No Pain No Gain....Doesn't Apply to Your Knees!

As a runner or any athlete for that matter, you often here people say to "Work through the pain." or "No pain no gain." For the most part that's true, especially if you're exposing your body to something new, be it running for the first time or changing up your normal running workout routine by throwing in some intense speed work. Your body is going to react with some soreness. This for the most part, is what's supposed to happen. You're breaking down muscle and it's the repair of that muscle that makes you stronger.

However, when it comes to the knees, you need to throw that logic out the window. If there's anything in your body that you want to protect it's your knees. Think of you knees as Mother Nature's gift of shock absorbers to your body. With every step you take when running, your body receives an impact of several times your body weight. Your knees work to help absorb some of this force.

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The problem with knee injuries is knowing what exactly is going on. It could be the knee joint or it could be the surrounding muscles, ligaments, cartilage or tendons or some combination of any or all of that "stuff." Best to let a sports doc determine the problem rather than guess your self.

I used to have an 18-year-old Ford Bronco II. That thing was ugly, but it sure was fun to drive. No air and it would hardly do 60 on the highway, but it was a good old truck. Every time we'd hit a bump in the road you'd feel it and go flying. My youngest used to sit in her car seat in the backseat and yell "Weedoggie" "YeeHaa!" "Do it again Daddy!" every time we hit a bump in the road. That is until the shocks went out. Oh man, then every time I hit those bumps, you didn't bounce, you just felt like you hit metal to blacktop. No fun at all. That's exactly what your knees can feel like once you've damaged your knees' shock-absorbing abilities. Problem is that you can't just drive into your local garage and ask for new shocks for your knees. The Bronco? Well, yeah, it lasted a few more years.

So, to avoid the Bronco II Syndrome, when you're feeling pain in the knee and it doesn't go away in a day or two, get yourself to the doc. Yep, he may say you have to stop running for a while in order for things to heal, but that's better than going to the doc after it's gone on too long and have him/her tell you to stop running altogether.

Running in itself is not bad for your knees. More and more research is showing that that old non-runner's excuse of "Oh, I don't run, it's bad for my knees" just ain't so. But, there can be things such as a biomechanical problems (like severe over pronation) that can contribute to extra stress on the knee which eventually will result in knee pain.

Mother Nature was pretty ingenious when it came to designing the knee. Your knees aren't just bone against bone. (That makes me hurt just to think about it.) In between those upper and lower leg bones and the petella is cartilage and something called the synovium. When you think of the synovium, think of a ball bearing. That's basically what it acts like in the knee. The synovium absorbs fluid called synovial fluid and it's this fluid that makes it so that the bones move smoothly over each other. There's even more cushioning called bursae. Bursae are fluid-filled sacs that are found around your knee joint. Actually you have bursae near or around most of the joints in your body. Ever hear of bursitis? That's a condition that happens when one of more of your bursae around a joint become inflamed.

Have you ever been for a run and then later when you try to get up your knee or knees have stiffened-up so much that you can't stand? Or maybe you've been on a long drive or sat in a movie and the same thing happened? If the stiffness is so bad that you can hardly stand, that's not just regular exercise-related stiffness. That could be something much worse called Plica Syndrome. Plica is tissue that sits around both sides of the knee cap. If you've ever fallen and landed on your knee, especially if you twisted your foot in the process and ended up with a sore knee, more than likely it's due to bruising of the plica tissue. A little rest and it usually heals and goes away. However, if the pain is the result of a biomechinacl problem like severe overpronation or maybe a really weak posterior chain (the muscle groups along the back side of your body - glutes, hamstrings, calves) this can cause your knee not to track properly which can inflame the plica tissue causing severe pain.

Some of you may be thinking...well it's just that tissue that's sore, no big deal. Well, if you let it go too long, it can definitely become a big deal. Over time, that inflamed plica can develop scar tissue and get thick. Once this happens rest and ibuprofen ain't gonna fix it.

