Runner’s knee.

June 2019 newsletter.

Source : Text in part from “Running Doc’s Guide”, by Dr. Lewis G. Maharam, MD.

Runner’s knee does not happen only to runners.  It is a condition with many names: chondromalacia patella, anterior knee syndrome, patella femoral disorder, and, of course runner’s knee.  It is seen every day by health care providers.  Understranding the real cause makes treatment easy and pain relief possible in a short period of time.

When it comes to runner’s knee, biology is destiny.  Anyone whose foot rolls inward (overpronation) during a stride is a candidate, but the real high-risk frontrunners are people with extremely flat feet; a large, pronating forefoot; or a Morton’s foot (a foot where the second toe is longer than the first), causing an exaggerated rolling in, or pronation.

Of all the aches and pains that one can get, this one’s probably the easiest to get rid of.  If you were doing some serious running mileage over the summer, maybe getting ready for a fall marathon, or pain came on “all of a sudden” without any apparent injury and your knee suddenly started to get sore when you walked up and down stairs, or you felt stiff when you were sitting in a movie, you most probably have it.  You could have come down with it when you were 12, or 65.  And the treatment, which is not complicated or extensive, is the same for everybody from kids to grandparents.

It all starts with the kneecap.  In a perfect world, your kneecap rides up and down in a V-shaped groove that sits just behind it as you walk, run or cycle.  More typically, however, your foot rolls in, or pronates, as you move from heel strike to toe-off, and the kneecap ends up scraping along one side of the groove instead of sliding smoothly up and down the middle.  The cartilage there doesn’t much like getting sandpapered down that way, nor does the back of the kneecap, which begins to weep fluid that in turn produces a feeling of stiffness. 

It a easy condition to diagnose: joint hurts, no particular injury caused it, worst going upstairs and downstairs or walking down an incline, stiffens after sitting a while, feels like it needs to be stretched. 

Despite what you may have read, arthroscopic surgery is not the immediate answer.  Surgery helps perhaps 1 out of 100 sufferers.  One favored operation consists of mechanically smoothing the rubbing surface of the kneecap; this treatment can give relief for six months or so, but unless your biomechanics have changed, it’s a borrowed-time fix. 

A proper orthotic is the single most important step because it will prevent the roll that caused the scraping in the first place.  The good news is that once you start wearing the orthotic, your knee cooperates quickly; the patella, cartilage that’s been rubbed down is able to regenerate and heal itself.  Just give it the chance.

But orthotics alone won’t do it.  You need your other ally, the medial quad, which is the muscle in the front inside of your thigh that’s supposed to hold the kneecap in the center of the groove.  The stronger your medial quad muscle is, the better it can do its job.  To strengthen it, you need to perform the “terminal” leg extension exercises (see image), which limit the motion to the last 6 inches of extension.  Do them daily until the pain disappears, then twice weekly.  And do both legs, please, even if only one leg hurts.  Your knees are a matched pair, and what’s already happened on one side is a good bet for the other someday.

Knee sleeves and elastic bandages are out.  Think about it.  If you compress the kneecap, every motion will press it into the groove.  Keep it loose and free.  So make these exercises a part of your weekly routine, keep wearing your orthotics and you can rid yourself of this unnecessary pain forever.

Limited quad extensions for runner’s knee.  1. Sit up on a desk or high surface, stick your leg out straight, drop it about six inches, and if possible support it with a chair or stool.    2. Wrap your ankle with a weight bag or strap made for the purpose.    3. Lift only the last six inches (about 30 degrees) to full extension, hold for three seconds, and then come slowly back down.  Do 5 sets of 10 reps each day, with just enough weight that you get to 5 or 6 on that fifth set and have to stop.

Achilles Tendinitis

Text from “Running Doc’s Guide to Healthy Running”, from Dr. Lewis G. Maharam, MD.

Any sport that keeps you on your feet and uses a pushing-off motion can produce Achilles tendon trouble. Orthotics are usually prescribed, but stretching is always your first defense.

The Achilles tendon, which is formed from your calf muscles, can be pushed beyond its limits and become inflamed. That’s the tendinitis to wich most athletes ascribe pain. There can also be some swelling tendinosis, or chronic tendinitis, above the upper heel. But every time the tendon gets inflamed, and certainly every time the pain comes from more serious microtears in the overused tissue that can easily be mistaken for tendinitis, the Achilles grows just a little weaker.

