Knee Care 101: It all adds up.. but then what?

I just got done treating myself for an overuse component of knee pain which is ohh-to-common to my patients. How did I do it? Well geeze, I just added an hour onto my longest level three mountain run- (I was lost ok?!) and put a 45 minute race pace downhill at full speed at the end of it (because I was ready to be back to the car.. Not a very smart choice eh?). As soon as I was done, I hit the GameReady machine and kept the swelling and inflammation down but I had definitely over-done it with an increased load on my tendons and muscle fibers. Downhill running requires excellent technique to not get injured (which everyone, I mean everyone should be practicing)... but when those miles and the forces add up, you are bound to have some sort of injury or overuse symptom as a result. Yielding much insight into your "woes" I have decided to add a section to my blog on knee pain/injury and treatment to show you that you too can improve on almost any routine, even if you are one of those "uninjurable types"... pride comes before the fall =) Scenario: Your driving home from a long run (or ride) and you feel your knee begin to cramp up, with pain around and under your kneecap.. what to do? My mentor, Dr. Jeremy Rodgers (Colorado Sports Chiropractic) stated that his most likely reponse in this situation is to pull over and get some ice at a gas station for the region(s) and tape it on tightly (but not too tight, and 20 min max!) with athletic tape-- compression and ice. A strong advocate of prevention, he would also cover abused joints and muscles with compression and ice on the way home after anything that he knew would probably not repair within a day or two. Following his advice, I have found myself running healthy as the trails are getting longer and steeper... and I don't know about you but as I get older, overuse shows up quicker and lasts longer- booh! But why does your knee hurt? The pain felt is often caused by increased pressure in the fluid sac under the patella (Retropatellar Bursa). The knee is surrounded by numerous "bursas" or fluid sacs that keep the pressure and friction as low as possible while tendons and muscle bellies are passing near sharp and pointy bony structures. As the muscles of the knee "clamp" down on the patella, the pressure in the region is heightened. This leads to the all-to-common painful post-run knee pain. But how to keep this from happening? Thats a loaded question. My best advice to keep you running and riding at your peak:

1. Keep the biomechanics as close to neutral (a whole other group of education sessions.. )
2. Watching for overuse or overstrain to an unprepared region (such as increasing speed/climbing/adding miles on too early or in too large of chunks)
3. Preventative Maintenance (Our goal for this conversation!!)

Besides good biomechanics (which unload the knee from abnormal forces) and proper training (which doesnt over-stress your body beyond what it can withstand) preventative maintenance in addition to your training can go a long way to making you faster, quicker, and stronger. What to do? Eat well, keep tabs on what is tight/painful- and work out plan to fix that tight/painful region...muscle work to realign the muscle fibers (deep, full range of motion, ripping scar tissue and reducing abnormal tone), strengthening exercises to reduce overuse on inflammed regions, core stability (just to balance out your strength- did you know your hip flexors go all the way to the back of your spine/ribs by your belly button?! (Psoas). Maintain joint motion and flexability, if something doesnt feel right have it checked out (a duh for me, but keep in mind those of you who hate getting help... what you dont fix causes over-use to another region, so perhaps your knee pain is caused by a problem somewhere else?!?) There is such a thing as abnormal muscle tone. A muscle that is tense, tends to stay tense if it is over-used, compensating for another region (such as another muscle that does a simliar motion), or held together by scar tissue. If you feel a knot in your traps, often it will remain there as bits of scar tissue hold the muscle in an abnormally shortened length. (This is why weight lifters must stretch.. the muscles heal in a shortened position and the joints are unable to go through a full range of motion as they once were (putting you at an increased chance of injury) . Taking time off can decrease muscle tension, but the scar tissue and shortened length of each fiber remains. Fascia what? There is also this amazing component of your body that is called fascia that is effected by this cycle. If we were to look at your muscle, it is encased in what looks like tightly adhered plastic bag that is thicker in regions of overuse and more thin in regions where very little motion occurs. The fascia is very much like a plastic bag as it can be stretched as a force is applied over a period of time (Why some ITB's feel like they have holes or divits in them if you poke around enough). It can also shrink or become shorter as it is abused or over-used which is why some people have hip pain on the top hip while laying on their side or why they feel pain with pressure directly to the fascia on the lateral thigh.

• Example: On a cyclists ITB (Iliotibial band, or the thick fibrous sheath on the outer thigh, this band grows thicker and can cause great pain as it shrinks or stretches.

• Example: On a runner, they can get plantar fascitis as the abnormal overuse from improper gait and usage leads to shortened fascia on the bottom of the foot

• Example: As people walk around with bad posture (slouching with rounded shoulders) their Pecs become shortened and as they age they cannot stand up properly because the ligament on the front of their spine, very similar to fascia, shrinks and will no longer stretch back to neutral!

Fascia is another component of your knee that you might never have thought might yield knee pain. It also needs stretched to maintain proper length.. Test: If your kneecap doesnt "float" left and right without having to put a high amount of force on it, you need to work on loosening the fascia around the knee. Fixing your knee in-flexibility: work on loosening your knee fascia by "floating" your patella medially (towards your midline) and laterally (away from your midline) with a straight relaxed leg. Holding the fascia in a prestretch with one hand to add stress to it, and moving the patella to the side with the other hand works best. Do this daily for a few minutes (I did it for 15 minutes for a few weeks!) until you note that the patella glides either way easily. As a general note, patellas usually glide towards the midline (medially) but have almost no motion laterally in a seasoned athlete who runs/cycles a lot. (This is due to over-use and seasons of that fascia shortening on the weakened side.. possibly caused by weak medial quads, the medial fascia becomes so tight that having tight lateral quads cannot overpower the tight "plastic bag" of fascia that holds it. Good luck you stretchers! As usual, if you have any questions, feel free to shoot me an email or give me a call! Happy Trails, Doc Lisa Notice: Nothing given in this posting is meant to be taken as medical advice but to be used for educational purposes only. If you are suffering from any injury as described above you should seek medical advice as your condition may not be related to this posting. We are not held accountable for any mis-treatment by the readers of the posting and re-iterate that this posting is only meant to be educational for the purposes of knowing when to seek care and why.