The risks of becoming a “Road Runner” overnight . .
A focus on issues at the Knee
Over the last month since the virus has taken hold here in Ireland, we have become quite restricted in our day to day movements. With the closure of all parks, gyms and playing pitches, more of us are seeking alternative forms of exercise to keep ourselves ticking over.
Not only does going for a run provide a focus from the point of view of structuring our day, it also keeps the mind and body active.
While running is a great form of exercise, and those who are seasoned runners have built up a robustness and tolerance to road or trail conditions, many of our bodies are not used to such load, impact or perhaps just this form of exercise, and the sudden change in demand on the joints and tendons can lead to their own issues.
Steep spikes in training/workload will subsequently increase the risk of injury, especially in athletes undertrained in this manner.
One of the more common injuries we see in our “road runners” is typically an overuse (or training load error) injury, albeit in the form of pain at the back of the heel (fat pad irritation, achilles tendon irritation, impingement to name a few) or at the front of the knee (patellar tendon or patellofemoral joint pain for example).
We will briefly discuss the anatomy of the knee and some of the common pitfalls that can be avoided.
Anatomy of the knee
The knee is one of the largest joints in the body and its function is to connect the femur (thigh bone) and the tibia (shinbone). The other bones involved in the make-up are the fibula and the patella (kneecap). The knee is supported further by the ligaments and two C- shaped pieces of cartilage (menisci) which also serve to protect the bones by acting as both shock absorbers & stabilisers.
Two of the most common causes of anterior knee pain that we would see in clinic are patellofemoral knee pain (irritation of the knee cap joint at the front of the knee) and patellar tendinosis (overload or irritation of the patellar tendon, which is the tendon just below the patella/kneecap).
Patellofemoral and patellar tendon pain can both be the result of a number of biomechanical issues or inefficiencies. What we see is as a result of excessive force being applied to the patellofemoral joint or patellar tendon (and quite often both), resulting in overload of the joint and/or the tendons. (Less often we see the quadriceps tendon implicated in anterior knee pain).
Today, we are going to focus on the importance of optimal lower limb mobility (ability to move efficiently with control) and strength, in order to reduce the risk of anterior knee pain associated with running.
Three of the main areas of focus:
1) Quadriceps muscular strength
The quadriceps function is not only to extend (straighten) the knee but also to control movement of the knee during the swing and contact phases of running. Good quadriceps function serves to offload and protect the knee joint by controlling the degree of force and load through the respective joint structures.
Suboptimal quadriceps muscular strength and movement control can lead to muscular fatigue. At this point we can quite often see the development of pain associated with overload of the knee joint.
(The joint is exposed to more force/load than it can tolerate, think of a sponge having a certain capacity for absorbing water)
2) Hip flexor muscle length/strength
The muscles which act to flex the hip (lift the knee towards the chest) require optimal length, strength and ability to function in a controlled manner as they lengthen and shorten through the movement cycle.
Timing of hip flexion in the running cycle is key for efficient running mechanics. Fatiguing hip flexors due to reduced strength endurance can be “ one of the culprits” associated with the development of knee pain.
3) Single Leg control
Suboptimal control at the trunk, hip, knee or foot can be a defining factor in overuse injuries. A common movement inefficiency I see in clinic which can contribute to knee overload during loading exercises (eg. running, jumping, landing) is dynamic knee valgus (Wilson et al, 2006). This is a technical term for not having sufficient ability to control movement at the knee on impact/foot contact and what we see is excessive loading being placed on the medial compartment (inside part) of the knee joint. Ideally we want that load being evenly spread across the knee joint (medial and lateral compartments).
Below you will find some suggestions as to how you can start to address some of the biomechanical inefficiencies we have already discussed within the facilities available to you at home. We are conscious that gym and running track facilities are not available at this time.
Typically from there, we will work with our athletes to progress them to the next phase with more challenging control drills, in addition to looking at running biomechanics, running cadence, training load (running volume) and overall movement efficiencies.
Here’s something to get you started :
1. Single leg wall squat (Targeting quadriceps muscular strength)
● Standing against a wall, with both feet together, 2ft out from the wall
● Slide down the wall, no deeper than 90 degrees.
● Slowly peel one foot off the ground, keeping the toes pointing towards the ceiling.
● Hold for 10 seconds.
● 3 sets x 6 reps
2. Split squat: (hip flexor muscle length/ eccentric strength)
● Kneeling with one knee on the ground; the front knee at 90 degree angle
● The trailing knee is directly underneath your hip.
● Push straight up into starting position
● Pull belt buckle up towards the sky, arms out in front.
● Drop trailing knee towards the ground; hover 3cm above the ground.
● Hold for 3 seconds.
● 3 sets x 6 reps
3. Standing fire hydrant (hip mobility/hip flexors strength)
● Standing on one leg, with the knee in full extension.
● Pull the opposite knee towards your chest to 100 degrees of hip flexion, peel hands away slowly, maintaining said knee position.
● Keep toes pointing towards the sky, turn your foot away from the body.
● Hold for 3 seconds, return to starting position.
● 3 sets x 6 reps.
4. Single leg squat (single leg control)
● Standing on one leg, arms out in front; imagine your trying to squash a pea with your foot.
● Keep looking straight head, stick backside towards the wall behind you.
● Keep the hips square, make sure the knee is correctly aligned with your foot that is pointing to .12 o’clock
● 3 sets x 6 reps
If you are not single leg squatting with good control, it’s highly unlikely that you are moving efficiently as you run. This is the foundation and the best place to start.
Areas to focus on to improve movement efficiency :
● Single leg control / stability
● Lower limb strength
● Optimisation of running mechanics/efficiencies
If you have any questions, in relation to the above don't hesitate to touch base with me or any of our team, we will be more than happy to discuss it with you.
Aodhán McEntee
Chartered Physiotherapist
BSc Sports Science
MSc Physiotherapy
Corú Registered
email: aodhan@mcenteephysio.com
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