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Published on May 03, 2018

woman running outside

Work Up From Feet and Down From Hips to Fight Off Runner’s Knee Pain

Let’s begin with a bit of myth-busting.

Your knees are not like a car – there’s no magic number of miles you can walk, hike or run before they eventually give way and lead to some sort of surgical replacement.

But ask folks who run for fun – or who compete with abandon – and you may have a few who espouse this false notion. You’ll find more who will attest to the fact that yes, they do have knee pain, and it can be part of a loosely defined pattern known as “runner’s knee.”

Depending on where the pain is situated, it could be arthritis, but it could be your habits when it comes to getting out there and logging your miles.

“Pain on the inside of the knee is likely arthritis, but if the pain is on the lateral or outside portion of the knee, that could be IT-Band syndrome, which can be painful and lead to distinct pain in the knee, especially after a run,” said physician Jonathan Buchanan, MD, CAQ-SM, MBA, Avera Orthopedics. “The iliotibial band is a set of muscles than begin in the pelvis and descend down your leg to the tibia, or shin bone. When runners only run, and avoid cross-training exercise, it can develop and become painful.”

Glutes Don't Lie

One place to look for answers is, ironically, in the glute muscles of an athlete, Buchanan said. Runners often have what’s called, in a humorous fashion, “Runner’s butt” which is usually non-existent or flat. Compare that posterior to one from a football or soccer player, and the differences are obvious.

“Runners, walkers and bikers – it’s all linear movement, quad, hammy, quad, hammy, repeat until the race is run,” he said. “That’s why the runner’s butt is like it is. Soccer players and other athletes have a bigger, rounder posterior, and that’s because they have a lot of necessity for changes in direction, to avoid a tackle or move laterally. When runners work cross-training into their routine, they run with a more-stable pelvis, and that can help them avoid knee pain.”

Stronger hips – the key starting point for that IT band group – can lead runners to have less pain in the joint. So for marathon-running record-setters, another five or six miles of training might be less effective overall compared to an intense game of Ultimate Frisbee, slide-boarding or other cross-training work.

“Even the experienced runner who’s perfected a stride will get tired and when the knee is no longer over the toes – and you can see that happen if you run on a treadmill with a mirror – you’ll start to get that pain,” he said. “Training the glutes and hips is important to avoiding this condition. It can be a hard sell, as many runners feel like their best bet is to run more miles. It’s hard to get them to do the squats and lunges or work with weights because they likely fear getting bulky, adding muscle weight and slowing down.”

Stronger Ankles Really Help

Buchanan practices what he preaches; he’s an avid barefoot runner and has been completing marathons, 10Ks and other distances for many years. He recommends getting stronger in the glutes, but also in the feet and ankles, because if either end of the leg is too weak, the pain will surface in the knee, in many cases.

“The best runners cross-train to make their glutes stronger, and there’s a lot of evidence-based studies that show that developing the muscles in your feet, which is what barefooted running helps with, can also reduce possible knee-pain,” he said. “It’s a matter of working down from the glutes and up from the feet. It’s a process that will help get the pain out of your runs.”

Proper identification of the pain – because it could be arthritis – is paramount. While cross-training and getting those parts of your body stronger may be a solution, in some cases other approaches are needed.

“There are a number of injections that can help, and we do have, I believe, an overuse of steroid injections for knee pain,” said Buchanan. “They help, but do not last for long, and I would encourage any runner who has knee pain to discuss injection options with their orthopedic provider because there are options that can help the deteriorating tissue.”

Live Better. Live Balanced. Avera.

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