Runners often talk about the ‘runner’s high’. It is a state of euphoria where runners feel extreme joy or delight. They also claim to feel less pain or anxiety immediately after they exercise.
To reach this state of joy, runners are generally disciplined people. Come rain or shine, they will put on their running shoes and strap on their running gear to head out and pound the pavements. That is a good thing, except that running also puts a lot of stress on the knees.
We want our patients to enjoy their runs without pain, so here are three tips for you to take care of your knees when you run. But first, let’s understand how running stresses our knee joints.
Why does running stress our knees so much?
Knee pain is often the result of the knee cap, known as the patella, being misaligned and tracking incorrectly. This pain is known as Patellofemoral Pain Syndrome. The improper alignment and tracking can be due to an imbalance of strength between the four muscles that make up the quadriceps group located on the front of the thigh.
This large muscle group encases your knee joint. Typically, the most lateral quadriceps muscle is the stronger muscle of the quadriceps group and overpowers the more medial quadriceps muscle, where your kneecap is located. When you run, this imbalance in strength causes the knee cap to be pulled out of its track by the stronger muscle.
Strengthening the medial quadriceps muscles can help correct this uneven pull. Because runners load their knee joints so much, which results in misaligned kneecaps, the syndrome is often known as ‘runner’s knee’.
Scientific explanation aside, did you know that the action of running itself does not directly cause knee problems? A study by Philadelphia’s Thomas Jefferson University found that runners were less likely to develop osteoarthritis than their non-running counterparts. The team from Thomas Jefferson believes marathoners and other runners may gain arthritis protection from muscle development, body weight control, decreased levels of inflammatory agents and the well-known bone strengthening that follows moderate-impact sports.
Other studies also show that runners’ feet strike the ground less frequently and more briefly than if they were walking. So, contrary to popular belief, walking might actually put the same stress on the knees!
If running itself does not cause knee pain, what causes knee pain? Some reasons include:
- Poor running form
- Running too much, too soon which stresses the joints
- Bad shoes
Knowing how to remedy the above reasons can help you prevent knee pain so that you can continue hitting the Runner’s high. Let’s look at each point in turn.
Three ways to prevent knee pain
1. How to get better running form
The way you run is your running form. Before you continue running, it’s a good idea to look at your form to see if you are maintaining proper run technique but do not try to copy what you see on the TV when Olympic runners compete. You might end up over-extending your joints and hurt yourself instead when you try to run differently from what you usually do. Here are some tips that we compiled from our research. Use them in your next run so that your form improves:
-Be upright and balanced when you run
When you run, rotate your hips back. Straight your spine and lift your chest. You should pull your shoulders back and down while your head is stacked directly over your spine. Imagine that there is a string above you that draws you gently forward.
Your feet should land under you as you move when you run in this way. Your spine does not have to be so rigid. Shifting your weight slightly forward is better for your knees.
When your spine is too straight, it cannot absorb the shock of the impact when your feet touch the ground. Your knees, quads, and hamstrings will sustain more stress and increase the chances of getting an injury. It also means that you are overstriding. Your feet are ahead of your body, slowing you down.
-Observe your arm position
Your elbows should be kept backwards when you run. This move will shift your balance upright and forward. Your feet also land closer to your body and propel you on when you move.
This arm position also ensures that your movement and force travel forward and backwards. If you keep your arms in front of your body, they tend to move around and you waste energy in sideways and rotational movements.
-Keep your steps quiet
When you attempt to keep your steps quiet, you will naturally use your core and pull your knees beneath your hips.
Runner’s World reports that in a 2011 study from the University of Delaware’s Motion Analysis Laboratory, runners who run softly and more quietly were able to reduce their foot impact, placing less stress on bones, joints, and muscles. After multiple sessions, the subjects retained the change for at least a month.
-Observe how your feet lands
The next time you’re running, pay attention to how your feet land. Or better yet, take a video of your feet as you stride along. If your heel hits the ground first before the rest of your foot, you run with a heel strike.
