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New Year BIG DECISION - should I stop running??

Discussion in 'Break Room' started by hann, Jan 5, 2011.

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  1. hann

    hann Active Member


    Members do not see these Ads. Sign Up.
    I have a big decision to make. I have run for about fifteen years, not exc essively, but the odd half marathon, and 3-4 times a week 5-8 miles. I have had medial knee pain in one knee for six months which has not improved with rest and now the other knee is similar. GP says " wear and tear/ osteo arthritis. I have addressed footwear, orthotics(i pronate) quads exercises and have seen physios to no avail. Now, biomechanics is not my thing - should I give up, or continue and is this likely to make the knee worse and hasten the degeneration or shall I plod on and take paracetamol. I love running - keeps me sane! Thanks
     
  2. markjohconley

    markjohconley Well-Known Member

    This is serious, Hann, all the best
     
  3. Will Smiths new film.
     

    Attached Files:

  4. hann

    hann Active Member

    ha ha
     
  5. markjohconley

    markjohconley Well-Known Member

    Sorry Hann, too easy, there would have been many with fingers poised over the keyboard to reply, it's just I'm not as self-controlled nor as gentlemanly as others
     
  6. footfan

    footfan Active Member

    Dr. Kevin Kirby and others have mentioned this many times before......... running keeps a person fit and healthy both in mind and body, people get injured and eventually everybody breaks down , basically its personal choice, if you feel good from running but feel long term it will do more damage than would benefit from doing it, then stop. If however you feel personally that the health benefits ect from exercise are too great you can continue as you are or venture other sports such as cycling or swimming both of which are less weight bearing on your joints. I would firstly ensure a more thorough diagnosis from your knee pain patello femoral pain ""the black whole"" to orthopods hits alot of runners and self managment it key . Theres some new research on the physio management of PFP that was covered at the conference try this with the suggested anti pronatory devices for maximum effect.......................happy running :D
     
  7. Hann:

    You have a problem that may be able to be addressed with foot orthosis therapy. Give us your location in this planet and, between all of us here on Podiatry Arena, maybe we can find you a quality sports podiatrist that can at least give you some expert opinions and expert orthosis treatment of your knee pain.
     
  8. physiocolin

    physiocolin Active Member

    Hann
    It sounds like what I would describe as "Non specific chronic anterior knee pain". Having dealt with this chronic pathology with athletes, kids and soldiers I have made a point of measuring their muscle stiffness in the Quads and Hamstrings.
    Over the years i have found that many NSCAKP's get better by lengthening these two groups, particularly the Rec Fem component, and many of these have been suffering for several years.
    The patients often report how they also feel better in their stride length and power once they achieve their full muscle length.
    This approach would precede any orthotic intervention.

    Colin
     
  9. Griff

    Griff Moderator

    Colin,

    How do you measure muscle stiffness?
     
  10. Colin:

    Why wouldn't you want to also attempt to alter the internal loading forces across the knee joint with either modified shoe insoles, modified prefab orthoses or custom foot orthoses? In other words, why should visits to the physiotherapist to "strengthen and stretch" muscles, precede foot orthoses therapy for athletes and other individuals with exercise-induced knee pain?
     
  11. footfan

    footfan Active Member

    he must have meant tightness, but im just guessing :D
     

  12. it is possible to measure muscle stiffness Jon, While you maybe correct that Colin is referring to tightness, it is possible to measure muscle stiffness, here for you to read if you want

    In vivo determination of triceps surae muscle–tendon complex viscoelastic properties

    If fact these people make a hand held machine for the job - Myoton-2 myometer here a link to the product and a list of studies of reliability - http://www.myoton.com/index.php?id=41.
     
