Prevention of Knee Injury
Injury prevention is a critical component to the success of runners of all ages, lifestyles, and phases in the sport of running. Likewise, prevention techniques are very important aspects for imaging and physical therapy students to know and understand.
Prevention techniques for the runner will assist in keeping them healthy. These also play an integral role in preventing further injury once patients have recovered from running-related trauma to the knee.
This section will cover proper run form, stretches, management of shoes and orthotics, and strength training for knee injuries.
Prevention techniques for the runner will assist in keeping them healthy. These also play an integral role in preventing further injury once patients have recovered from running-related trauma to the knee.
This section will cover proper run form, stretches, management of shoes and orthotics, and strength training for knee injuries.
Objectives
Upon completion of this section of the module, participants will be able to:
1. Understand, practice, and communicate general injury prevention methods with 80% accuracy.
2. Know how to select a running shoe and how to incorporate foot orthotics with 80% accuracy.
3. Know and put into practice various stretches to prevent knee injury with 80% accuracy.
4. Know and put into practice various strength training exercises that will build knee strength and prevent knee injury or re-injury with 80% accuracy .
5. Counsel patients on proper injury prevention for common types of knee injury that result from running with 80% accuracy. (For imaging and physical therapy students only)
1. Understand, practice, and communicate general injury prevention methods with 80% accuracy.
2. Know how to select a running shoe and how to incorporate foot orthotics with 80% accuracy.
3. Know and put into practice various stretches to prevent knee injury with 80% accuracy.
4. Know and put into practice various strength training exercises that will build knee strength and prevent knee injury or re-injury with 80% accuracy .
5. Counsel patients on proper injury prevention for common types of knee injury that result from running with 80% accuracy. (For imaging and physical therapy students only)
General Injury Prevention
Image courtesy of Creative Commons from sportsEX journals.
Injury prevention is critical to any individual or group who participates in sports such as long and short distance running, soccer, raquetball, football, and other sports that utilize the lower body heavily. We've recently come across a set of injury prevention guidelines that were developed by Amby Burfoot, who is a marathoner and Runner's World editor. He developed 10 "laws" that will keep runners on the road more and in therapy less. They are listed below.
1.Know your limits.
The muscles and joints need time to recover in order to be able to keep up with and handle the demands of constant training. Making haste during the healing phase could cause a breakdown (injury) rather than increased performance. For this reason, runners and injury patients alike sould increase their mileage gradually.
2. Listen to your body.
Running through the pain can cause more harm than good. When pain is first noticed, especially if it gets worse during a run, that is an indication to take a breather. Take a few days off to recouperate, then begin to and continue to get back into your normal schedule gradually.
3. Consider changing your run form by shortening your stride.
An overly wide stride can cause injury and ultimate may lead to a drop in efficiency. Prevention consists of running at your regular stride--only shorter. This shortened stride decreases the impact load and your feet will land "softer".
4. Use strength training to balance your body.
Increasing the strength in your hips (which includes the glutes, abductors, and adductors) has been shown to increase leg stability for the entire leg--all the way to the ankle. Leg stability and proper positioning of the pelvis and lower-extremity joints keep runners from losing symmetry; lost symmetry is when patients begin to have issues.
5. RICE works!
Nothing is better for aches and pains for immediate relief than Rest, Ice, Compression, & Elevation. Following these steps speeds healing and if done when you first feel you've sustained an injury.
1.Know your limits.
The muscles and joints need time to recover in order to be able to keep up with and handle the demands of constant training. Making haste during the healing phase could cause a breakdown (injury) rather than increased performance. For this reason, runners and injury patients alike sould increase their mileage gradually.
2. Listen to your body.
Running through the pain can cause more harm than good. When pain is first noticed, especially if it gets worse during a run, that is an indication to take a breather. Take a few days off to recouperate, then begin to and continue to get back into your normal schedule gradually.
3. Consider changing your run form by shortening your stride.
An overly wide stride can cause injury and ultimate may lead to a drop in efficiency. Prevention consists of running at your regular stride--only shorter. This shortened stride decreases the impact load and your feet will land "softer".
4. Use strength training to balance your body.
Increasing the strength in your hips (which includes the glutes, abductors, and adductors) has been shown to increase leg stability for the entire leg--all the way to the ankle. Leg stability and proper positioning of the pelvis and lower-extremity joints keep runners from losing symmetry; lost symmetry is when patients begin to have issues.