Why is this information important? Studies show that heel strikers are more susceptible to knee injuries when they run. That’s because their heel hits the floor first, which sends the impact toward the knees. Their hips also take the blow of the impact which is damaging in the long term.
If you feel your knees often hurt post run, it’s time to change how you land. You can try landing on the middle of your feet for a few minutes each time you run. By making small adjustments, you’ll train yourself to change the way you land and prevent long term injury to your knees and hips.
2. Planning your run so that you do not overtire your joints
During running, the knees, hips, and lower back take most of the impact. Our joints have cartilage that helps absorb the impact.
The knee takes so much impact that it has evolved a secondary chunk of cartilage, the menisci, to absorb force further. When running reasonably quickly, it can be up to five times a person’s body weight. The bones in the feet and shin area also feel bone stress.
Your joint and bone tissues adapt to constant exercise, so the more you walk and exercise, the stronger and less injury-prone you get.
However, it is important to realize that muscles, bones, and joint tissues need time to adapt. Suppose you intend to run a marathon eventually, you have to create a sustainable exercise plan. If you do not exercise consistently and decide to run a marathon within a week, you may overstress your joints, increasing your risk of joint injury and bone stress.
Create an exercise plan that will increase your physical strength. It is not just about having strong calves. It would be best to strengthen your knees, hips and spine.
These will, in turn, take some of the brunt force off your joints and help distribute the stress throughout your whole body come marathon day. Here are some exercises from Runner’s World that you can include in your exercise plan to increase your mobility when you start training for your run.
Next, evaluate your Training Plan and consider: Have you been increasing speed or distance recently? Are you allowing for adequate recovery time? Increasing mileage suddenly or introducing speed too soon increases the risk of injury.
A recommended rule for increasing mileage is the 10 per cent rule. Increase weekly mileage by just 10 per cent weekly. Every few weeks, cut back your mileage by 10-20 per cent for a rest week before building again.
Recovery time is another critical factor and one that athletes neglect. Be sure you allow recovery time to give your body rest and time to adapt.
You can also try cross-training, which is helpful especially if you have injuries because it can maintain and expand our aerobic base without pounding the pavement. In fact, research shows that triathlon training is attributed to lower injury rates before athletes switch to marathon training.
3. Bad shoes
If you feel any pain or swelling in your ankles, your Achilles heel or your feet, your running shoes may be the problem.
Apart from that, if your knee hurts, it can result from wearing running shoes that have lost their cushioning and support. Effective running shoes must absorb shock absorption to combat and prevent any pain from occurring.
Continually assess your running shoes when experiencing any aches or pains.
Here are more reasons to check whether you should change your running shoes:
- You’ve worn your running shoes for longer than six months, or you’ve run about 500 km in them.
- Your feet hurt during or after your run.
- You lose your toenails, which signifies that your shoes are too small.
- You get blisters, calluses, and corns. These are all caused by prolonged pressure and friction. Your shoe is probably too narrow or too short, or the supporting material inside of your shoe begins to break down.
- You develop plantar fasciitis.
- If you feel stabbing pains in your heel, your plantar fascia band is inflamed. This connective tissue runs from your heels to your toes. You need proper shoes to prevent this pain.
- You develop tendonitis when you run.
- Your tendon is a cord of strong, flexible tissue that connect your muscle to your bone. They also help to absorb some impact when you run. However, if you wear a shoe that allows your ankle to roll to the inside, your tendons may get sore and inflamed, causing tendonitis. If you feel that any part of your feet is swelling, you need to change your shoes!
Finally, if your knees hurt when you run, you should stop and try the Rest, Ice, Compress, and Elevate methods. If it does not improve, see a doctor and get professional advice before you continue running.
At Hip and Knee Orthopaedics, we believe that every patient deserves to receive comprehensive and efficient care for their musculoskeletal conditions so that they can gain back their independence in mobility and enjoy quality time with their loved ones.
With a passion for treating hip and knee conditions, Knee Specialist Singapore makes sure to provide you with quality care by thoroughly assessing your condition and personalizing your treatments to meet your needs and goals.