Print and Go Back ESPN.com: Workouts [Print without images]

Tuesday, July 12, 2011
Don't let runner's knee slow you down

By Selene Yeager

Stay off the sidelines and in the game. Our espnW physical therapists dish out cutting edge advice for avoiding (and quickly rehabbing) common sports-related injuries.

The injury: Anterior knee pain, also known as "runner's knee," or more scientifically, patellofemoral pain syndrome. A variety of conditions can make the front of your hinges hurt. Most often the underlying culprits are malalignment of the kneecap, poor mechanics, muscle imbalances, general overuse and, in extreme cases, chondromalacia -- degeneration of the cartilage that forms a slippery cushion between the underside of your kneecap and the top of your femur, so the bones rub rather than glide over one another when you bend your knees.

"Years ago, almost all anterior knee pain was called chondromalacia," said ESPN injury analyst Stephania Bell, PT. "But that's just one, very extreme, contributor; and you can't diagnose it without surgery of a very sophisticated scan, because you need to see the degeneration. Now it's more commonly called patellofemoral pain syndrome because you can have pain without any cartilage breakdown."

Anyone who runs a lot or plays sports is susceptible, especially over time as the knees succumb to general wear and tear. Since biomechanics plays a role, active folks with flat feet and/or knock-knees are at increased risk, as are women whose wider hip to knee angle can cause uneven wear.

What it really feels like: It starts as a dull ache on the front of your knee, especially when you go up and down the stairs, squat or after you've been sitting with your knees bent for a long time, like in a movie theater. Your knee might also feel as if it "catches" when you bend it. Or it can buckle and feel like it will give out unexpectedly. In some cases, it may also get swollen and tender to the touch.

Who's been there: Two Philadelphia stars in different sports were sidelined by runner's knee earlier this year. Andre Iguodala of the Sixers played hurt, eventually missing two regular-season games, while Phillies second baseman Chase Utley was forced to sit out spring training with both chondromalacia and patellar tendinitis.

Don't feel their pain: It's important to stop runner's knee in its tracks before it leads to a lifetime of hurt. "You can't reverse cartilage damage, but you can slow the progression, and you can fix many of the underlying causes of knee pain," Bell says. The usual rules apply. When pain pops up, stop activity; take nonsteroidal anti-inflammatory drugs to relieve the pain if you tolerate them; and ice the knee for 15 to 20 minutes several times a day.

The secret to keeping it from coming back is strengthening, stretching and taking any other steps necessary to improve your alignment, Bell said.

"The quad tendon inserts on the kneecap. When your quads are stronger [and especially if they're also tighter] than your hamstrings -- and they are in many women -- it creates more compression and pressure against the kneecap," Bell says. Weak hips are another underlying factor. Your hips are supposed to stabilize and control the motion in your legs. When they're weak, your legs collapse inward, leaving your knees to bear the load. "You want the proper balance of strength and flexibility in the muscles that surround the knee and control movement in the lower body," she said.

Do three sets of the following exercises three to four times a week.

Quad stretch

Reach back with your right hand and grab the front of your right ankle. Bring your heel to buttock. Make sure your knee is pointed down toward the ground. Keep your right leg close to your left. Don't allow knee to wing out to the side and do not bend at the waist. Hold for 30 seconds and switch sides.

Stability ball leg curl

Lie on the floor with your arms at your sides and place your heels on a stability ball. Press up, so that your hips are in the air and your torso forms a straight line. Next, pull the ball toward you, squeezing your hamstrings, and then roll it back out without dropping your hips. Do 10 to 15 reps.

Clamshell

Lie on your left side with your knees bent in front of you so your ankles, knees and hips are stacked. Prop your head up with your left arm and place your right arm, palm down, on the floor in front of you for balance. Keeping your heels together, lift your right knee as far as possible. Return to start. Repeat for a full set of 15 to 20. Then switch sides.

More TLC to please your knees

Taking a few extra precautionary steps when you exercise can help keep your knees pain free:

• Zigzag when running down steep hills rather than running straight down

• Mix gentle on the joint exercises like swimming and cycling into your exercise routine

• Run on softer surfaces like cinderpaths rather than cement

• Consider orthotics to support your arches if you have flat feet

• Taping your knee may provide immediate relief. Your therapist can show you how to do it yourself. "It doesn't work for all cases, but you'll know right away if it helps because your knee won't hurt when you bend it," said Bell, who is quick to add that even if taping makes you feel like new, it's not a cure. "Taping adds support, gives you feedback on how your muscles are moving and eases the pain," she said. "All that helps you do the exercises that will provide lasting benefits, so eventually you don't need the tape."

* This does not substitute for medical advice.