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Highway to Health


Runner's knee (also known as chondromalacia patellae) is caused by an erosion of the cartilage covering the underside of the kneecap.   Under older terminology, any pain of the anterior knee was called chondromalacia patellae.  Now this diagnosis is supposed to require arthroscopy to see the underside of the kneecap. 

Runner's knee is probably the most frequent overuse injury for runners and possibly for all of sports.  If you have knee pain, or clicking and you are a runner, then this is probably your problem.  But be careful,  there are other problems that can cause the same symptoms and you really should see a sports orthopedist.  But, the following will tell you more about the disorder and what to think about:

Runner's knee usually causes pain during running or when going up or down stairs.  Four factors can occur to cause runner's knee.

1.  Structural instability of the foot.  Pronation   or flat feet can cause a torsion of the fibula and tibia (the two lower leg bones) causing the patella to leave its natural groove and rub on a condyle (bump) on the distal femur (leg bone). 

2.  Short calf and hamstring muscles contribute to this same torsion.

3.  A difference in leg length can contribute.

4.  Environmental stress: overtraining, inadequate shoes, and running on slanted surfaces will further stress the area.


Start with the foot.  Use good shoes and replace them when they wear down.  Consider extra arch support.  If store bought supports do not help with your flat feet, then see podiatrist or orthopedist who specializes in sports medicine.

Here are some questions to ask:

1.  Have I changed shoes?

2.  Have I let my old ones run down?

3.  Have I increased my mileage?

4.  Have I changed my terrain?

5.  Have I changed my training routine?

6.  Am I doing more speed work?

7.  Did I race in racing shoes?

8.  Am I running on a track?

Much of the above came from Dr. George Sheehan's Medical Advice for Runners.   In 1976, I went to the city library in Birmingham, Alabama (where I lived) and the only book by an MD that condoned running was by George Sheehan.    At the time, he was a prophet that hailed the value of running when many if not most MD's were still saying to just polish your car a little more vigorously and take the stairs at work and don't waste your time and use up all of your heart beats with running.   I had the opportunity to meet Dr. Sheehan about 10 years ago.  He talked and behaved like the gentleman and the philosopher that he appears to be in his writings.   Unfortunately the book mentioned above is out of print.  If you want to read an excellent recent medical paper about knee injuries see Ped Clinic of North America 1998 Dec;45(6) 1601-35.  Unfortunately, most of the literature I have found in this area is written  from a surgical perspective.  My orthopedic colleagues do a great and noble work; but,  I don't know one who would not salute efforts to avoid the blade when healing is possible without it.  I pray that someone will save a knee with this information. 

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