Considering all of the possible clinical conditions affecting the jogger, knee pain is frequently the most common offender. Its original source, clinical character, and level of debility often vary from runner to runner. It is the responsibility of the sports minded physician to focus in on the various involved factors by persuing a thorough examination and history of the problem. Years ago, a runner with knee pain was in most cases, advised to eliminate the involved activity or else, was injected, given oral anti-inflammatory medication, or surgerized.
Today, our level of sophistication in both the examination and treatment procedures for this problem have fortunately, improved. But, what is more important, is that our understanding of the knee, its function and related conditions, as well as our appreciation for the needs of the runner as an athlete, have changed immensely. The following paper will cover briefly this authors approach to this problem and, in so doing, will hopefully cast some light on the nature of knee pain for those afflicted.
As a practicing foot specialist, one of the primary goals of my initial history and examination of a running knee problem is to ascertain whether the condition is intrinsic or extrinsic in nature. In other words, is there a previous history of injury to the knee? Is there localized swelling? Was the condition a result of running or was it a preexisting ailment, merely aggravated by the external influences of the activity? Our evaluation involves such points as discoloration, pinpoint pain in and around the joint area, a painful limitation of motion, an inability to bear weight comfortably, an existing systemic ailment with obvious knee involvement, and the list goes on and on. This line of questioning and clinical exam help to distinguish the problem as an intrinsic knee condition aggravated probably by running. Such a patient is immediately referred to a sports orientated orthopedic surgeon for case management.
Once we have determined that the patientís pain is secondary to or a result of factors outside of the knee, our next approach is to categorize its possible origin. We attempt to evaluate existing limb length differences, obvious back or shoulder curvatures, lower limb deviations, particular muscle strength and flexibility ranges, as well as an exam of foot and ankle positioning. The gait of the patient is studied in addition to the weight bearing patterns of the foot. The information thus acquired, is compiled and utilized to draw conclusions as to the possible stress factors impacting the knee area.
Again, in certain cases, a referral for orthopedic consultation is suggested, while in others, a sports physician therapist should be sought. In a vast number of these patients, it is found that improper foot and ankle function often creates abnormal forces to occur at the knee due to postural imbalance and excessive rotation of the leg. Controlling the existing foot and ankle function can frequently assist these patients in the management of this condition.
Usually, by the conclusion of our examination and review of the available findings, we are able to categorize the problem into one of four types. The first is that of soft tissue involvement, and as the title suggests, involves those ligaments and/or tendons in and around the knee joint. There may well be restrictions in the flexibility range of certain muscle groups as well as abnormalities in strength. Proper exercise patterns and specific physical therapy often prove beneficial to such individuals.
A second category is the shock impact group. Here we are dealing with a seemingly normal appearing limb which, for some reason, is unable to adequately absorb or dissipate shock on contact with the ground. Upon heel contact with each gait cycle, we know that tremendous pressure and force is transmitted into the limb by way of the foot. Normally, this force is handled without problems by way of various joint function and inherent ranges of motion. In a number of cases, this shock absorbing mechanism somehow, malfunctions and pain, usually at the knee level, results.
Our third category is that of biochemical dysfunction of the foot and ankle leading to knee stress. Due to the various positions of the foot and leg at heel contact, the foot will go through certain motions which encourage stability and allow proper weight bearing and ambulation to occur. Along with these foot motions, however, is associated limb motion, which in turn often creates stress and stain on the knee. The obvious approach in therapy is to control these excessive motions thereby, reducing the excessive stress levels. Although rather simplistic in nature, the actual applied management is often times more complex.
The fourth category is perhaps the most frequent and certainly the most troublesome. For lack of a better title, we will refer to this group as merely "combined." In this category, we are dealing with any combination of the above mentioned topics. Our success in treating a knee problem in the jogger seems to be a function of how effectively we isolate the probable cause. The types of devices utilized in shock absorption versus biochemical problems are completely different as are also their respective results. The combined problems necessitate a thorough and complete examination followed by a specific therapeutic approach.
In closing, we have discussed briefly the topic of knee pain in joggers as we approach it from a diagnostic standpoint. An evaluation of its source and character must be made in order to ensure its proper management. Postural instability, excessive impact shock, and abnormal foot and leg rotations can and do lead to painful knee conditions. Our approach to managing these problems is dependent upon our ability to recognize and identify the causative factor(s). For the jogger so afflicted, the condition should not be left unattended, for its course is usually progressive with the possibility of irreversible damage.