Running has seen a huge increase in popularity since the beginning of the pandemic as an essentially free and easy way to stay active – but the flipside has been an increase in running-related knee injuries.
As with all sports, there are steps you can take to avoid a mishap that could result in serious injury. We spoke to Mr Akash Patel, a Consultant Trauma and Orthopaedic Surgeon at St John & St Elizabeth Hospital – and a keen runner himself – about best practice for running safely, and some of the common knee injuries that runners might encounter.
A checklist for running safely
A proper warm up is very, very important before you go on that long-distance run. You can do any kind of gentle exercises so that you start off at a slow pace before you really get going. That should include stretching and range of motion exercises – which you can also do on a regular basis to help relax your muscles and reduce your risk of getting an injury.
It’s important to reduce your risk of injuries by having strong muscles. You should do this by exercising in ways besides running, for example walking, going for a swim or to the gym.
Maintain your balance
One of the key issues that we find with patients getting knee injuries is that they might slip or fall over. This is less likely if you’ve got good proprioception – or joint position sense – which will help you to stay balanced. You can improve your proprioception with exercises like standing on one leg and closing your eyes to help build up that joint position sense.
Watch your weight
The heavier that you are, the higher the impact on your knee joint when you’re running. So if you can watch your weight by eating sensibly and having a good diet, you will be putting less strain on your knees when you run.
Plan your runs
Think about how and where you are going to run. In an ideal world, I would recommend flattish ground on a safe type of terrain. If you run on a hilly, mountainous area with lots of rocks, you’re more likely to slip and get injured or hurt your knees – so you’ve got to be sensible about where you choose to run, especially if you’re a beginner.
Wear good, comfortable footwear
It’s vital that you have the right kind of running trainers, and everyone’s feet are different. Obviously, there are lots of different shops and companies that sell different types of shoes, so you’ll need to find something that works best for your feet. There are even labs now that analyse your gait – your walking and running pattern – and design shoes for you, although this process is expensive.
One of the things that happens is people get cramps or get dehydrated – so when you run any kind of long distances such as a marathon the key advice is drink plenty of fluids and make sure you have the appropriate kind of fluid nutrition. That will reduce your risk of getting cramps or other problems, which has a knock-on effect of reducing your risk of having knee problems.
Common knee injuries
Runner’s knee is the most common ailment, which is pain at the front of the knee, where you can get a bit of wear and tear of the tendons and behind the kneecap.
ITB friction syndrome is where tightness of the iliotibial band – around the lateral aspect of the knee – causes it to rub against the bone, resulting in soreness.
Meniscal tears refer to the knee’s meniscus – which is like a piece of rubber that acts as a shock absorber within your knee. Sometimes they can slip or turn, leading to damage that causes either a traumatic injury or a degenerative tear – the latter referring to the wear and tear around your bones and joints that occurs as you get older.
These are the three conditions that runners experience most frequently, but there are many different things that can go wrong with the knee.
The most common treatments for knee injuries
Our treatments for knee injuries fall into two broad categories: operative and non-operative. The former refers to injuries which require an operation, the latter to injuries that require activity modification on the part of the patient – for example if they’re running for 90 minutes five times a week, we’d advise they reduce the amount of running they’re doing.
Non-operative treatments might also include analgesics (i.e. painkillers and anti-inflammatories). There are also injections, which could involve steroids or platelet-rich plasma, or a jelly-like substance called hyaluronic acid. Physiotherapy would be another non-operative treatment, to help patients with strengthening muscles, range of motion or balancing.
Operative treatments are most often for meniscal tears, where an operation would be carried out to either remove or repair the meniscus.
There are also osteochondral injuries, which is where small bits of cartilage and bone are damaged, and caused by slips and falls. One treatment option would be to remove the fragment and carry out a micro-fracture treatment by drilling holes into the bone, or another option would be to repair the broken fragment.
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