What Your Knees Need

They're more prone to injury than any other part of a runner's body. But if you know how they work--and how to take care of them--they won't let you down.

Runner’s World—May 15, 2007

Anterior knee pain. Patellofemoral pain. Chondromalacia. Iliotibial band syndrome. No doubt about it, the knee is a cranky little thing. You need only look at it to see why, and how, it differs from the body's other major joints. The shoulder consists of a huge capsular contraption that holds the bones in place. The hip, too, is built like a suction cup.

No such deep-fitting sockets for the knee, which swings almost like a hinge on a gate. But as the knee swings, it pivots to accommodate a thigh bone that's longer by design on one side than the other. Every flexion and extension and simultaneous rotation pulls into play four major ligaments that strap the joint together, some of them passing right through its center. No wonder sometimes it gets sore or swollen—or worse.

The Knee Crisis
We're in the midst of a knee crisis, says Brian Halpern, M.D., a sports-injury specialist at Hospital for Special Surgery in New York and author of the just-released The Knee Crisis Handbook. The knee held the No. 1 spot in a notorious top-10 list last year ["The Comprehensive Study of Sports Injuries in the United States," by American Sports Data, Inc.], beating out every other body part for the greatest number of sports injuries, according to a survey of more than 15,000 households.

Fortunately, for all its complexity, the knee is well designed to perform its most basic function—allowing you to walk and run in a straight line. Every fitness and medical expert recommends brisk walking as a great exercise routine.

That said, no one can deny that runners get knee injuries, sometimes from physical differences that are difficult to control, and sometimes from personal training habits that we should monitor more closely.

High arches and low ones. Bow legs and knock knees. Too little strengthening. Too little stretching. Too many miles. Too many hills. And those are just the major culprits. Another one: the huge number of strides that a runner takes in a week, month, year—about 1,400 per mile. Each stride sends a jolt up your legs and through your knees.

When you walk, a force equivalent to several times your weight travels up your leg with each heel-strike. When you run, the shock forces increase. Yet running researchers tend to be runners, and while they recognize the price they may pay for enjoying their chosen sport, they don't see it as a reason to quit. There's no perfect training formula, but Dr. Halpern and other knee experts believe runners can keep themselves sound--if they pay attention to their bodies and run at a level that's appropriate for them.
 
A Good Start
The best way to protect your knees is with daily stretching and strengthening exercises, and the easiest way to stick to your daily program is to do the exercises at home without any special equipment. Here we show the two best, simplest home exercises to keep your knees in top shape.

ITB Stretch
Stand with one leg in front of, and crossed over, the other leg. Exhale, and bend your body to the same side as your front leg. Hold for a count of 20, straighten up, then repeat the bend nine more times. Reverse leg positions, and repeat 10 times in the other direction.

Quadriceps Strengthener
With your feet side-by-side, extend both arms forward and slowly lower yourself into a half-squat, stopping before your legs are parallel to the ground. Keep your back straight. Repeat 20 times.
Adapted from The Knee Crisis Handbook,
—Brian Halpern, M.D.

Treatment 101
The best bet for preventing a serious knee injury, or any other running injury, is to nip it in the bud. As soon as you begin to feel pain, stop running for several days. In addition, try the following:

• Ice the knee and surrounding tissues several times a day.
• Wrap the knee with elastic tape and elevate it as much as you can.
• Take anti-inflammatories for a week to ease the pain and reduce inflammation.
• Try glucosamine or glucosamine-chondroitin supplements for possible cartilage repair. You'll probably have to take them for at least a month to notice any results.
• Stay fit with cross-training activities (such as walking, bicycling, elliptical training, swimming, and others), but only if they don't hurt your knee.
• When your knee pain is gone, begin a gentle, progressive stretching and strengthening program. Don't do this at the outset, when you are first injured. Wait until you have the pain and inflammation under control.
• Return to your training program with brisk walking, and then run/walk intervals.
• Build mileage and pace very gradually. Avoid hills for a month if possible.