Looking to train for a marathon or fun run in the New Year?
Joshua recalls a patient that he treated for knee pain and how he could help them improve their running.
“I recently had a patient who was training for a ½ marathon but had been stopped in his tracks by knee pain. The pain came on at the front of his knee immediately with running.At around the five kilometre mark into a run his symptoms increased to the point that he had to stop running. He had been running up to twenty kilometres only a few weeks ago and the ½ marathon was in 6 weeks time!
On the first visit – we looked at his knee in detail, where he was getting the pain and the muscles that attach onto that area. He was very tight down the band on the outside of his leg (ITB) and this was having an effect on his knee cap and the way it moved when his knee was bent. He was tender and sore on the inside of his knee at the front, just next to the knee cap. He had pain hopping on that leg and couldn’t perform a single leg squat either. Double leg squats were painful and his glut muscles were also weak, particularly on his injured side.
We discussed the various options and I formed a treatment plan for him that would help him to get back to running as quickly as possible. I treated him 2 times a week for the first 2 weeks and worked on loosening the tight ITB through dry needling and myofascial release techniques. I also taped his knee using kinesio tape to improve the tracking of the knee cap. This allowed him to squat with no pain and he could start some of the strengthening exercises without them flaring up his symptoms. These exercises included a wall slide squat and a single leg bridge with the aim to start to improve his glut strength and control. He also worked at stretching out his ITB and using a foam roller to add a myofascial self release at home.
He kept up his cardiovascular fitness by riding his bike and going swimming. There is a really good technique in the pool called deep water running whereby you can maintain running fitness to quite a good standard without actually needing to do any impact. I asked him to use deep water running 3 times a week to help maintain his running fitness. As the pain started to lessen I introduced single leg squats and hopping back into his routine. But the focus was on re-training his movement pattern so that his was better able to shock absorb through his muscles and reduce the load on his knee cap.
At the 3 week mark he was able to start running again with no pain over short distances. I started him on a return to running program to slowly build up his ability to tolerate load again. Because of his commitment to the other exercises and swimming, he managed with this really well and 2 weeks later he was able to run 5 km continuously with minimal discomfort. That left us with a week to go until the ½ marathon. During this week he built up his running, as best he could given the circumstances. At the end he did compete in and complete the ½ marathon!! That looked like an impossibility 6 weeks ago. He might not have got his best time but he got through it and was very pleased!!
He still had some niggles and twinges around his knee and with further treatment and exercises and time, this improved. Now he keeps up with a maintenance program of exercises and a physio session for a check up and treatment every 6 weeks or so to make sure he is staying on track with his program and to address any other little issues brought up by his running. With this approach he is staying for the most part pain free and we are able to stop potential problems before they really get going, meaning that he is able to keep running!”
If pain or slight niggles are annoying you or preventing you from trying a new form of fitness, don’t let it hold you back!
An assessment with a physio will help address areas you can improve on and together, you can help achieve your goals!
Joshua Stewart, myPhysioSA Associate Phyiostherapist