The many causes of runners' knee problems, as told by a track coach

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The many causes of runners' knee problems, as told by a track coach image

If a runner experiences joint pain in his or her knees, could it be a reflection on technique? Originally answered on Jan. 30th, 2016

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Answer by Aaron Ellis , former track coach:

Poor technique is often a cause of knee injuries in runners. Overstriding, heel running, overleaning and overpronation are all technical problems that immediately come to mind. That said, there are a significant number of things I would also look into as the possible causes of knee pains based on age, physique, medical history, training conditions, equipment, etc.
  1. Natural growth : Many young people who are growing naturally experience pains in their joints. The most common issue I hear of is Osgood-Schlatter disease, in which they get a painful, knobby lump in the lower knee / patella tendon area. Having Osgood-Schlatter can hurt so much that the knee is sensitive to the touch, and physical activity can enhance that pain. There is no real remedy for this other than reaching full growth. The interesting thing about this point is that many young people who are still growing might have horrid form because they don't have much physical strength and body control, so one might be tempted to blame their poor technique on their knee aches, when in reality it's more a product of growing pains.
  2. Weight : This is a simple fact: being overweight can take a serious toll on the body. The knees and ankles in particular are vulnerable to this, as the weight places a constant strain on the joints. Many people mistakenly believe that this is only a problem when one is morbidly obese, but in truth, it can affect anyone who is overweight.
  3. Overuse : This is what happens when one does too many workouts or runs too much mileage without a proportional amount of rest time. Rather than building up the body, overuse causes muscles, tendons and ligaments to break down. I frequently saw this with kids who played multiple sports in a single season, like track and soccer at the same time. The combination of two practices per day and multiple games and meets in a single week would inevitably lead to joint pains and eventually injuries if they didn't find a way to get in some rest time. This was also common for runners who try to rush into high-volume distance running without gradually building up their strength and endurance to reach to that point.
  4. Running Surface : A general rule for training is that one is more susceptible to injury on harder surfaces. Soft surfaces, like grass or  trails, absorb the force you exert on the ground when you run. Bouncy artificial surfaces, such as a rubber track, can also absorb some shock. Hard surfaces, like asphalt, concrete, or impacted dirt/clay, don't absorb the shock well. Too much running on hard surfaces will strain the knees and ankles.
  5. History of Injury : When it comes to knee injuries, the past matters. A person who once tore an ACL or sprained their meniscus is far more likely to experience knee pains than someone who has never had a serious injury in the past. This is especially true if the person didn't fully rehabilitate their injured joint. Inadequate rehabbing means that the muscles, tendons and ligaments might not be as strong as they should be and will be even more vulnerable to injury than before.
  6. Weather : Past knee injuries also have other lingering effects. For example, it's quite common to hear people who have had knee surgery in the past (even the distant past) complain of aches and pains when the weather is cold, especially when it is about to rain. There is still great debate among the medical community about why this is, though some say it is related to barometric pressure changes in the weather. Regardless, some people experience knee pain in cool or inclement weather.
  7. Shoe Quality : First off, one should only be running in shoes that are meant for running. Whenever I see people jogging in skate shoes or casual shoes, I immediately cringe. Running shoes are designed to absorb shock, and provide cushioning and stability. Shoes that are not specifically designed of training should not be worn because they don't offer enough support. Furthermore, running shoes have a limited lifespan. Putting too many miles on shoes wears them down and they will no longer offer any support. Knee and ankle pains very quickly arrive when one runs in shoes that are too old or worn out.
  8. High Impact Workouts : Athletes who like to add in plyometrics, hill runs, bleacher runs, and so on should be careful not too do too much of that in a single week. High impact workouts - while beneficial to one's training - take a heavy toll on one's legs. They should only be done in moderation in the average week
  9. Miscellaneous :  In my senior year track season in college, I experienced a sudden and very painful knee injury that seemed to have no cause. Worse, the trainers and doctors couldn't figure out what it was. I had flexibility tests, scans, and even an MRI, but no one could figure out what it was. Finally, one of the university doctors guessed (correctly) based on an X-ray that it may have been a calcifications in my knee, or a series of sharp, miniscule bone fragments that were digging into my ligaments when I ran. There was no cure for this rare issue, only coping. I figured this was a unique injury, but it turns out I'm not the only one to experience this. On Quora alone, Ellen Vrana also dealt with the same injury. Tiny bone daggers are our struggle, but others deal with their own strange knee injuries that defy explanation.
Knees are funny and fickle. They're complex, and weird things set them off. While there are some likely culprits, such as poor running form, the list of possible problems is endless.
 
Also read:
  1. Top 10 Running Surfaces  
  2. Weather and Joint Pain: What's the Link?
  3. When Should You Replace Your Running Shoes?  
  4. My murder, Agatha Christie-style - Dealing with Death through Humor by Ellen Vrana on You better be written down
  5. Osgood Schlatters Disease  

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