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Nobody likes the “Injured Runner” life

Brodie Sharpe / Founder & CEO The Run Smarter Series

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<p>One of the most common injuries for runners is Patellofemoral joint pain AKA ‘Runner’s knee’. This injury is due to an overloaded kneecap with activities such as running, sitting and squatting. For more information about PFJ pain you can refer to&nbsp;<a href="https://runsmarter.online/treat-running-injuries/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to treat your running injury</a>. However, in this blog we will discuss if it’s okay to run with pain.</p><h4>Can you still run with Patello-femoral pain?</h4><p>It is never a fun experience for anyone, but can you still run with this condition? If your symptoms are irritated with walking, you might need a day or 2 of rest. But&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/17307888/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">research has been published</a>&nbsp;to show low levels of pain during and after exercise may help recovery. Because this injury is correlated to spikes in training load, it’s best to return with a conservative mileage while constantly paying attention to symptoms. As a rule of thumb, pain levels below a 5 out of 10 during a run that stays at low levels the following 24 hours is a sign of success. If pain levels are higher then a 5, try combining a run with treatment and re-evaluate running symptoms.</p><h4>Runners knee treatment?</h4><p>If your Runner’s knee is proving to be more stubborn, a visit to the physiotherapist may be necessary. Running can still be achieved but treatment may be implemented in the short term to reduce symptoms while you continue running. These include:</p><ul><li>Patella taping</li><li>Quad stretches</li><li>Running gait retraining</li><li>Patella mobilization</li></ul><p>Keep in mind that research for a knee injury recommends the above treatments for short-term benefits only. For long-term results, a tailored strengthening program is gold-standard. If pain levels are still elevated then running may need to be substituted with&nbsp;<a href="https://runsmarter.online/cross-training-tips-for-running-injuries/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">cross-training and strengthening</a>&nbsp;for 2-3 weeks. Once symptoms are settled, working with your running coach, physio or health professional to implement a return to run program will allow a swift recovery.</p><h4>Relevant Blog posts</h4><ul><li><a href="https://runsmarter.online/run-more-without-injury/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How do I run more without injury?</a></li><li><a href="https://runsmarter.online/does-tape-benefit-my-running/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">How to know if tape can benefit your running</a></li><li><a href="https://runsmarter.online/when-to-rest-when-to-run-with-your-injury/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Is it Best To Rest Or Run</a></li></ul><h4>Relevant Podcast episodes</h4><ul><li><a href="https://runsmarter.online/podcasts/all-things-runners-knee-with-the-boys-from-thats-running-podcast/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">All things Runners Knee with the boys from Thats Running</a></li><li><a href="https://runsmarter.online/podcasts/principle-8-to-overcome-your-running-injury-rest-not-always-best/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Rest not always best</a></li></ul><h4>References</h4><ul><li><a href="https://pubmed.ncbi.nlm.nih.gov/17307888/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Research on healthy pain levels during rehabilitation: Silbernagel et al. 2007</a></li></ul><p><br></p>

Running with a knee injury: Good or Bad?

<p>Most runners know what and where the ITB is located. Some of you may have even experienced iliotibial band syndrome resulting in pain on the outside of the knee. Commonly, this condition is linked to female runners, perhaps with a lower cadence &amp; a recent bout of downhill running. I thought I would help shed some light on the ITB and provide some tips if pain is occurring.</p><h3>Your ITB pain is not from tightness</h3><p>This is the most common fallacy around the ITB. You may have the perception of ITB tightness and dry needling, massage, foam rolling may help reduce symptoms. However, it most certainly isn’t ‘releasing’ the ITB. This extremely thick fibrous band is consisting of strong connective tissue, not muscle. It doesn’t contain any elastic properties and surgeons even report the ITB blunting their scalpel when operating! The perception of tightness may be due to the tissue and surrounding structures being overloaded. Now that is understood let’s explore further.</p><h3>Consider your running bio-mechanics</h3><p>ITB syndrome is more common in females due to the greater angle created from your hips to your knee during midstance. If you view a runner from behind, you will see the knee cutting in toward the midline in relation to the hip. This will put the ITB under more tension especially if it is combined&nbsp;<a href="https://runsmarter.online/running-cadence-take-full-advantage/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">with a low step rate (under 160)</a>&nbsp;and a<a href="https://runsmarter.online/running-technique-step-width/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">&nbsp;‘crossover’ strike pattern</a>. If you think this might be the case, then having your running assessed is the best option.</p><h3>Modifications &amp; gait retraining</h3><p>If you wanted to settle down symptoms or prevent symptoms the first intervention might include changing your training, for example spikes in training load. If you have identified a crossover pattern (see image below) in your running or a lower cadence, then gait re-training is a good option. Otherwise, running uphill while walking downhill can be a good solution until symptoms calm down. Another preventative approach is to include terrains like trial running where you have more foot placement variety.</p><h3>Consider hip control &amp; strength</h3><p>Even though the evidence shows that hip strengthening does not alter running biomechanics, it does help your body become more resilient when tolerating load. Get your glutes, quads and hamstrings has robust as you can and your ITB will have more reinforcements when tolerating the load required for running.</p><h4>Relevant Blog posts</h4><ul><li><a href="https://runsmarter.online/running-cadence-take-full-advantage/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running cadence: How the take full advantage</a></li><li><a href="https://runsmarter.online/running-technique-step-width/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The running technique: Step width</a></li><li><a href="https://runsmarter.online/running-and-stretching-is-there-benefit/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Running &amp; Stretching is there any benefit</a></li></ul><h4>Relevant Podcast episodes</h4><ul><li><a href="https://runsmarter.online/podcasts/itb-friction-syndrome-what-you-need-to-know/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">ITB friction syndrome: What you need to know</a></li><li><a href="https://runsmarter.online/podcasts/the-benefits-of-trail-running-with-daniel-farrugia/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The benefits of trial running with Daniel Farrugia</a></li></ul><h4>References</h4><ul><li><a href="https://www.researchgate.net/publication/230893219_Iliotibial_Band_Syndrome_in_Runners_A_Systematic_Review" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Iliotibial Band Syndrome in Runners A Systematic Review 2012.</a></li></ul><p><br></p>