So, let's back up a little... the biggest lesson from this post is, if you're knee hurts either from stiffness, soreness, dull aches or sharp pain....go get it checked. Better safe than sorry. Remember that old saying, "An ounce of prevention is worth a pound of cure."

A Run A Day Keeps the Doctor Away!

If you're a runner, especially one who's been running a while, you've undoubtedly heard, "Why do you do that to your body? Doesn't it hurt your joints or knees?" This often comes from someone eating a double-bacon cheese burger, fries, and a Coke. It's hard not to reply back with a similar set of questions, but replacing "knees" with "heart."

I guess it's not too bizarre of an assumption that running could be bad for your joints, after all your knees do absorb about 8 times your body weight with each stride when running. For me that's 1,104lbs, and I'm a little dude. That sounds like a lot of force/weight, and it is, but you know what, the body is an amazing machine. The human body was actually designed to run and Mother Nature crafted some pretty amazing shock-absorbing mechanisms to handle that force.

It's been fairly common thought that regular running during adolescence as well as involvement in other sports that impact the joints at an early age may lead to osteoarthritis in adulthood. One research study back in the 90s seemed to support this thought. Basically is showed that of the 5000 women involved in the study, the ones who were involved in heavy physical sports as teens or were involved in weight-bearing exercise in middle age had a higher risk of developing osteoarthritis of the hip. Well, that was one study.

Today's research is showing the opposite, especially in respects to running. A long-term study out of Standford shows that there's no connection between running and arthritis. Actually the study shoes that running and other "regular vigorous exercise" may even protect the joints in later life. The study followed a group comprised of 1,000 people (runners and non-runners). None of the participants had arthritis at the beginning of the study. Many of them had arthritis by the end of the study. Interesting finding was that the runners' joints were no more or less healthy than the non-runners in the group. This was true for even the really high-mileage runners in the group (averaging over 2,000 miles a year). Another great finding from the research was that the runners tended to be in better health and they had a 39% lower rate of mortality than the non-runners.

There's other research coming in with similar findings. Together all the research seems to be saying that osteoarthritis is mainly determined by genes and other things like obesity. Research shows that obese individuals are four times more likely to to get arthritis than leaner individuals.
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Going back that what I said about Mother Nature.... James Fries (the leader of the Standford research) says, "Normally functioning joints can withstand and actually flourish under a lot of wear," In a recent Time article, he explains that healthy joints depend on movement because cartilage depends on the "pumping action generated by movement to get its regular dose of oxygen and nutrients. When you bear weight, [the joint] squishes out fluid, and when you release weight, it sucks in fluid." This is why daily exercise (including running) is good for keeping that cartilage healthy. Obese individuals may have an increased risk of arthritis because the added weight they're carrying is putting constant stress on their joints while at the same time, they're probably not very active so their joint cartilage isn't benefiting from that"squish factor."

The key is to avoid overuse injuries. Even though your joints like the exercise, you still need to incorporate rest into your running/exercise program. Your body needs time to regenerate and repair which in return builds up your body making it stronger. Another way to avoid overuse injuries such as stress fractures is to increase muscular strength. "Increasing muscular strength" is a phrase that often scares runners because they think it means adding bulk. However, you can increase muscular strength as well as muscular endurance without bulking up. If you focus on lighter weights and more reps, you're not going to end up with the "Arnold look."

Think about it. If you strengthen the muscles not only is this going to protect/support your bones, it's also going to help protect those joints. Your calve muscles are natural shock absorbers for your lower body. You don't need "boulder calves", but if you increase your calf strength, you'll increase their shock-absorbing capabilities at the same time. (Side Note: once during a marathon, my calves blew out. As a result, I ended up with a stress fracture in my heel. I now add calf-strengthening exercises to my weekly routine.) A simple way to to this is by doing body-weight calf-raises or standing calf-raises holding light dumbbells.