5. RICE works!
Nothing is better for aches and pains for immediate relief than Rest, Ice, Compression, & Elevation. Following these steps speeds healing and if done when you first feel you've sustained an injury.
Knee Ligaments, [Public domain], via Wikimedia Commons
6. Run on level surfaces
One little known fact about running on the road facing traffic is that although you are safer when you run facing traffic, road camber is constantly working against you and increasing the risk of injury. The way road camber works is that as you are placing you left food down on a slant, limiting healthy pronation of the foot. Meantime, your right foot is coming down in a position that encourages overpronation of the foot. Alleviating injury this way can come from simply running on a greenway or bike path. For those patients that already have an injury, consider running on a treadmill.
7. Do not race or do speed-work too often
Training for speed once or more per week then participating in a race on the weekend may be acceptable for those racing for a medal, however, for the majority, this is a great deal of hard work and does not allow sufficient time for rest and recovery if done regularly.
8. Stretch the back of your legs.
If there was a list of "Best Muscles for Runners to Stretch", hamstrings and calf muscles would top off the list. Flexibility in the hamstring and hip-flexor muscles show to improve knee function while calf muscle flexibility keep the Achilles tendon and plantar fascia good and healthy. Dynamic stretching (controlled leg movements that improve range of motion & loosens muscles) are effective for this area as a warmup prior to a run.
9. Cross training provides active rest and recovery.
Most runners will benefit from at least one non-running day within a week. If you are prone to injury, consecutive running day should be avoided. Training on an elliptical machine, cycling or spinning, and swimming are excellent options.
10. Get shoes that fit.
Because of the many different sports and many different surfaces that individuals can train on, the running shoe industry has changed greatly. There are more shoes to choose from than ever--cross-country, triathlon, track, walking, and cross-training are just a few. The critical point is to select the correct shoe...GET FITTED! (Read below for further information on proper footwear)
One little known fact about running on the road facing traffic is that although you are safer when you run facing traffic, road camber is constantly working against you and increasing the risk of injury. The way road camber works is that as you are placing you left food down on a slant, limiting healthy pronation of the foot. Meantime, your right foot is coming down in a position that encourages overpronation of the foot. Alleviating injury this way can come from simply running on a greenway or bike path. For those patients that already have an injury, consider running on a treadmill.
7. Do not race or do speed-work too often
Training for speed once or more per week then participating in a race on the weekend may be acceptable for those racing for a medal, however, for the majority, this is a great deal of hard work and does not allow sufficient time for rest and recovery if done regularly.
8. Stretch the back of your legs.
If there was a list of "Best Muscles for Runners to Stretch", hamstrings and calf muscles would top off the list. Flexibility in the hamstring and hip-flexor muscles show to improve knee function while calf muscle flexibility keep the Achilles tendon and plantar fascia good and healthy. Dynamic stretching (controlled leg movements that improve range of motion & loosens muscles) are effective for this area as a warmup prior to a run.
9. Cross training provides active rest and recovery.
Most runners will benefit from at least one non-running day within a week. If you are prone to injury, consecutive running day should be avoided. Training on an elliptical machine, cycling or spinning, and swimming are excellent options.
10. Get shoes that fit.
Because of the many different sports and many different surfaces that individuals can train on, the running shoe industry has changed greatly. There are more shoes to choose from than ever--cross-country, triathlon, track, walking, and cross-training are just a few. The critical point is to select the correct shoe...GET FITTED! (Read below for further information on proper footwear)
Injury Prevention with Proper Footwear & Orthotics
Any given shoe is not 100% guaranteed to stop an injury or heal an injury if you have one, but the correct shoe on the correct runner can definitely help in prevention as they cannot prevent injury that occurs as a result of weak muscles or training accidents. A good rule of thumb is to replace your shoes every 300 to 500 miles (less often if you run long distances more often). Different types of athletic shoes and their characteristics are below.
Orthotics should be used to help cushion the foot and to control foot motion. The most common orthotic used is one that controls over-pronation or too much rolling in of the foot by use of good, firm support in the arch or mid-foot. Sometimes, a lateral wedge is used to control over-supination or rolling out of the foot. Most individuals can wear off the shelf orthotics in their shoes, however it is best to be properly fitted for the particular type that you need by a person trained in orthotic fitting. Individuals that have sustained previous injury or that have had previous orthopedic issues may need custom orthotics to support them when they run.