How to Overcome ITB Issues

<h3>Our current understanding of Osteoarthritis in running</h3><p>There are currently leaps forward in our understanding of Osteoarthritis (OA). However, it requires a bigger leap to spread the message into the community. It is a common question. Does running cause OA? It’s truth there are wild,&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/31192807/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">misconceptions</a>&nbsp;about this condition. Among them, beliefs that OA presents as&nbsp;<strong style="color: rgb(16, 94, 162);">bone-on-bone</strong>&nbsp;due to joint over-use. However, this cannot be further from the truth. In fact, the team at&nbsp;<a href="https://bodylogic.physio/conditions/arthritis-treatment/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Body Logic Physio</a>&nbsp;have shown the hard facts perfectly in the picture below.</p><p>Not only is OA&nbsp;<strong style="color: rgb(16, 94, 162);">not&nbsp;</strong>caused by pounding the pavement, it has been shown that cartilage growth is stimulated when striking the ground. Therefore,&nbsp;<strong style="color: rgb(16, 94, 162);">the act of running and hitting the pavement helps OA</strong>!</p><blockquote><a href="https://academic.oup.com/rheumatology/article/57/suppl_4/iv1/4975696" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Hunter, 2018</a></blockquote><blockquote>“This is no longer a cartilage-centric disease and archaic terms such as wear and tear and degenerative are now considered inaccurate”.</blockquote><h3>Does Running increase the likelihood of OA?</h3><p>&nbsp;<a href="https://pubmed.ncbi.nlm.nih.gov/28504066/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">A study</a>&nbsp;in 2017, collected a massive population of 125,810 people in an attempt to determine the likelihood of OA in runners and non-runners. Interestingly, they discovered 10.2% of non-runners had OA while only 3.5% of runners had OA. In other words,&nbsp;<strong style="color: rgb(16, 94, 162);">you are 3 times more likely to suffer from knee OA if you are a non-runner!</strong>&nbsp;This would make a lot of sense from our discussion above. Runners ARE hitting the ground on a regular basis which helps joint health. Additionally, runners are likely to have healthier lifestyle habits such as maintaining a good body weight, correct stress levels and maintaining strong muscles surrounding the knee.</p><h3>How to run while managing Osteoarthritis</h3><blockquote>“Among individuals at least 50 years of age with knee OA, running was not associated with worsening knee pain”.</blockquote><p>Their is less risk of runners developing this condition, there are still 3.5% of us running with OA. Dealing with flare-ups is expected but do not interpret this as your joints getting worse. Your plan will include carefully monitoring activity levels to avoid any spikes in load and building strength in the legs and hips. If a flare up occurs, having a proactive ‘flare-up plan’ and avoiding complete rest is often best. Also, consider other factors that may increase the sensitivity of the joint which could contribute to a flare up. These factors would include stress, loss of quality sleep, nutrition, medication, alcohol and fear.</p><p>Therefore, it should be made clear that running with OA is perfectly acceptable. In fact, it is recommended! Ensure the activity levels are tolerated well, maintain a healthy body weight, practice an overall healthy lifestyle, stay educated on the facts about this condition and maintain a high level of strength and you have set yourself up for success!</p><h4>Relevant Blogs:</h4><ul><li><a href="https://runsmarter.online/what-runners-need-to-know-about-bone-density/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">What Runners need to know about Bone Density</a></li></ul><h4>Relevant Podcast episodes:</h4><ul><li><a href="https://runsmarter.online/podcasts/survive-thrive-as-a-masters-runner-with-matt-walsh/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Survive &amp; thrive as a masters runner with Matt Walsh</a></li><li><a href="https://runsmarter.online/podcasts/knee-oa-misconceptions-with-kevin-maggs/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Knee OA misconceptions with Kevin Maggs</a></li></ul><h4>References:</h4><ul><li><a href="https://pubmed.ncbi.nlm.nih.gov/28504066/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">The Association of Recreational and Competitive Running With Hip and Knee Osteoarthritis: A Systematic Review and Meta-analysis</a></li><li><a href="https://pubmed.ncbi.nlm.nih.gov/31192807/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis.</a></li><li><a href="https://bodylogic.physio/conditions/arthritis-treatment/" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Body Logic Physio Arthritis Treatment</a></li><li><a href="https://academic.oup.com/rheumatology/article/57/suppl_4/iv1/4975696" rel="noopener noreferrer" target="_blank" style="color: rgb(16, 94, 162);">Hunter. Osteoarthritis: time for us all to shift the needle (2018)</a></li></ul>

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