Your glutes and hamstrings are also great running muscles not only for power and speed, but for shock absorption as well. The ball-bridge-burnout and dead lifts (using moderate weights) are great ways to strengthen those muscles.

Hamstring Exercises with a Stability Ball -- powered by eHow.com

So the next time, someone says, "You know, running's bad for your joints." Be sure to reply, "Nope, actually it's exactly what the doctor ordered!"

Knees, Knees, Woe the Knees

In two recent posts, I shared two main causes of knee pain for runners—Iliotibial Band Syndrome and muscle imbalance. There are a few other culprits that may be worth checking out if you've addressed the other two causes and you're still having problems—overpronation and leg-length discrepancy.

Almost every runner pronates to some degree. This is normal, but when a runner overpronates sometimes it can cause problems. There's a really simple test you can do to determine if you over-pronate. All you need is a brown paper grocery bag, a cotton ball, and some cooking oil. Lay the bag flat on the floor. Using a cotton ball, spread a thin layer of cooking oil on the bottom of both feet (bare). Next, carefully step onto the bag to make a set of footprints. Now examine your prints and compare them to the illustration. If you have a solid print, you're what is known as an overpronator. Ever heard of the term "flat-foot?" That's you. If you have slight curve in the middle of your print, you're neutral. If you have a very significant curve in the middle of your prints, you're a underpronator or supinator.

Now having said all of that, not everyone fits perfectly into a category. For example, I have running friends who have flat feet but have a neutral gate and I have running buddies who have high arches that overpronate. Having a gate analysis done where someone observes your actual running gate is the best method for determining your specific gate. Many local running stores as well as sports medicine doctors can examine your gate and help you determine the best running shoe for you.

If you determine that you do overpronate, make sure you use shoes that offer more anti-pronation features. The key word to look for in the shoe description is "stability." If you've tried stability shoes and still have problems, you may want to consult your sports doc and see if orthodics are in order. The sports doc can also help rule out other knee problems that might be causing the pain.

Another possibility for your knee pain could be leg-length discrepancy (one leg shorter than the other). My good friend Gary has been a runner for many years. But a year or so ago, he started having problems with his knees, especially when he upped his mileage. It got so bad that he had to stop running for a while. He went to his sports doc and discovered he actually had one leg longer than the other.

I did a little research and come-to-find-out leg-length difference is often a factor in knee pain. The reason it's a problem is because your body will try to compensate for the discrepancy. For example, your body may try to flatten the foot, drop the hip, or bend the knee to try and make up for the difference in length—all of which adds pressure on the knee.

Putting an orthodic such as a heel raise in the shoe of the shorter leg may be the answer, but you need to have a sports doc determine the cause of the discrepancy first. The difference in length could be something the person was born with and never really noticed until (like my friend) the mileage was upped and the pressure on the knee got to be too much, resulting in pain. Or, the pain could be due to inflexible hips or pelvic rotation, which is often the reason for leg length differences. If inflexible hips or pelvic rotation is the culprit, the doc may prescribe a series of stretches and/or exercises that may completely correct or dramatically reduce the leg-length difference. When this is done, the over compensation should end and your knee pain should go away.
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Now, a good friend of mine—Josh-the Barefoot Runner—will tell you that shoes in general are the culprit. Shoes do tend to make heel-strikers out of many runners. Heel-striking can jar the body causing lots of problems. You can learn to run with a mid-foot or fore-foot strike to alleviate this problem, but it is a little harder to do in shoes. I'm not a heel-striker and I wear shoes. But, if you're interested, check out my post on Josh and his barefoot running. Many barefoot runners will tell you that a whole host of ailments disappeared when they began barefoot running. Josh had several bouts with ITBS and it completely disappeared once he began barefoot running. So, it's definitely worth checking out and you may find that it's just the answer you've been looking for.

Bottom line. Having knee pain doesn't have to mean the end to your running. Take some time and find the root of your problem. Chances are you may be able to correct it and be back on the road in no time!