What brings the condition on besides simple overuse? The Achilles is vulnerable to misuse. Designed to do its job of guiding the heel in a vertical plane, it’s intolerant of the rolling of the ankle when it overpronates (rolls inward) or supinates (rolls outward). Stretching and an orthotic can help prevent the inflammation by biomechanically allowing the tendon to pull in proper alignment.

But a calf muscle routinely loosened by conscientious stretching every day and after a workout cuts the tendon some slack, particularly in stiffer athletes, reducing the tendon’s role as a shock absorber – for witch it’s not very well suited anyway.

So on those hectic days when stretching seems too much of a bother, remind yourself that a neglected and partially torn tendon needs to rest and heal in a cast for six to eight weeks unless you like courting a rupture.
And if that tendon does pop? The gulf between the two ends creates a hole you can actually feel. A clock has just started ticking, during which the tendon’s two ends will drift apart. As soon as possible you must decide if you want the rupture repaired by surgical reattachment of the ends – the best choice for most athletes. After the operation, you will have to wear a cast or cast boot at first and then undergo probably 9 to 12 months of therapy. The sooner the surgery’s done, the easier the repair. Or you can just go into a cast for maybe 8 to 12 weeks and accept whatever healing nature is able to provide – probably a weaker result and longer recovery. Given all this, a couple of minutes of prevention does not seem like such a bother after all…

So what do you do if stretching alone doesn’t work? The longer you take before you seek help, the longer the problem will take to fix. All structures in the body constantly remodel (at different rates). The Achillles tendon gets its strength by its fibers lining up in parallel. In its originating calf muscles are inflexible, living in an environment of overpronation and inflammation (tendinitis), remodeling proceeds with the fibers lining up every which way instead of parallel. This results in a weakened, swollen, painful tendon, which is the definition of tendinosis (instead of tendinitis). This tendon is more easily prone to tear, and you will need a full-length flexible orthotics (worn full-time instead of just when running) and physical therapy for eight or more weeks minimum.

Recreational activities to minimize stress and prevent back pain.

Source: Canadian Chiropractic Association.

Going to the chiropractor can help relieve pain and prevent injuries, but being active is also a great way to help keep your spine healthy. Just going for a brisk 10 minute walk each day is enough to help improve your health and prevent conditions of the spine, joints and supporting structures of the body. But there are also a few other recreational activities that you can incorporate into your daily routine to prevent back pain and reduce stress.

Here are a few suggestions and why you may benefit from them:

Yoga and Pilates:

Yoga and Pilates are forms of exercise that typically focus on moving the body while focusing on breathing and body awareness. The poses are purposeful and usually work a few areas of the body at once, including the back and leg muscles to build a stronger foundation for other movements. Also, the poses often focus on balance which can be important to prevent falls and injuries as we age. Compared to higher impact activities that cause added strain to the body, Yoga and Pilates are known to be ‘safe’ for healthy and even injured individuals. Yet, with most practices being keenly aware of your body is important and adapting movement to your skill level. However, regular practice has been shown to decrease back pain. The great thing about Yoga and Pilates is that there are several types of classes catered to your specific skill and comfort level.


Aquafitness is a dynamic, low impact activity that usually involves the entire body in movement, including the abdominals, gluteal, and leg muscles. Since the movements are done in water, the water adds extra resistance to strengthen muscles but also minimizes impact on your joints. Aquafitness has been shown to be an effective management tool for those suffering from certain MSK injuries allowing them to keep active. Notably, people suffering from low back pain may particularly benefit from aquafitness or gently swimming in water.

Tai Chi

This Chinese martial art focuses on meditative, deep breathing combined with methodical practice of slow movement enhancing mobility and balance among those who practice the art. Tai Chi is known to have major health benefits – even for those with back pain. Tai Chi can improve pain and function, while decreasing likelihood of chronic pain. It is a safe and effective activity for those experiencing long-term back pain symptoms.

Other activities you may want to consider are low-impact cardiovascular exercises such as walking or striding on the elliptical machine. There are always alternatives to staying active, even when you experience pain. Some of these can even help relieve the pain.

If you’re looking for ways to stay active and relieve pain, meet with your chiropractor to discuss more options.