Overall, the orthotic should provide good support for your arch, not collapse when you are running, and should provide cushioning. To use a full-foot orthotic, remove the sock liner from your shoe (the padding in the bottom of the shoe), and replace it with the orthotic. To use a hard plastic 3/4 foot orthotic, use the sock liner in your shoe over the plastic orthotic.
Orthotics should be used to help cushion the foot and to control foot motion. The most common orthotic used is one that controls over-pronation or too much rolling in of the foot by use of good, firm support in the arch or mid-foot. Sometimes, a lateral wedge is used to control over-supination or rolling out of the foot. Most individuals can wear off the shelf orthotics in their shoes, however it is best to be properly fitted for the particular type that you need by a person trained in orthotic fitting. Individuals that have sustained previous injury or that have had previous orthopedic issues may need custom orthotics to support them when they run.
Overall, the orthotic should provide good support for your arch, not collapse when you are running, and should provide cushioning. To use a full-foot orthotic, remove the sock liner from your shoe (the padding in the bottom of the shoe), and replace it with the orthotic. To use a hard plastic 3/4 foot orthotic, use the sock liner in your shoe over the plastic orthotic.
Exercises and Stretches for Injury Prevention
Runners KneeVery common to runners, especially beginners, this condition is the result of irritation where the kneecap rests on the thighbone. Prevention of "runner's knee" which is also called patellofemoral pain syndrone is critical for runners who are just beginning to train for the various events that require a run; whether it be a 5K, half marathon, or a triathlon. According to Runner's World (2013), simple preventive measures include running of softer surfaces, limiting increases in the running distance to less than ten percent each week, and stretching of the hamstring and calf to help eliminate overpronation. Likewise, getting fitted for the proper running shoe (preferably at a specialty store for running)--one that is suited to your particular foot type and gait is recommended. Another prevention measure comes in the form of strengthening of the quadriceps to ensure your kneecap and thighbone are gliding smoothly.
Review the stretching exercises for the hamstring and calf below for further information on how patients can be counseled on preventing Runner's knee. |
Meniscal Injury
Any one who is involved in a sport or has a patient that participates in activities that require the person to plant a foot down to change direction; are susceptible to being hit in the knee area by another person--as would happen with soccer players and football players; or those who are likely to misstep or accidentally step into a pothole while running are vulnerable to meniscal injury. As mentioned meniscal injury can be very painful, however, there are pre-hab stretches for the quadriceps and hips that can keep beginner runners from potential injury as well as injury patients back on track and on the road to recovery and prevention of re-injury. Below are three exercises to consider. When patients are counseled, it is important to remember that patients should start slow if they have recently suffered an injury and are beginning to work their way back in to their perspective sport.
Four-Way Kick
1. Attach your ankle to a cable machine (or use a resistance band) and face the machine. 2. Kick your leg backward 20 times. 3. Rotate 90 degrees and kick to the side. 4. Repeat in all four directions (when you're facing away from the machine, kick forward). Start with two sets of 20 in each direction on each leg. |
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Stress Fracture and Soft Tissue Injury
Stress fractures, like many other running and contact sport injuries are overuse injuries. Knowing this, runners and injury patients must keep in mind that as changes are made during training and it increases in intensity, the body must be afforded the time to build itself up and adjust to the increase. According to Running Times, "keeping to the widely accepted 10 percent per week rule when increasing mileage may help prevent many stress fractures" (2005).
For patients currently sufferning a stress fracture, recovery consists of no running or weight lifting activies; therefore the key to success with stress fracture is prevention. For soft tissue injury, there has to be a level of due diligence to prevent weakened muscles. Muscles that are weak, get sore, which is indicative of lessened shock absorption; making patients and new runners more susceptible to injury.
Critical preventive measures should be taken for both stress fractures and soft tissue injury. For stress fractures, those counseling patients or coaching new runners should address the potential of repeat injury. A conversation on what factors a person should avoid prior to injury as well as how to prevent re-injury should be conducted. The following questions are a good starting point:
Stress Fracture
1. Is personalized advice needed for selecting and wearing the proper footwear?
2. Were/Are the scheduled training plans and goals from a trained coach or therapist to ensure overuse is alleviated?
3. In an attempt to get the most out of your training, did you do too much too soon?
Soft Tissue Injury
1. Are the same muscles consistently sore? (Strength training may be necessary to relieve the soreness.)
2. Is one side of the leg or foot sore normally? (A possible mechanical fault may be the culprit and may require professional correction)
For patients currently sufferning a stress fracture, recovery consists of no running or weight lifting activies; therefore the key to success with stress fracture is prevention. For soft tissue injury, there has to be a level of due diligence to prevent weakened muscles. Muscles that are weak, get sore, which is indicative of lessened shock absorption; making patients and new runners more susceptible to injury.