Don't Run Due to Knee Pain? Read on!

More than not, the reason a non-runner tells me he doesn't run is due to knee pain. "Oh I'd run, but I have bad knees." "My knees just can't take the pounding." It's not just non-runners, though. Former runners will often say the reason they no longer run is due to "bad knees."

Knee problems are often blamed on the constant pounding that a runner does when running. Each time your foot hits the ground the force exerted is about 6 times your body weight. So, if you weight 175lbs, one foot landing in running is taking on about 1000lbs! That's a lot of force! But you know, Mother Nature is a pretty smart cookie. Weren't we designed to walk and run? Okay, maybe she didn't intend for us to run grueling ultramarathons, but shouldn't we be able to handle running 5-10 miles several times a week? The answer is, "Yes!"

So, why do so many of us have knee problems? Well, the problem usually isn't the knee. Knee pain is usually the end result. Earlier this month, I wrote a post on how a tight ITB (iliotibial band) that runs along the outside of each leg can cause knee pain. Muscle imbalance is another culprit for knee pain.

There are several groups of muscles that support the knee. The two main groups are the quadriceps and the hamstrings. The quads are actually made up of four different muscles—Rectus Femoris, Vastus Lateralis, Vastis Intermedius, and Vastis Medialis. The hamstrings consist of three different muscles—Biceps Femoris, Semitendinosus, and Semimembranosus. Other muscles that help stabilize the knee (but to a lesser degree) include your calf muscles, the hip abductors (outer thigh), the hip adductors (inner thigh), and as mentioned earlier, the iliotibial band.

Okay, that's a lot of muscles with big names and you're wondering how all of that's related to your knee. Well, remember that song you sang in elementary school—"Dem Bones"? You remember

Toe bone connected to the foot bone
Foot bone connected to the leg bone
Leg bone connected to the knee bone...

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Well, your body actually works like that. Nothing in your body really works in isolation, it all works together. But, sometimes there can be an imbalance which will cause other areas to work harder. When this happens, sometimes pain can occur.

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Often knee pain is the result of such an imbalance. Sometimes a runner can have strong hamstrings that overpower his/her weaker quadriceps. When this happens it can cause the patella (knee cap) to be imbalanced resulting in pain. Because the quads are weaker, they're not able to support the knee which can cause the knee cap to twist and pull.

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The opposite can also be true. A runner can have dominant quads which overpower the hamstrings. Your quads are typically stronger than your hamstrings, but they should only be about 25% stronger. Quads that are stronger than this can also cause an imbalance in the support of the knee cap.

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To even further confuse you...you can have an imbalance within your quads. Remember there are 4 different quad muscles. If the inner quad (Vastis Medialis) is stronger, it can pull on the knee cap. If the outer quad (Vastis Lateralis) is stronger, it can pull on the knee cap. Just tight quads in general can also pull the knee towards one side.

So, now that I've fully confused you, what can be done to prevent knee pain. This part isn't as confusing. Just be sure to do a balanced set of quad and hamstring exercises. Runner's don't often go to the gym and when they do, they may hop on the leg extension machine and pop-out a few sets and think that's good. First of all, I don't recommend getting on the leg extension machine. Research has shone that it puts an awful amount or tension and pressure on your knee cap. Your knee's weren't designed to hold that much weight. Think about it. How many times during the course of the day do you naturally extend your knee with 100+ pounds on your feet? Never. The leg extension machine will be adding to your knee pain instead of strengthening your quads.

Exercises good for strengthening your quads and hamstrings include:

• Body-weight, barbell, and/or dumbbell squats—a squat is great for strengthening your glutes, hams, and quads. The deeper the squat, the more the hamstring/glutes are targeted. A quarter squat will target more quad.

• Body-weight, barbell, and/or dumbbell lunges—lunges are great for strengthening your quads. Lunges can be stationary or you can do walking lunges.

