Dr. Robert Gregory Lusk - Chiropractor

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Knee Pain with Running?

Rarely a day goes by when I don't see someone running outside.  The lovely weather takes exercising outdoors and regardless of body type or experience, running is a low cost option and something we have all done.  I often think "Good for you" when I see a runner, but due to my occupation I cannot help but analyze the techniques I see.  Is the person running heavy on their feet, striking at the ball of the foot or the heel, are the legs swinging straight through or out to the side, are the knees buckling inward, how are the arms swinging, how much bounce up and down is occurring?  If I do see something that seems less than perfect, the next thought I have is "I wonder if they feel pain due to running that way."  Now, having less than perfect biomechanics does not always result in pain and it's amazing how much inefficiency the body can tolerate.  However, in the absence of prior injury many runners do begin to experience pain due to the repetition of poor mechanics.  Knee pain is one such presentation.

The knee is a slave to what the foot/ankle and hip are doing.  The long levers of the lower leg and thigh exert much force on the mostly hinging knee joint.  Therefore, any movement that occurs at the foot/ankle or hip that is less than ideal can wreak havoc on the knee.  Let's start where we make contact with our environment - the ground.  When our foot contacts the ground, we should first hit with the outside of our heel and then roll inward, or pronate, as our stride proceeds forward.  This pronation is important and normal to dampen the forces that occur at heel strike.  Over-pronation, however, is not ideal and causes poor mechanics in the ankle/foot and for the lower leg to rotate inward excessively.  This over-rotation is then experienced by the knee and further up the skeleton, often resulting in painful conditions or irritating existing structural damage (e.g. knee osteoarthritis).

With respect to the hip, adequate mobility is needed to allow the desired motions to occur throughout the gait cycle.  Stability is also crucial at the hip.  Running, and walking for that matter, can be considered controlled falling with alternating single leg standing.  As our centre of mass is not balanced over any one of our two hip joints, our bodies would tip sideways if it wasn't for the strength of the muscles on the outside of our hips and sides of our torso.  These muscles also control thigh rotation.  Therefore, if they are weak, which they notoriously are, due in part to the amount of sitting we do which does not activate these muscles but has them function more as "cushions", you get excessive thigh rotation.  Knee pain, once again, is a possible end result.

There are a few things to consider which may alleviate and/or prevent knee pain related to running.  Be mindful of your knee position when running and try to prevent it from buckling inwards too much.  Do you have good shoes with appropriate arch support to prevent over-pronation?  Does your hip have sufficient strength or endurance to stabilize itself effectively?  There are exercises that can be done to strengthen the appropriate muscles.

Knee pain begs us to at least look at its neighbouring joints.  Otherwise, we're just managing symptoms and not getting to the root of the problem.  This article is for general information purposes only and is not to be taken as professional medical advice.

Tennis Elbow...Minus the Tennis!

"Tennis Elbow" is the common term for lateral epicondylitis, which refers to an overuse muscle strain injury of the tendons that attach to the outside of the elbow.  This is in contrast to "golfer's elbow" where pain is experienced on the inside of the elbow.  Despite its name, most cases of tennis elbow are not related to tennis but to other causes of stress and strain to the elbow.  Repetitive gripping or leveraging activities are common culprits as muscles involved in these activities attach to the bony bump on the outer elbow.  Occupations or activities with repetitive hand use, such as carpentry, weight training, and even constant computer mouse use can contribute to development of this condition.

The symptoms of tennis elbow may include pain at the bony bump on the outside of the elbow and possibly down the back of the forearm to the wrist.  Pain is often experienced with gripping activities and even things as simple as holding a cup of water can become quite painful, requiring the assistance of the other hand to support the load.

Early on (i.e. within the first few weeks), self care efforts such as icing, avoiding aggravating activities, and the use of pain medications may be sufficient to ease the pain.  However, if the pain persists, which is quite common, it would be appropriate to seek treatment to help get things under control.  In fact, the longer this condition lasts the less likely the pain is due to inflammation in the soft tissues but rather to degenerative changes in the tendon.  This is true for all tendon injuries and at least in part explains why long term ice and anti-inflammatory medication use may not be effective beyond their "pain killing" benefits.

Management of a degenerated tendon is different than that of an inflamed tendon as the tendon structure has become disorganized and scar tissue is present, in the absence of inflammatory markers.  Healing and regeneration of the tendon must be facilitated and conservative treatment to assist this may involve the following techniques and strategies. 

  • Manual or tool-assisted soft tissue therapies are effective at breaking up scar tissue, improving blood and lymph movement in the tissues, decreasing tissue tension, and improving relative movement of one tissue across another.  Also, the micro trauma caused by the soft tissue treatment itself helps to restart the healing process with the end goal being a healthier, more properly organized tendon structure.
  • Eccentric exercises.  This refers to the part of an exercise movement where the muscle is lengthening while maintaining control of the weight.  Research shows this increases protein production in the tendon which is important for healing.
  • Other treatments, such as acupuncture or electrotherapies, may help at promoting healing and managing the associated pain.
  • Adequate rest is important to let the structural damage to the tendon heal.
  • Looking at the aggravating activities and modifying things to decrease the load imposed on the tendon.  In the case of tennis, there may be swing or footwork improvements that can be made which will decrease strain at the elbow.

On a final note, if the above ideas or other treatments directed at the elbow are not yielding positive results after a fair trial period, it would be worth having your shoulder and neck assessed as anatomy located here can cause pain at the elbow and may be the ultimate source of stubborn elbow pain.

This article is for general information purposes only and is not to be taken as professional medical advice.

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