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Knee Pain

Knee Pain – All runners’ nightmares

Interest in running and outdoor sports has been in a state of explosion in Vietnam for the past decade.  Every year thousands of runners take to the road, often for the first time in their life.

As with any physical activity, injuries will occur for many athletes, and runners are no exception. Among  the most common injuries that runners suffer are knee pains of various kinds. Chronic knee pain that develops slowly over time and eventually sidelines the athlete, is the most common nemesis for runners, especially in Vietnam, by a factor of many times to any other complaint.  Why?  Is running naturally badDo Vietnamese have naturally weak knees?  

Actually it is none of these.  The reason so many Vietnamese and other South East Asians have so much knee pain comes down to three things, and the first starts with the feet, not the knee. 

Flat feet and knee pain in runners

As we run, the long arch of foot flattens out under impact  and rolls in slightly to act as a shock absorber. This is called pronation, and is a natural part of how the foot works during walking and running.  In Vietnam however, many people have severely flat feet and the foot starts out already rolled into pronation, even before the runner weights it.  During the gait cycle, the foot rolls even further into pronation as the full weight of the body comes onto it, creating a sheer angle between foot and upper leg. The pronation is then translated into rotation of the lower leg causing the knee to twist from side to side during each step, stressing and damaging the joint much more than in a runner with normal feet, whose knees move only back and forth. 

 As the Runner trains he / she gradually damages the knee joint with pain and often swelling build up in the joint.  Flat feet and pronation can be addressed by choosing the right shoes, which are specifically designed to block this excess inward motion. Most major shoe companies make such shoes. Further correction is often needed in the form of a foot orthotic, which can be custom made for the foot to support the arches and also align the foot correctly during the gait cycle.  Finally, changing the running style to a midfoot or fore foot strike, will also often remove the problem of pronation. However it must be gradually introduced to the runners type, otherwise new injuries can occur— especially in the Achilles tendon.  

Running style  

The second cause of chronic knee pain developing in runners is having an improper running style. There are several comports to the way a runner might injure their knees, but the most common problem is to weight the forward foot before the body is fully over the knee joint. This most commonly occurs in new runners trying to lengthen their strides. When the knee is weighted with the foot too far forward, it causes  a shearing force on the knee joint. This can rapidly cause   ligaments of the knee to become stretched, injured and inflamed.  

There are a number of other running form styles that can lead to development of the knee problems, but they are difficult to diagnose and fix.  The best way to assess a runner is with two cameras, one behind and on to the side, and to film the runner in slow motion.  A knowledgeable running coach or doctor who specialize in running can then make the proper assessment and assist the runner in changing their form. 

Source: Altra Running

Over Training

The third most common factor that leads to chronic knee pain in runners is over training.  This simply means putting in too many consecutive and intense runs without adequate recovery.  For any of us who have done a full marathon, having knee pain for several days after is almost a given. This is because the knee joint and shrinking muscles are stressed and injured during the run. All of the tissues of the knee react to the stress of running by growing stronger. The leg muscles of a runner are obviously filled out and defined.  But less well known is that the cartilage, tendons, liniments and bone all get thicker and stronger as well.  

However after a training run, there needs to be adequate rest for the joints to recover and grow stronger.  A well conditioned runner might get away with running 5 to 10 km a day every day of the week, but when a runner begins to up the mileage in preparation for an event, they need to have more rest days. These are either days that they do not run at all, or days that they run much less. 

The more intense the running and the more kilometers a week that a runner starts to put in, the more carefully he or she needs to plan the recovery between races. A good running coach can make the difference between reaching ones potential as a competitive distance runner, and breaking down with chronic knee pain. 

In conclusion, the explosion of interest in running and other outdoor races as well as activities that included running in Vietnam  has been an exciting thing for all of us to be a part of.  In general it is a vey healthy development. Unfortunately, knee pain and knee injuries side line thousands of Vietnamese runners each year.  With proper understanding of the causes leading to these problems and by addressing them, most runners can recover and can run for many years to come— even into old age in many cases.