Is running bad for my knees?

“Is running bad for my knees?”

I often get asked this question by patients who are attempting to add running into their weight loss regime but who are being told by others, almost always non-runners, that they are putting themselves at risk for a future of damaged and arthritic knees. This has to be the most common misconception about running within the general public. It is a great example of something once claimed, but not researched, becoming a fact which we cannot seem to ever escape.

There are a number of reasons a person who previously did not run could develop knee pain after starting. The purpose of this blog post is to show that arthritis is not one of them. If we take a person who previously had no knee pain or medically diagnosed bone disorders and have them start running they may develop pain first and foremost from poor running technique.  If you think about it, running is one of the few athletic activities which we feel we can take on without some kind of training or coaching. We take swim lessons, surfing lessons, and skiing lessons but very few of us ever take running lessons. I believe a great deal of the discomfort people experience when they first start to run could be avoided by taking advantage of a good coach or running club for beginners advice. Next time you run, take a look at the other runners around you. You will see people leaving forward, leaning backward, and even to the side. Often one shoulder is hiked up higher or the foot kicks out to the side each time it comes back. All these technique issues can lead to knee discomfort but the activity of running itself does not.

Additionally, much of the discomfort people mention in their knees is actually muscular soreness radiating in from a different area. Their tight IT Band could be pulling on its attachment and creating pressure in the knee. Their tight quads maybe pull the kneecap to the side when they run creating patello-femoral syndrome.  Maybe they just bought minimalist shoes and are running a few miles on them without ever building up to the switch from normal running shoes. The bottom line is that there are a number of reasons a person’s knee might hurt while learning how to run, almost all are correctable through a good coach, and rarely if ever is the cause the osteoarthritis your non-runner friend/family swore you would have because you started running in your 40s or 50s.

Train smart, run well, and read this NY Times blog about this subject and the study that shoes running does not cause knee arthritis. It was the inspiration for this post.

Chronic Hip Pain AKA Dead Butt Syndrome

A tremendous number of patient come into the clinic with a chief complaint of pain and discomfort in the low back and hip. Often these are people who are accustomed to an active lifestyle of hiking, biking, or yoga and have now been sidelined by this painful condition. The pain most often feels one sided and is worse when they first wake up in the morning and take those initial steps out of bed. This is frustrating because after a night of rest and inactivity one would think that pain in a highly active person would diminish.  Patients commonly report that the pain is more severe not only when participate in running or hiking but also when they find themselves sitting for long periods of time in the car or office. Stretching seems to help for a short period of time but does not last and most people who visit the acupuncturist are not the type who like to chew Ibuprofin all day just to get through work. Maybe worst of all, is the feeling that one should rest and recover, when the activity that they are now avoiding was the one outlet for stress in their lives. The rest actually creates a new kind of tension that they have to deal with! So what is it? What is this nagging pain in the low back and hip that seemed to develop slowly over time without a specific explainable injury?

A recent New York Times article, “When the diagnosis is Dead Butt Syndrome”, coined a phrase for this condition which brings a little brevity to a very frustrating situation. “Dead Butt” is a set of symptoms resulting from overuse and inflammation of the tendons of the Gluteus Medius (GM) muscle, which sits at the top of our glutes/butts, and which causes burning or aching pain in the low back, hip, and upper leg.  The GM runs from the top of our pelvis and sacrum down to the outside border of the Femoral head.  It is part of a kinetic chain of muscles that we use when moving our legs in sports, starting with the low back and running all the way down to the lower leg and foot. A dysfunction in the GM, the crucial bridge muscle between spine and leg, can create pain which spreads along this entire chain, inevitably leading to further muscle dysfunction down the limb. The first job of the GM is to extend, move backwards at the hip, our upper leg when kicking back in a running stride or lifting ourselves up on our bike pedals while struggling up hill. Its second job is to maintain the balance of our pelvis as we do these one legged strength movements so that we do not tip over each time we balance on one leg in a yoga class or climb up a rocky trail. Basically, the muscle gets used a whole lot of the time, and worse, it gets used in a way it was not designed for which is balancing on our butts. When we sit in our cars many of us lean against the door or on the center arm rest, likewise at the office desk, and this causes the GM to contract for long periods of time to keep our pelvis balanced as we lean our weight to one side.  For active individuals this may mean that they put the muscle to good use while sitting at work and then follow it up with activity in their sport afterwards.  A long day of work for one small muscle, maybe that is why it has such a high pain potential with which to catch our attention when we have pushed it too far.

What helps with GM tendonitis? Keeping moving at work, not sitting for too long at a time, and taking standing breaks can help. Self or professional massage which works out the spasms in the Gluteal muscles can bring great benefit towards recover and regular icing around the attachment points, the outer hip and sacrum, can bring down the pain when it is severe.  Ibuprofin does work when taken diligently, throughout the day, for a short period of time as the bottle suggest. All these home therapies will be coupled with your regular acupuncture which needs to be at least twice a week for the first three weeks.  Do the work and you will learn a whole lot more about your body mechanics, how ways you were sitting or moving were causing you harm, and you will survive the dreaded Dead Butt Syndrome.