Runners Knee – Chondromalacia

Definition:

A softening or wearing away and cracking of the cartilage under the kneecap, resulting in pain and inflammation. The cartilage becomes like sandpaper because the kneecap is not riding smoothly over the knee.

Symptoms:

Pain beneath or on the sides of the kneecap, crepitus, (grinding noise), as the rough cartilage rubs against cartilage when the knee is bent.

Causes:

• Overpronation (feet rotate too far inward on impact) – can cause the kneecap to twist sideways
• Weak quadriceps (thigh) especially the inside quad can prevent the kneecap tracking smoothly.
• Muscle imbalance, weak quads and tight hamstring and Iliotibial band (ITB).
• Incorrect or worn shoes
• Overtraining

Iliotibial Band Syndrome – ITB

Definition:

The ITB is actually a thick tendon-like portion of another muscle called the tensor fasciae latae. (TFL). The band passes down the outside of the thigh and inserts just below the knee. The main problem occurs when the TFL and ITB become tight. This causes the tendon to pull the knee joint out of alignment and rub against the outside of the knee, which results in inflammation and pain.

Symptoms:

• Initially a dull ache 1-2 kms into a run, with pain remaining for the duration of the run. Pain disappears soon after stopping running.
• Severe pain which prevents running, worse on downhill or on cambered surfaces, walking up or downstairs.
• Local tenderness and inflammation

Causes:

Overload on the ITB can be caused by a number of things. They include

• Exercising on hard surfaces, like concrete
• Exercising on uneven ground
• Increasing exercise intensity or duration too quickly
• Running in worn out or ill fitting shoes
• Excessive uphill or downhill running

Biomechanical Causes

• Leg length differences
• Tight stiff muscles in the hips and legs

Medial tibial stress syndrome ( shin pain on inside of lower leg).

Definition:

Inflammation of the muscle attachments and interosseous membranes to the tibia (shin bone) on the inside of the front of the lower leg

Symptoms:

• Pain or tenderness along the inside of the shin, usually about half way down
• Painful to touch
• Severe pain at the start of a run, but may disappear during a run, as the muscles loosen up

Causes

• Inflexible calf muscles and tight Achilles tendons.
• Overpronation (feet rotate too far inward on impact)
• Excessive running on hard surfaces
• Incorrect or worn shoes
• Overtraining or a rapid increase in intensity

Plantar Fasciitis

Definition:

An inflammation of the plantar-fascia, a thick fibrous band of tissue in the bottom of the foot which runs from the heel to the base of the toes. When placed under too much stress the plantar fascia stretches too far and tears, resulting in inflammation of the fascia and the surrounding tissues. The tears are soon covered with scar tissue, which is less flexible and aggravates the problem.

Symptoms:

• Pain at the base of the heel which is most severe in the mornings on getting out of bed, and at the begging of a run
• The pain may fade as you change running stride, in an attempt to alleviate the pain

Causes:

• Stress, tension and pulling on the plantar fascia
• Inflexible calf muscles and tight Achilles tendons – place more stress on the plantar fascia
• Overpronation, high arches, and rigid feet
• Incorrect or worn shoes
• Over training

Achilles Tendonitis

Definition:

Inflammation of the Achilles tendon. The Achilles is the large tendon connecting the two major calf muscles, gastrocnemius and soleus, to the back of the heel bone. Under too much stress the tendon tightens and is forced to work too hard. This causes it to become inflamed and overtime, can produce a covering of scar tissue, which is less flexible than the tendon.

Symptoms:

Dull or sharp pain anywhere along the back of the tendon, but usually close to the heel, limited ankle flexibility, redness or heat over the painful area, a nodule on the tendon or a cracking sound with ankle movement (scar tissue rubbing against tendon).

Causes:

• Tight or fatigued calf muscles, which transfer the burden of running to the Achilles
• Poor stretching, rapidly increasing distance, over-training, excessive hill work or speed work
• Inflexible running shoes, overpronation

Management and Rehabilitation

The RICE method should be applied to any soft tissue injury i.e. rest, ice compression and elevation for the first 24 to 72 hours. DO NOT APPLY HEAT OR MASSAGE for the first 24 to 72hrs. After diagnosis (Sports Physician or Physio) physiotherapy will be needed to treat an acute injury and begin the rehabilitation process. Rehabilitation may also involve seeing a Podiatrist.

How Massage Can Help with Management and Prevention of Running Injuries

Massage is a very effective form of injury rehabilitation therapy for speeding the healing process and preventing re-injury.

Massage improves circulation and general nutrition of muscles. It maximizes the supply of nutrients and oxygen through increased blood flow, which helps the body rebuild itself.

Massage improves the range of motion and muscle flexibility, which results in increased power and performance.

Waste products such as lactic acid build up in muscles after exercise. Increased circulation to the muscles helps to eliminate toxic debris and shorten recovery time.

Massage can help prevent over-training. It has a relaxing effect on the muscles, as well as a sedative effect on the nervous system. This can prevent over-training syndrome.

Massage used during rehabilitation can break down and realign scar tissue and adhesions.