Monday, September 10, 2018

Runner's Knee - Part V

Last week, we continued our discussion on how to prevent runner's knee with a discussion of some exercises that can be done for recovery as well as some post run training that helps reduce injuries and performance.  This week, we will wrap up our discussion starting with when should you see the MD for your knee pain?
  • When should a runner go to the doctor for their runner's knee?  In many states, you can see a physical therapist for your knee pain and have this covered by your insurance without seeing a physician.  As the musculoskeletal and movement experts, this can often expedite your return to running pain free.  However, it is important to make sure you get with a therapist who understands runners, running biomechanics and the nuances of dealing with runners.  So make sure to do your research.  
    • Some key indications that you should go see a doctor or a physical therapist:
      • Your pain is preventing you from running.
      • Your pain is limiting your activities of daily living.  In other words, you are having pain with ascending/descending stairs, walking long distances, or it is impending your ability to work or stand for prolonged periods.
      • If you feel like your pain is progressively getting worse.  How do you know if it is getting worse?  First rate your pain according to the scale below.  If getting worse, the pain increases in:
        • Intensity – how bad it hurts.  Pain started at a 3/10 and is now a 6/10
        • Frequency – how often it hurts.  Initially only hurt after runs, now hurts when you walk, during work or after sitting for long periods of time
        • Duration – how long it hurts.  Initially hurt only after a run for about 45 minutes.  Now it hurts for 2 days following a run.
      • Your pain is causing you to limp or altering your running gait.

    • Be Proactive - as we spoke about last couple of weeks with ice and increasing recovery methods, you can often prevent your pain from getting to this level.  Being proactive is KEY.
  • What are some holistic, diet, and/or lifestyle changes that runners can incorporate to prevent and treat runner's knee? Proactively runners can do a lot to prevent runners knee. 
    • First have a running assessment by a qualified athletic trainer, running coach or physical therapist.  Majority of runners, novice and expert, would benefit from a through running assessment.  Two traditional running assessments.
      • Video based – in this type of assessment the clinician will have you run on a treadmill while video tapping your running mechanics.  As mentioned previously, there are a lot of things we can assess with video that tells us a lot about areas of weakness, tightness and overall flaws in the running technique. When identified and corrected this will not only improve performance but decrease risk for running injuries. Couple of things for you to determine if this is right place to do your assessment.
        • Do they use an app or software based technology?  Software based is much more accurate technology.  Dartfish is the most frequently used and the gold standard in these assessments.  Use of apps is good but angles are not accurate and people tend to hold their phone to record (provides poor quality of video).
        • Do they have a standardized protocol? Is the camera secured to a tripod or stable surface.  Is there a sequence they go through with you, varying speeds of run, multiple directions.
        • Are you provided with a comprehensive report?  Some will just review the video with you.  Others will analyze the video and provide you with a comprehensive report.
      • 3D Running assessment.  We typically use a 3D wearable sensor technology that allows us to assess how you run on a treadmill and on the road.  With this technology, once your treadmill assessment is complete, we can then hook the sensors up to you and have you do a 10 mile run outside in your environment.  This allows us to see how you run on different surfaces and for a prolonged period of time.  This will provide us with data throughout that entire event and let us see where and when the system is breaking down.
        • Shoe assessment - in several of our facilities we use this technology as well to help runners choose the right shoe.  This allows the runner to try various pairs of shoes and collect biomechanical data to see what is the better shoe for them biomechanically.  This system will provide comprehensive data to allow you to make a more informed choice on what shoe is better for you.  Below is a snap shot of the data that is provided during the run.
    • Second, stay hydrated and eat a proper diet.  Nutrition and hydration have a direct impact on running biomechanics.  Athletes who are dehydrated and who put subpar fuel in the system break down faster.  Proper diet and hydration also aids in soft tissue repair.  This builds a chemical environment that is optimal for soft tissue repair.  Below is the hydration chart which will help determine your level of hydration based on the color of urine.  


    • Third, get enough sleep.  Most of the time runners knee is the result of the tissues being broken down faster than they can repair.  Getting enough sleep and REM sleep is vital for soft tissue repair and recovery.
    • Fourth, if you run a lot, consider finding a provider that provides recovery tools.  What are recovery tools?  Things like the Hypervolt, Normatec boots, Cryotherapy and dry needling.  All of these are research based methods shown in the research to aid recovery.  There are some out there that are not named here that have no basis in the science but being used a lot in recovery.  Stick with what works and what is supported in the research.  It will help you keep on the road, running pain free and continuing to enjoy a healthy life style.
    We hope you enjoyed this series.  We hope you learned something and more than anything, we hope this helps you keep on the road and injury free.  Stay tuned and please share with others you think might be interested.  #ViPerformAMI #ACLPlayItSafe


    Dr. Nessler is a practicing physical therapist with over 20 years sports medicine clinical experience and a nationally recognized expert in the area of athletic movement assessment and ACL injury prevention.  He is the founder | developer of the ViPerform AMI, the ACL Play It Safe Program, Run Safe Program and author of a college textbook on this subject.  Trent has performed >5000 athletic movement assessments in the US and abroad.  He serves as the National Director of Sports Medicine Innovation for Select Medical, is Vice Chairman of Medical Services for USA Obstacle Racing and movement consultant for numerous colleges and professional teams.  Trent is also a competitive athlete in Brazilian Jiu Jitsu.