SPORTS INJURIES: RUNNERS KNEE

Also known as patello femoral pain, this refers to pain somewhere under the knee cap and the creaking, grinding sensations you can feel or hear when you bend the knee.  It is caused by the wearing away of the cartilage under the knee cap and apart from the ache or pain on activity, there will probably be no outward signs such as swelling, except in acute cases. 

Causes 

1. Weak vastus medialis:  Because the quadriceps muscle (front of thigh) plays a part in ensuring correct tracking of the knee cap, this will be affected if the inner head of the quads is weak.
2. Over pronation:  If the arches of the feet are weak (flat feet), your feet will roll inwards.  The quads will try to correct this by pulling the knee cap out, causing it to grind against the thighbone.
3. Ilio tibial band (ITB):  This ligament runs from the hip to the shin along the outside of the thigh.  If this, together with quads and hamstrings (back of thigh), is tight, it will pull the knee cap out of line.
4. Poor foot wear:  Either old, worn out shoes, or shoes that are not specifically designed for your gait.
5. Poor training habits:  Such as not warming up, cooling down and stretching adequately; a sudden increase in intensity, distance or frequency; uneven surfaces or hill work. 

Treatment 

• RICE:  Anyone who is physically active is always reluctant to rest, but in order to recover from an injury, it is vital to abstain from the activity that caused it in the first place.  Try and find another activity that won’t aggravate it so that you can still maintain
  

  Avoid sports injuries by thoroughly warming up and stretching

  your fitness levels.  If there is swelling, use an ice pack to reduce it.  A bag of frozen peas wrapped in a tea towel held in place for about 10 minutes every couple of hours should help.  Compression will give the knee cap support and further reduce the swelling and if necessary, when you are relaxing, keep the leg elevated.

• Shoes:  Do you need new shoes?  Are the ones you are using appropriate for the activity in question?  Did you take advice as to the best style, fit and type?
• Training:  Take a look at your exercise training programme and see if anything has changed over the past couple of months which may have contributed to the injury and ensure you make changes to avoid a recurrence. 
• Over pronation:  Apart from buying shoes designed to support the arches, you would be wise to strengthen them.  In Pilates many of the exercise require pointed toes, but we work the feet by pointing and flexing.  Try picking tissues up off the floor using your toes.
• Muscle imbalances:  Find out whether this is the culprit and address it.  The vastus medialis is worked frequently in a balanced Pilates programme.  The hip abductors are also strengthened in the side leg series, the legs are lengthened, the toes pointed and legs turned out.  In the leg circles, similarly.  If you lie on your back, good leg bent with the foot on the floor and the injured leg extended and turned out, then raise the injured leg until the thighs are parallel, you will be working the appropriate group.  Repeat 10 times, rest and do it again for 2 more sets.

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