• Body-weight, barbell, and/or dumbbell side lunges—side lunges will help strengthen your quads, adductors, glutes, and hamstrings.

• Deadlifts—Deadlifts are one of the best exercises for strengthening your quads, adductors, glutes, and hamstrings. Be sure to use proper technique. Stand in front of the barbell. Squat down and grab the bar using an overhand-grip with one hand and an underhanded-grip with the other hand (this provides a nice secure grip). Your hands should be positioned just outside your legs when you squat down. Keeping your back flat and your head up, stand up with the barbell while pulling your shoulders back. Slowly return the barbell back to the floor, still keeping a straight back and head up. You don't have to do a ton of weight to get benefits from a deadlift.

• Jumpsquats—this simple exercise can be done with just your body weight or you can hold a medicine ball to raise the difficulty level. To do a jumpsquat, simply descend until your thighs are parallel with the floor, then immediately fire upward using your thighs and calf muscles to jump off the floor. Upon landing, immediately go into your next jump. Try doing 3 sets of 15.

• Stability ball leg curls—this looks really simple, but beware! They are killer for your hamstrings! Simply lie on your back (on a mat) with legs extended and your heels resting on top of a stability ball. Your hands should be beside you resting on the floor. Use your heels to pull the ball toward your buttocks. The ball will roll from your heels to the bottom of your feet. Then slowly extend your legs and return the ball to starting position. Try doing 3 sets of 12 reps.

These are just a few of the many exercises that target your hamstrings and quads. The key is balance. If you do an exercise that targets the quads, follow it up with a hamstring exercise. It's also a good idea to have a personal trainer or your running/workout buddy check to make sure that you're using proper technique when doing these exercises, especially the squats and lunges. A key thing to look for when doing a squat or lunge is that your knee does not go past your toe during the squat/lunge. Also, stand in front of your buddy while he/she does a body-weight squat. Check to make sure his/her knee (one or both) is not turning inward during the squat (this is called Valgus Knee). The knee should remain neutral. Also check and make sure that his arch isn't collapsing inward. This inward motion of the arch or knee needs to be addressed before continuing with your squats. A personal trainer can help you correct this. Proper technique is very important with these exercises.

Need ITB Relief? STRETCH!

ITB (Iliotibial Band Syndrome) is one of the most common aliments of runners. ITB often presents itself as pain on the outside of the knee. Overpronation or underpronation can often be the cause of ITB, but more than not, it's due to inflexibility.

Runners often think ITB is a knee problem. That's because the pain along the outside of the knee is the end result. Actually, the Iliotibial Band is a part of a longer tract which includes the Tensor Fasciae Latae (TFL) that originates at the iliac crest continuing down to the Iliotibial tract and attaching to the tibia in the lower leg just below the knee. This muscle braces the knee when walking. Without the iliotibial band your leg would collapse. Handy muscle, huh?

The real culprit often causing Iliotibial Band Syndrome is the 9-to-5 job desk job. Think about it, if you sit at a desk for 8, 9, 10 hours, your hip flexors aren't living up to their name. They're not flexing. They're stuck in the same bent position, getting tighter and tighter. Then you hop up and go for a run most times without any stretching before or after. A combination that spells Iliotibial Band Syndrome over time for some.

Stretching is one of the best ways to help recover from Iliotibial Band Syndrome as well prevent it from happening in the first place. [Click here] for some great stretching and strengthening exercises for Iliotibial Band Syndrome from Running Times.

Stretching of course isn't the ITB "cure-all" for everyone, but it is worth talking to your sports doc about. Also, if you haven't experienced ITB problems, starting a regular stretching routine consisting of dynamic stretches before your run (i.e., stretches that are comprised of active movement specific to running such as butt kicks, knee lifts, jump squats, side shuffles, etc.) and static stretches after the run (more traditional stretch-and-hold type movements) will hopefully keep you ITB-problem-free. For more information on dynamic and static stretches [click here.]