Spring is here! Don’t let knee pain stop your running routine

By Kenneth G. Swan, Jr., M.D.

Spring is finally here to stay! For many of us this means we can hit the streets and get back to a running routine. Running is a great form of exercise and an important part of many people’s lives. However, the joys of running and all the mind and body benefits do sometimes bring some collateral damage. Runner’s knee is one example. Runner’s knee can mean different things to different runners, trainers and physicians. I will discuss three knee conditions often seen in runners with knee pain: IT Band syndrome, Hoffa’s syndrome, and osteoarthritis.

My wife developed knee pain while training for her first half-marathon last summer.There was lateral sided knee pain (pain on the outside part) that started to bug her midway through her longer training runs, and became really painful by the end of the run.There was no swelling or stiffness. It was troublesome for her because there was no obvious injury, and she was concerned it would stop her from finishing the Philadelphia Rock and Roll Half Marathon. Her exam was typical for ITB syndrome seen in runners: strong thighs, good range of motion in terms of knee bending, and no swelling. But she had very tight IT bands, or iliotibial bands, which are the long, soft tissue structures that go from the outside of our hips to just below the knee.They often become tight in runners, and can be painful and tender anywhere along their course.This condition can be seen in non-runners as well.We treated my wife with a therapy regimen that focused on stretching and massaging her IT band, and she was able to not only compete in the half marathon, but finish at a very high level.

In the front of the knee, behind the knee cap and patellar tendon is a structure referred to as Hoffa’s fat pad. In runners it can become inflamed and painful, causing a very sharp and pinching pain.The treatment may include a steroid (cortisone) injection into the affected area, which often resolves the inflammation. Other times, a knee arthroscopy (“knee scope”) may be required to get the runner back to their tiptop form. Hoffa’s Syndrome may mimic chondromalacia patella, a cartilage condition that also causes pain behind the kneecap, or patella.This can occasionally be seen in runners, but is treated differently, usually focusing on therapy, taping and bracing.

Arthritis is a controversial topic when it comes to running. Does distance running lead to arthritis of the knee? If it does, should we avoid running? Physicians may disagree on this second question, but I strongly believe that if there is an exercise that helps our overall health and helps relieve stress, then we should be encouraged to do it. Our society is overweight, and many people are over worked. Go run, and enjoy it!

But to answer the first question, several studies show that distance running at the recreational level does not increase the risk of knee arthritis.This is not to say that people with pre-existing knee arthritis are not going to develop any knee pain if they run.They may. Indeed, higher impact activities like basketball, racquetball, and high-volume long distance running may have a detrimental effect on the already arthritic knee.There are things all runners can do to lessen this load, however: 1) Replace sneakers every 300-500 miles. 2) Consider running part of your run on a local track — the surface is usually spongier and more forgiving 3) Cross train, to give muscle groups and joints a break. 4) Stretch.

The jury is still out on the risk of arthritis in longer distance, higher volume runners.As my wife and I noticed last summer: the human body may not be made for running really long distances, including half- and full-marathons.These are great feats to accomplish, but injuries and conditions are bound to develop along the way. Seeing your doctor early can help get you back on the road quickly, and can rule out other serious conditions such as stress fractures. Happy running!

Board certified orthopedic surgeon Dr. Swan is a member of the Human Motion Institute at Raritan Bay Medical Center, a comprehensive musculoskeletal program dedicated to returning patients to normal activities quickly and safely with help from a nurse navigator who guides patients and their families through surgical care. Dr. Swan has offices in Perth Amboy and New Brunswick. To make an appointment, call 855-5-MOTION.