It's that time of the year again! As Vancouverites gear up for this year's Sun Run, 1/2 and full marathons, running injuries in a doctor's offices and physiotherapy clinics increase. The most common running injuries are from overuse: plantar fasciitis, achilles tendonitis, shin splints, IT band syndrome, and anterior knee pain - all of which are usually the result of doing too much, too hard, too soon!

Injury Definition: Anterior knee pain is also Patellofemoral Pain Syndrome (PFPS). It is likely the result of repetitive activities, poor training technique or a new movement. PFPS can be managed with exercise changes, physiotherapy, and a little common sense.

Mechanism of Injury: The quadriceps muscles attach to the patella(kneecap), which attatches to the lower leg(tibia) via the patellar tendon. The patella makes the contracting quadriceps more efficient and helps distribute its forces throughout the joint. When moving from straight leg standing to a full squat, forces transmitted through the patellofemoral joint increase from 1/3 to 6 times your body weight! In many cases, the athlete is predisposed to PFPS by poor tracking of the patella. This may be from anatomical problems or muscular imbalances.

Signs and Symptoms: PFPS often occurs in young athletes. It starts as an aching pain under or around the knee cap, during or after training. As the problem progresses, it becomes noticeable when sitting for long periods of time - "movie-goers sign." PFPS is aggravated by sqatting and by going down stairs. Swelling is rare.

Managing Patellofemoral Pain: The guidelines for treatment, rehabilitation and prevention of PFPS suggested by physios are:

Train Smart. Wear well-cushioned, supportive footwear and focus on proper biomechanics. If you have not maintained your fitness level throughout the winter, gradually increase the duration and intensity of your training by 5-10% per week. Beginners should always start training with a walk-run program.

Avoid any sudden changes in your activity level and approach new training techniques and excercises with caution. They may stress your muscles and joints in a new or different way. Be sure to include off-days and to alternate hard and easy workouts. Only one run per week should include hills. One should be on a flatter route, and a third run on a softer surface such as a field, mulch trail, rubberized track or treadmill.

Listen to your body! If you notice symptoms of PFPS, stop the exercise or activity. Icing for 10-15 minutes every hour should help ease the pain. When the pain is gone, begin a gradual return to running - at first, on a flat route or softer surface.

Stretching. Key muscle groups to include in your stretching are the hamstrings, quadriceps, gluts, IT band, and calves. Hold stretches for a minimum of 25 seconds and repeat 2-3 times.

Hamstrings (back of thigh):
Keep knee slightly bent
Both feet facing forward
Lean forward from the hip not the upper back

Warm-up. A proper warm-up helps increase blood-flow to working muscles and lubricates the knee-joints. Begin with 5 minutes of a walk-run routine. Gently stretch the muscle groups described above 2-3 times each. Finish your warm-up with some standing leg-swings: Front to back, side to side, and a figure eight.

Iliotibial Band:
Cross legs
Lean hips to one side

Strength Smarts. Deep squats and lunges are likely to aggravate the PFPS knee. Remember, as the knee bend increases, so do the fores of compression in the pattelofemoral joint.

Quads (front of thighs):
Tuck the hip under
Don't arch lower back
Keep knees together

The following exercises develop and maintain proper strength and activation of the quadriceps and hip stabilizers:

1/3 squats
Step-ups (6" step height)
1/4 lunges

Make sure that, as your knee bends, your knee-cap stays centered over your 2nd toe.

Balance Exercises: To maintain joint propioception, stand on one foot with your eyes closed or use a wobble board or sissel disk.

Prevention: Well cushioned, supportive shoes are essential. Warm-up and training smarts also help prevent PFPS. Avoid the temptation to do too much, too fast, too soon.

PHYSIOTHERAPY: If the problem persists, your physiotherapist can help identify faulty biomechanics and muscle imbalances, and suggest changes to your training. Ultrasound and electrical stimulation may help ease the pain and get you on the fast track to recovery.

Call our therapists to arrange an assesment or treatment of your running pain. Or let them help solve problems caused by other injuries and activities.