Critical preventive measures should be taken for both stress fractures and soft tissue injury. For stress fractures, those counseling patients or coaching new runners should address the potential of repeat injury. A conversation on what factors a person should avoid prior to injury as well as how to prevent re-injury should be conducted. The following questions are a good starting point:
Stress Fracture
1. Is personalized advice needed for selecting and wearing the proper footwear?
2. Were/Are the scheduled training plans and goals from a trained coach or therapist to ensure overuse is alleviated?
3. In an attempt to get the most out of your training, did you do too much too soon?
Soft Tissue Injury
1. Are the same muscles consistently sore? (Strength training may be necessary to relieve the soreness.)
2. Is one side of the leg or foot sore normally? (A possible mechanical fault may be the culprit and may require professional correction)
ITB Syndrome
Stretching and to keep your Iliotibial band from causing friction is key to getting and staying pain-free due to ITB Syndrome. Strengthening your glutes and hip-abductors (as listed in the Meniscal Injury exercises) assist in alleviating the pain by keeping you stable; stability is critical. The following stretches for the IT band can be combined with the glute and hip-abductor exercises to maintain knee health and assist in injury recovery as well.
Backward T Stretch 1. Stand facing a wall with your feet together--approximately 12 inches away. 2. Hold your arms out to your sides like you're forming a T. 3. Without bending your knees, reach down and back as far as you can with your right hand. 4. Hold for up to 20 seconds and repeat with the left hand. |
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Prevention Self-Check
Image courtesy of Creative Commons
from lululemon athletica
from lululemon athletica
Then next step in this lesson is to test your knowledge with a short quiz. The self-check can be accessed from the navigation menu above (hover over the Prevention of Knee Injury link). It can also be accessed by clicking HERE or by clicking the button at the bottom of the page called "Prevention Self-Check".
References
1. Information about Orthotics written by Nancy Smith, PT, DPT, GCS
2. Content on prevention written by Kim Cross, triathlete & mentor
Additional Resources1. Burfoot, Amby (2010, Jan 2010). The 10 laws of injury prevention. Runner's World. Retrieved from http://www.runnersworld.com/health/10-laws-injury-prevention, April 13, 2013.
2. Elkaim, Yuri. "Best Exercises for Runners Knee." Treadmill Trainer Blog. Wordpress, n.d. Web.
3. Spiker, T. (2007, February 16). Build a better knee. Runner's World. Retrieved from http://www.runnersworld.com/health/build-better-knee
4. (2013, April 10). How to avoid runner's knee. Retrieved from Berkeley Wellness website: http://www.berkeleywellness.com/fitness/injury-prevention/article/how-avoid-runners-knee
5. (n.d.). Runner's knee. Retrieved from Running Times website: http://www.runnersworld.com/tag/runners-knee
6. (n.d.). How to select the right athletic shoes. Retrieved from FootCareMD website: http://www.aofas.org/footcaremd/how-to/footwear/Pages/Selecting-Athletic-Shoes.aspx
2. Content on prevention written by Kim Cross, triathlete & mentor
Additional Resources1. Burfoot, Amby (2010, Jan 2010). The 10 laws of injury prevention. Runner's World. Retrieved from http://www.runnersworld.com/health/10-laws-injury-prevention, April 13, 2013.
2. Elkaim, Yuri. "Best Exercises for Runners Knee." Treadmill Trainer Blog. Wordpress, n.d. Web.
3. Spiker, T. (2007, February 16). Build a better knee. Runner's World. Retrieved from http://www.runnersworld.com/health/build-better-knee
4. (2013, April 10). How to avoid runner's knee. Retrieved from Berkeley Wellness website: http://www.berkeleywellness.com/fitness/injury-prevention/article/how-avoid-runners-knee
5. (n.d.). Runner's knee. Retrieved from Running Times website: http://www.runnersworld.com/tag/runners-knee
6. (n.d.). How to select the right athletic shoes. Retrieved from FootCareMD website: http://www.aofas.org/footcaremd/how-to/footwear/Pages/Selecting-Athletic-Shoes.aspx