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Treatment Recap: Runner with Knee Pain

What does an episode of treatment look like at Zenith Performance and Wellness? Let’s take you inside the treatment room/gym for a brief look at a typical client’s physical therapy experience.

Let’s talk about a high school track runner who came into the clinic with pain on the inside of the knee.The pain came on suddenly with jumping up before a race and landing sideways on the knee. This caused him to walk with a limp and took him out of running. He first tried resting it for a few weeks, but the pain came right back when he tried to run hard on it again.

Rest can be a first approach when something feels ‘off’. However, oftentimes, rest alone is insufficient. When that is ineffective, it is a good time to seek the help of a professional, as this individual did.

When the client decided to seek treatment, he was back to running small amounts, but was still getting knee pain with both sprinting and running uphill. First, we physically moved and tested his knee to ensure he didn’t have any damage to the structures like the ligaments and meniscus, since those can get injured with this type of jumping/landing injuries.

On their first visit to the clinic, he experienced knee pain with simple movements like stepping off a step, and squatting on one leg. He had very limited balance and control when trying to do these tasks on the painful leg. (These are both motions that runners should be able to do well). Despite being a fast runner, his knee wobbled on the painful side with both tasks, and he shifted through the trunk and knee to make up for the lack of dynamic control. We found weakness in his hip muscles, and tightness in the front of his ankle joint, limiting his ability to bend the ankle up. Being able to bend the ankle is an important component of the motion required for the leg to advance forward with running and squatting motions.

You can be a high level athlete without having mastered important movement patterns. Think what room for improvement is left on the table when single leg strength and control is not mastered.

It is not uncommon for areas above and below the knee to have an impact on what is happening in the knee. A stiff ankle changes the way the knee tracks and moves forward through space. A weak or inhibited hip can contribute to suboptimal shock absorption and power generation at the knee itself. Both of these factors were at play for this individual, contributing to his “runner’s knee.” Although this individual was lifting weights and assumed that was enough, he was not utilizing and challenging the stabilizer muscles above and below the knee that runners need for a clean and efficient stride.

After our initial assessment on the first visit, we started with manual therapy to improve the bend through the client’s ankle joint, to reduce the mechanical stress that the stiff ankle was having farther up the chain on the knee joint. We followed that up with a self stretch to work on at home, and included targeted exercises to address the strength and control deficits we found in the hip and knee muscles.

By the next visit, knee pain

had improved to where the athlete was returning to running on flat surfaces and incorporating quicker strides. We then did a gait analysis in the clinic. We walked through the frames of his gait analysis together, providing cues to help him improve his form. We also tailored drills for him to work on improving the efficiency of his running stride. Another big piece of the running picture for this client was addressing cadence. As a middle distance runner, his cadence was much lower than the ideal range.

Research shows us that when one is not taking enough steps per unit of time, improving this metric can make your running more efficient, and mitigate the forces that contribute to injury risk.

By visit three, the client's knee pain was becoming less frequent, and he was gradually building up mileage and reincorporating some speed and hills. In addition to working on manual therapy to address the joints and tissues of the knee and ankle, we progressed his exercises, incorporating more challenging and running specific movements to challenge his hip and lower leg control.

On visit four, the client’s training was no longer being hindered by pain. This might be a point where a conventional physical therapy clinic would discharge the patient. However, just because the pain is gone, doesn’t mean treatment is over. At Zenith, we know pain is only part of the equation, and don’t end treatment when a patient is back to 80%. So next, we built upon his existing strength plan to tailor to the specific needs of being a runner. We also went over the strength training program he had been doing on his own. We made modifications to make his strength program both more specific to his areas of weakness, and more closely tailored to the specific demands of a middle distance runner.

Early on, we identified factors that contributed to the initial injury. At this point, the client had made good progress, but we were still seeing some asymmetry, or differences, in both control and joint mobility on the previously injured side. If we were to end treatment here, we would be doing the patient a disservice, sending him out still at risk of re-injury.

On the fifth visit, this client was continuing to progress well, and was adapting well to his home strength program. Treatment then started to shift more towards performance physical therapy. We talked about how his strength training, just like his running training, should be periodized based on where he is in his season. With this in mind, we progressed to higher level plyometrics (or jumping) into his program. Yes, his rehabilitation would not be complete without taking his improvements gained through his home exercise program and strength work to the next level. After having built a stronger foundation, we got back to the type of movement that caused the client’s knee injury in the first place. Now, he can jump efficiently with good mechanics, without knee pain or fear of re-injury, and is doing so on a regular basis.

Now, as this client continues to work on his home program independently throughout his season, we have transitioned into “Maintenance” physical therapy. In this format, we touch base every four to six weeks, working on little niggles as they crop up, providing guidance with his program as appropriate, and progressing his strength and athletic development program. This helps him stay on track and progress his training under our expert guidance. It also allows us to address little issues before they have the chance to evolve into an injury that interferes with his ability to train, compete, and continue to love his sport.

If you are interested in learning more about how Zenith Performance and Wellness can help you, feel free to contact us, or click here to schedule.

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