six months), that person is unlikely to continue to run.
What muscles to train to prevent knee pain while running?
The most important muscle groups here are the gluteus maximus, gluteus maximus, quadriceps.These muscles need to swing. There are also muscles that need to be stretched – this is also a quadriceps and gastrocnemius muscle. Short gastrocnemius muscle greatly affects the pain in the knee joint.
Among other preventive measures – hitch, warm up, it is useful to use a foam-roller. It is important not to overload, follow the trainer’s plan, in principle, work out with the trainer. You need to listen to your body. If you feel that the fabrics do not stand up, then you need to be able to stop in time. Run in a good, proper shoes and regularly change it.
Taping for knee pain
Kinesiotherapy is a good thing, but it is important that the doctor selects the application. Further, when you learn, you can tap yourself. Use tapes and for the prevention and treatment. I often recommend using as an aid in treatment.
Errors in self-treatment
The biggest mistake is simply taking anti-inflammatory drugs. Many drink, for example, nimesil – and run on it. This leads to very unpleasant consequences. Another mistake – too early return to training.People feel that the pain subsides – and then they cut in full all the workouts and get big problems.
And if this is not a runner’s knee, then what?
Pain in the knee can be associated with damage to the meniscus, there may be problems with the cruciate ligaments, medial ligaments – anything.
Recently, they often come with marching injuries – these are intraosseous fractures of the intrafusion bone. This season there were 6 patients. In people who are heavy and do not run correctly, an intraosseous fracture of the tibial plateau occurs (this is near the knee joint). Such a trauma “quilts” for a very long time.