  13. physiocolin

    physiocolin Active Member

    Kevin

    I am not shying away from balancing the foot it's just that I have dealt successfully with so many of these chronic AKP's by working on increasing the length of Rec Fem. Foot balancing will probably follow, but I want to see if a simple self applied intervention can achieve some alleviation.
    Now I know there are plenty of practitioners out there advising on quads and hams stretching but in order for there to be some level of progression and positive feedback to the patient, the joint range has to be measured at the first consultation. This measurement forms the base line from which progress is measured.
    How many patients tell you they do stretching? But is it effective? In order to be effective you must first be able to see if they have increased the muscle length by way of an improved joint range.
    I have yet to see a failure to achieve significant improvement when the patient improves Rec Fem length in the presence of Chronic Non-specific AKP.

    Colin
     
  14. Colin:

    You didn't answer my question. My question was, why did you make the following statement? "This approach would precede any orthotic intervention." In other words, why do you claim that foot orthoses should not be used before or during "muscle strengthening/stretching"?
     
  15. physiocolin

    physiocolin Active Member

    Kevin

    When assessing CNSAKP patients there is most often a description of vague but troubling sx and these patients will present with tight Rec Fem. Measurement determines how obvious this is, so why 'muddy the waters' at this stage with any additional intervention.

    Once the patient is making significant progress, normally around 3 - 4 weeks, I will often fit an orthotic as a supporting role to maintain as good foot/leg symmetry as possible.

    Colin
     
  16. Griff

    Griff Moderator

    And your clinical measurements of muscle 'stiffness' Colin?
     
  17. barry hawes

    barry hawes Active Member

    Hi Hann,

    Sorry to join this discussion so far into debate. As an enthusiastic runner myself I sympathise with your dilemma Hann, but I think diagnosis is (as always) the most important consideration. You said that your symptoms are on the medial side of your knee, and that your physician had diagnosed O/A. Have plain film radiographs been taken? Is O/A confirmed in the medial compartment, or in the patellofemoral joint? If so, I think you can possibly rule out other causes for your knee pain, such as non-specific chronic anterior knee pain, which may allow you to consider your future as a long distance runner.

    I am familiar with the body of evidence supporting foot orthoses with lateral posting for early medial compartment O/A, particularly in patients with tibial varum, but have not seen any research to support this in the running community. Any out there seen something that I have missed?

    For what it's worth I have had to retire after 30 years of long distance running due to early O/A in my hip, which was discovered following removal of a large osteochondroma off the neck of my femor. I can still cycle, swim, row, ride a surf board and play the guitar - plenty of other things to "keep me sane" Have to admit though, I do still miss running!

    Good luck Hann,

    Barry Hawes
     
  18. hann

    hann Active Member

    thanks Barry
    well the decision has been taken out of my hands both knees swollen and hurts even to walk now last thing I feel like doing is running ....... so been cycling ( hurts) swimming front crawl ( hurts) walking ( bearable if brufen'd up) am incredibly frustrated and really hope this isn't the end of an active life. booked to go skiing in Feb too. I ll go and request an MRI scan
    thanks for your good wishes. Hannah ( only 40 ish)
     
  19. hann

    hann Active Member

    ps. guitar too ( classical ) doesn't hurt !!!!
     
  20. physiocolin

    physiocolin Active Member

    Ian

    Here goes! Measuring the Rec Fem length means placing the patient in side lying, with the underneath hip and knee flexed to 90 deg. The patient flexes the upper knee, and with both hands behind his back grasps the foot and pulls the heel into the bum and extends the upper hip as far as possible, whilst maintaining medial knee contact with the couch.
    By placing the goniometer on the Gtr trochanter, one arm aligned with the shoulder and the other with the knee we get a reading.
    If you had a straight line from shoulder to knee then we have 180 deg, anything short of that is a negative reading (say minus 20 deg for example).
    In order to achieve 180, or better, the patient is shown how to load Rec Fem using the grip of both hands (resisting quads extension). The pre loading prior to stretch is a pre-requisite in order to achieve progressive stretch. The new position gained is retained ready for the next loading. There is no springing back to the previous start point otherwise there would be minimal, if any, progress.
    8 - 10 reps of between 6 - 10 secs will normally produce a significant improvement in range in 3 - 4 weeks.
    With so many of my CNSAKP patients their sx are equally reducing as their range improves.
    I think where many stretch programmes go wrong is the omission of the pre-loading, to overcome the inherent restraint of the golgi tendon organ.
    In the absence of any joint derangement this range is worth measuring!
    Give it a try. Let me know how you get on.

