We all hate getting a knee injury just like we hate getting any kind of injury. But when it’s the knee there’s an added sting to the tail; non-runners will delight in reminding us that running is ‘bad for your knees’. Whilst most runners know that isn’t true, it’s still grates to hear it, doesn’t it?
For the record, running is categorically not bad for your knees. Numerous studies have repeatedly shown this to be true. Many ill-advised people will point to the ‘pounding of pavements’ resulting in the ‘hammering of knees’ as a one-way street to osteoarthritis, but it really isn’t. In fact, running makes you stronger and more resilient to degenerative joint conditions. Reliable studies have proven that regular runners actually have a reduced chance of developing osteoarthritis.
Whilst it’s good to know that you can now win an argument with a non-runner about knees and running, it doesn’t change the fact that knee injuries are still common amongst runners. Running isn’t bad for your knees (as we’ve established) but running with poor form and/or over-training is. Knee injuries, like many other injuries occur because we’re doing something wrong. I’m not going to argue with this, but I am going to share some frustration about this point.
In February, after I had recovered from my debilitating plantar fasciitis, I was extremely careful not to increase my training load too quickly. I kept the increases in my mileage tiny and avoided hill reps or anything too speedy. I even pulled off an enjoyable half marathon with a very sensible run/walk strategy. I was quietly confident that I was finally going to experience a decent period of injury-free running. But by the end of March I was worrying about a new pain under my left kneecap that wasn’t going away.
I’ve spent a lot of time with physios and have a really healthy respect for their expertise, but this time, I was determined to avoid the weekly treatment bench. Partly because fitting in the appointments is such a hassle but also because treatment usually involves a selection (sometimes a very large selection) of exercises that take quite a long time to complete.
When you’re injured as frequently as I am you spend a lot of time doing the physio’s prescribed exercises and whilst I diligently complete them they are rather boring and, at least for me, they never seem to work. A running club mate who shall remain nameless told me she avoids going to see a physio because, “they only ever give me clamshell exercises”. I must admit, I have been given a lot of clamshells in my many lists of exercises!
Six weeks of sessions then a referral to a consultant is the standard procedure for me once I press the physio button. Thankfully, I don’t have to worry about the cost as I have private health insurance via my job, but I’m getting a bit fed-up of the injury treatment treadmill. With this new injury, in an effort to avoid this treadmill, I tried a few weeks of a more traditional injury self-care: not running. It was just a niggle, so I thought that was probably the right thing to do and it might even work.
After two weeks I could still feel an ache in my knee when I woke up in the morning, and when I walked up and down stairs. I consulted an excellent Christmas present from a few years ago – Running Free of Injuries by Paul Hobrough. It’s about the most practical and professional advice a good physiotherapist can give, including self-diagnosis and self-treatment, whilst somehow still managing to encourage you to see a real-life physio. Given my propensity to injury, I refer to it rather a lot. Using this book I self-diagnosed myself with patella tendinopathy.
The patella tendon runs from the bottom of the quadriceps (thigh) muscles over the kneecap (the patella) and attaches to the top of the tibia (lower leg bone). The early warning signs noted in the book matched mine very well; pain just below the kneecap, especially when the quad muscle is being used e.g. walking upstairs; stiffness in the front of the knee in the mornings and finding it difficult to kneel.
Now I had a diagnosis, albeit a self-diagnosis, I could embark on suggested treatment offered by Hobrough in his book. I followed the suggestions in the book about carefully loading the tendons and bought some K-Tape which I strategically applied after watching various You Tube videos. But after another two weeks I started worrying I had completely mis-diagnosed it for something more serious. The knee pain hadn’t got any worse, but it also hadn’t got any better. What if my self-diagnosis was wrong? What if I had a cartilage or ligament tear and was making it worse?!
My physiotherapy avoidance strategy lasted just a few weeks before I was back on the treatment table. The good news is that the physio agreed with my self-diagnosis. The bad news is that I have been doing a long list of boring exercises every other day for two weeks now. And that includes the aforementioned clamshell exercises. In defence of the humble clamshell (and the physios who prescribe them) a friend who until recently was a practicing physio did explain that the clam-shell exercise is key for strengthening the gluteus medius. The ‘glute med’ is often a weak link in the kinetic chain and is frequently the cause of a lot of lower leg issues. Like it or not, all of us can benefit from the modest clamshell from time to time.
In the meantime, as I plough away at the physio exercises, I’m still musing how I got the injury in the first place. I was so careful not to increase my training load too sharply and so I’m not convinced that this new knee injury is due to over-training. If I rule out over-training, then maybe I should be looking at my form. I’ve been running for years and never had this injury before so it seems unlikely. However, I went to buy some ski boots recently and the fitter said to me: “Did you know that your left foot severely over-pronates (rolls inward)?” This really surprised me. I have had so much analysis and prodding of my feet over the years with two previous ankle and foot injuries, and this has never been mentioned. I have been wearing custom-made orthotics for some years which should be managing anything like that. When I performed some simple squats in front of a mirror, my left foot did roll in and subsequently so did my knee. Bingo! Maybe something about my gait had changed and perhaps I was rolling in on my left side more than I used to.
When I saw a podiatrist last year about my plantar fasciitis during my London Marathon training he chuckled at my old orthotics. I couldn’t remember how old they were, but he found it amusing that they squeaked when I walked and ran. Sticking with the age-old and reliable mantra of not changing anything so close to a big race, he said we shouldn’t replace them there and then, but he did encourage me to come back post-marathon and get fitted for some new orthotics.
After checking recently, I discovered my orthotics are seven years old. I don’t know the recommended life of a custom orthotic but mine have worn down in a couple of places. If nothing else, it is evident technology has come on a bit and I can now also have a pair that don’t squeak when I walk!
So, I’ve been measured up for new orthotics via a plaster cast mould that was taken of my feet whilst lying on my front on a treatment bench, legs hanging off the end. The podiatrist took a photo of my legs from behind clearly showing that my right leg is straight(ish) from hip to ankle but my left leg isn’t. The lower half of my leg skews out a little. That’s probably going to put some pressure on my knee! Hopefully my new orthotics might be able to compensate for this lack of alignment. I collect them in a couple of weeks. Until I can start running again, I won’t know if they improve my current situation. In the meantime, its clamshells and squats every other day for a little while longer. I just really hope it’s not too much longer because this Perpetually Injured Runner is running out of patience.
Thanks for reading. Happy running (and clamshells).