Don't Run Your Knees into the Ground: Dr. Michael Bernstein Says Knee Injury Isn't Inevitable for Runners and Offers Tips for Keeping Knees Healthy

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According to Dr. Michael Bernstein, Knee injuries from running aren't inevitable or necessarily debilitating. Running does put stress on the knees and knee injuries are common in runners, but they are also correctable.

Are runners doomed to suffering with sore knees? It is true that runners sustain an average of 4 injuries for every 1,000 hours of running. That means that runners who pound the pavement for 5-10 hours per week might suffer 2 injuries over the course of a year. It is also true that the knees account for 42% of those injuries. But knee injuries aren't inevitable or necessarily debilitating, according to Dr. Michael Bernstein of Somers Orthopaedic Surgery & Sports Medicine Group. “Running does put stress on the knees and knee injuries are common in runners, but they are also correctable,” he says.

The most common knee problems are patellofemoral pain syndrome, also known as runner's knee, iliotibial band syndrome and patella tendonitis. Runner's knee occurs when the kneecap (patella) moves improperly and irritates the surrounding cushioning cartilage, which eventually wears away causing tenderness in the front of the knee and underneath the kneecap. The iliotibial tendon runs along the outside of the upper leg, from hip to knee, and may be subject to friction, causing inflammation and pain on the outside of the knee (or hip).

“These conditions – as well as others that affect runners' knees – can be painful and worrisome,” says Dr. Bernstein, “but they are also avoidable. Overuse and poor running form are often to blame but runners can take steps to prevent knee pain and continue their workouts.”

Dr. Bernstein's top tips for keeping knees healthy include these measures:
Train smart: Increase running speed and distances gradually. Don't run too many miles without adequate rest between runs. Incorporate one or two days of rest each week and mix a few easy (or short) runs in with the hard (or long) ones. And use proper form: land with feet under the body's mass not out in front of the body, which can result in over-striding and cause a knee injury.

Cross train: Focusing on just one method of exercise can throw the body out of balance. Running tends to develop the muscles in the back of the thighs (hamstrings) more than those in the front (the quadriceps), and the imbalance is enough to contribute to the development of runner's knee. Adding exercises that decrease impact will help prevent injury. These are cycling, swimming and elliptical machines.

Strengthen and stretch: Strong muscles stabilize joints. The integrity of the knee depends on the alignment and strength of the entire leg from the hip joints to the feet. Strengthening the muscles of the lower body strengthens the knees for running. Exercises should include one-legged resistance and one-legged balance exercises, along with leg extensions, leg curls and isometric exercises. Stretching before and after running will keep muscles limber and joints flexible. It also keeps the iliotibial band from causing friction and gets the blood flowing, especially in cool weather. In addition to preventing knee injuries, stretching can also help runners prevent hip injuries, shin splints, and foot-cramping.

Wear the right shoes: There is no single best running shoe. The size and shape of each runner's foot, body weight, stride pattern, and running surface are factors in shoe selection. Choosing a shoe with the right balance of cushioning and stability – the shoe's ability to control motion and correct irregularity in the stride, such as the ankle rolling inward – are key to protecting the knees. A specialist can assess these factors, fit you with the right shoe and determine if you would benefit from special inserts (orthotics) in your shoes. Keep in mind also that failing to replace worn shoes is a major cause of running injuries. Most runners should replace their shoes between 350 and 550 miles, which may be before they show wear. Even without obvious signs of wear, the shoe will gradually lose its shock absorption capacity and may also start to lose some of its stability.

Dr. Bernstein has one more important reminder for runners: “In addition to doing everything possible to prevent knee injuries, cut back your mileage at the first sign of pain. The sooner you reduce the workload on the knee, the sooner healing can start. If the pain persists, see a doctor. And when the pain is gone, rebuild your speed and mileage gradually. Treat your knees well and they will carry you pain free through many miles.”

Michael L. Bernstein, M.D., F.A.A.O.S. joined Somers Orthopaedic in 2007. He has been an orthopaedic surgeon since 1975. Dr. Bernstein earned his medical degree at New York Medical College and completed an internship at the University Hospital in Washington, D.C. He served as Lieutenant Commander at the Brighton Marine Hospital in Boston, Massachusetts, followed by a residency in orthopaedic surgery at the Henry Ford Hospital, Detroit Michigan. Dr. Bernstein is a board-certified orthopaedic surgeon and a member of the American Board of Orthopaedic Surgeons, a fellow of the American Academy of Orthopaedic Surgeons and a member of the NYS Society of Orthopaedic Surgeons.

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