    Colin
     
  21. It might be, but it's not a measurement of muscle stiffness as you stated previously. I believe this was Ian's point.
     
  22. DONT stop running! I almost stopped running five years ago because of constant knee & back pain. No, I did not see a doctor, I just researched other options. I am now pain free running more than I ever have.......running barefoot. I am not suggesting to you to do the same, just look at all other options. When I wore shoes, I was very happy to finish one marathon a year. In 2009, I finished 3 marathons in three months-all barefoot. 2011 I plan on doing more!
     
  23. physiocolin

    physiocolin Active Member

    Simon

    Thanks for that. Whether the muscle is stiff, tight or shorter than it should be for the functional demand it is having to meet, it needs lengthening. I am trying to help Hann reduce his sx if possible, with a very modest self help method.
    In many instances it has prevented unneccessary investigative surgery.

    Colin
     
  24. footfan

    footfan Active Member

    Ahhhhhhhhh, and the debate begins............... :bash:
     
  25. hann

    hann Active Member

    interesting Jon. not sure would be a good thing on our local streets lot of dog poo , glass etc will test on treadmill . hann
     
  26. footfan

    footfan Active Member

  27. David Wedemeyer

    David Wedemeyer Well-Known Member

    Colin are there any other main flexors of the hip that might influence this test negatively?

    Regards,
     
  28. physiocolin

    physiocolin Active Member

    Hi David

    Not to my knowledge! Rec Fem I feel is often overlooked in CNSAKP, where the shortening creates too much retro patellar compression. In addition many of these patients are quite sensitive at the infra patellar teno osseous junction (increased traction through the patella tendon?).
    Pre test with deep as pos squats then retest after a couple of weeks of corrective exercise - see the difference!

    Colin
     
  29. David Wedemeyer

    David Wedemeyer Well-Known Member

    Colin what about the much more powerful deep flexor, the illiopsoas?
     
  30. physiocolin

    physiocolin Active Member

    David

    It's not about hip flexors per se, its about the double action of Rec fem as hip flexor and knee extensor and about how it's shortened length can have a deleterious effect on the function of the knee. Which can create increased tension of the retro patella, creating OA type sx.

    Colin
     
  31. David Wedemeyer

    David Wedemeyer Well-Known Member

    I agree with the above Colin with regard to the effect on the knee. I was inquiring regarding the test you described. Wouldn't a tight psoas nullify the test you describe? How about the old standard, Ely's vs. Thomas'?
     
  32. physiocolin

    physiocolin Active Member

    David, if you want to differentiate between the tight illapsoas and rec fem then apply the same test without bending the knee.
    Unfortunately when quads exercises are dispensed as an exercise the two joint action is often overlooked. Therefore the wrong start position is applied (eg single leg standing) - isn't the pelvis going to drop being held on one ball and socket joint?? Wouldn't that then mean an anatomical position where the rec fem couldn't be adequately stretched?

    Like most two joint muscles they tend to be the most troublesome due to double demand, but in this instance it's the effect it has at the 'bottom end'.

    Colin
     
  33. David Wedemeyer

    David Wedemeyer Well-Known Member

    My whole point was the test you described (does your version have a name, is it a standard orthopedic evaluation manuever?) is often nullified entirely by a tight hip flexor (psoas). Even a standing or prone test (Ely's) is. A more complete differential cycle here would be Ely's, Thomas' and Patricks', Patella Grind/Apprehension would it not?
     
  34. physiocolin

    physiocolin Active Member

    Hi David

    we discussed way back in January regarding your knee. did you try the exercise I suggested?

    Colin
     
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