The era of running as a fitness activity superimposed upon the competitive sport programs has resulted in many knee and leg overuse problems. Three of the most common running problems are runners knee, shin splints, and Achilles tendonitis/tendinosis.
An analysis by The American Academy of Orthopedic Surgeons reveals that about one fourth of all problems treated by Orthopedic Surgeons involve the knee. This estimate is fairly consistent with the patient population of our Sportsmedicine Orthopedic Clinic as well. Although many problems are torn ligaments and cartilage usually associated with collision sports such as soccer and football, many knee ailments associated with running are a loose compilation of pains associated with the knee cap, the so called runners knee.
Runners knee affects aerobic exercisers, cyclists, swimmers, and other running and jumping sport participants as well. The basic problem is roughening or arthritis of the surface under the knee cap as well as tendonitis/tendinosis of the lower and sometimes the upper knee cap tendons. The knee cap is designed to move up and down but because of mechanical alignment problems (such as knock knees or flat feet) the knee cap slips sideways. This sideways movement increases friction and over the years causes the joint surface to roughen. The symptoms of runners knee are crunching sensations behind the knee cap especially with stair climbing and descent, and knee cap pain when the knee is bent as sitting in a theater. Swelling and increased pain often occur with running, especially on hills or uneven surfaces.
Preventing or treating runners knee includes strengthening the top thigh muscle (Quadriceps) which controls the knee cap and stretching the hamstring muscle. To decrease unwanted stresses on the knee cap, control flat feet with a counter force arch brace or orthotics, run shorter distances, switch to softer running surfaces and change shoes after 400 miles. Anti-inflammatory medicines such as Ibuprofen, proper warm up and ice after exercise are all helpful. Accurate diagnosis and supervised treatment is indicated if symptoms persist over 3 - 4 weeks.
Shin splints is also a catch all term but specifically refers to pain along the inner lower shin of the leg and is often associated with running and dance aerobics. The problem is irritation to muscle attachments and the bone covering called Periosteum in the area. On occasions the problem can progress to a stress fracture in the bone. Like runners knee it is often associated with flat feet as well as major weakness to the lower leg muscles. Once the pain is calmed down, major strengthening is needed and control of overuse again by proper training techniques, and bracing are important.
Achilles tendonitis/tendinosis has mechanical issues (e.g. heredital problems) similar to shin splints, primarily flat feet. For some reason the overuse affects the Achilles tendon more. The breakdown in the tendon just above its attachment to the heel bone causes swelling and pain. Conservative treatment is similar to shin splints. On occasion lingering symptoms in the Achilles tendon as well as runners knee may require surgery.
Running is an important and generally healthful exercise, but like so many things in life abusive excess causes problems. Easy does it and happy trails.
Dr. Nirschl is a practicing orthopedic surgeon and sports medicine physician at Columbia Virginia Hospital Center Arlington, Va. and is Associate Clinical Professor of Orthopedic Surgery at Georgetown University Medical School in Washington, DC.