Today is my day off. Did meditation first thing in the morning with my freshly brewed coffee and followed it with a walk/jog in the park. It was a good start. When my walk/jog ended, I sat on the grass right in front of a beautiful water view and performed and filmed via iPhone what I consider standard exercises for a runner's knee. Runner’s knee is called chondromalacia but it is not solely due to running. It is a reduction of the cartilage of the inner side of the patella and starts rubbing on the distal femur bone which can also erode its cartilage. It can be due to wear and tear as we get older, due to running or other sports, or obesity that puts stress on the knees, or prolonged standing like how teachers, nurses, retail salespeople to name a few do it in their jobs. I won’t consider my knee pain chondromalacia because I can still manage some heavy knee exercises without traumatic pain. But I suffer from muscle weakness due to my sudden stopping of exercises on account of the pandemic some three years ago. Still, I don’t completely rule out chondromalacia so I adjust and modify my exercises. My guide is pain and I avoid anything that causes it : I reduce the range of my knee ROMs when dealing with knee extension machines, I certainly avoid low squats. I also avoid climbing and descending steep steps. I am alright with lunging. I have generally switched my running to walking and if I jog, it is only a little faster than my regular walk. I’d rather call it a fast walk bordering on jogging.
[NOTE: some of the exercises I feature are for educational purposes only. Consult your PT or MD before self-diagnosing and trying these out on your own]
Having said that, the pitfall of running is the overuse of a certain group of muscles while ignoring another group in the legs. Contact sports like basketball or football or tennis or volleyball involve almost all the leg muscles in available planes of motion and directions, giving and receiving forces which can sadly cause a variety of injuries - fractures, meniscal tears, ligament tears/sprains, muscle tears/strains, cruciate injuries, dislocations etc.
Running muscles, ligaments (soft tissues) and joints on the other hand tend to utilize only one plane of direction of movement using the same soft tissues acting over and over again while ignoring the non-involved tissues. It leads to muscle imbalance. The movement is forward, a little swerving here and there, a little alteration of terrain but running doesn’t require back steps and side steps or even full turns unless you turn at the midpoint of your distance to return to where you started. Unlike contact sports (and others that include swimming, biking, ballet/dancing, yes that is sports), running doesn’t have much variety in its execution.
In my nearly 20 years of running I suffered plantar fasciitis, Achilles tendon pain, knee pains, low back pain but none of them required me to go to the ER or visit MD. For some lucky reason, I recovered from them by just doing what I thought was appropriate. It can be argued that I am a PT so I have some self-skills to recover. From the very first day of my running days, I was cognizant of the fact that there is wear and tear inflicted by running on the body, especially the muscles and joints. Sooner or later, I will retire my running shoes and switch to simple walking and if not, swimming. So there was a sense of less aggressive training on my part.
It helps also that I saw a lot of patients who developed joints’ wear and tear WITHOUT running. Wear and tear indeed is not exclusive to a certain sport or people. It applies to any human who is involved in using the legs which obviously means everyone.
How many non runners have undergone total knee replacements or knee arthroscopy, and who suffered osteoarthritis? Some of my friends think that running is abusive to the joints. I beg to differ. As long as you don’t abuse your legs by pushing and pounding to the max and resting when your body warns you and adjusting your pace at your most convenient level, it can work. Wisdom through caution plays a big part as well. A 61 year old man playing a full basketball game with 20 year olds is not wise. A 61 year old trying to beat an elite runner half of his age may not be wise. Even if it is not your knee getting damaged, your heart or brain would.
And then there are knee problems resulting from events beyond anyone’s control. Genetics is one of them. Arthritis is usually genetic. Most knee conditions I have treated in my 30-year hospital work involved bone fractures resulting from falls, especially postmenopausal women suffering from osteoporosis while their reflexes and strength are being depleted by age. They fall. Between lack or speed (poor reflexes or what I call ‘self-correction’ while losing balance, weakened muscle strength, low endurance combined with other medical issues like vertigo, low BP, abnormal heart rhythms, poor sensation and proprioception or even neuropathy resulting from bad circulation and diabetes), elderly people are at high risk of falling.
I know this because I feel it. Despite my years of being active, I sense the fall risk. When I need to grab on the bathroom sink to balance myself while changing undergarments after a shower, or when I cannot stand on one leg long enough to put in my sock, it means I am a fall risk. A sudden turn, a sudden change of position, an unexpected change of the terrain or surface of the sidewalk, and those little bumps on the streets, (I think they are called pavement heaves), can easily destabilize an older person. A sudden curb in the dark, or a sudden drop of an incline, there are many risks in the real world.
I had a patient who lived in one of the rich enclaves of my county who fell in her vast garden and stayed on the ground for two days because no one heard her cries. Another fell while stepping in her bathtub, again, no one heard her cries. There was elderly small lady with a big dog who fell on her face as her dog on leash ran towards another dog across the street. Another elderly gentleman who was taking photos of ducks while backing to get out of their way, stepped on a big rock and fell backwards. All of them broke either a hip or a knee.
These are anecdotal stories, more like a warning than a trend. The good news is bone and joint injuries aren’t a death sentence or debilitating. With proper management of an Orthopedist for surgical interventions and Rehab Therapists for proper recovery, a patient can return to his or her normal lifestyle in no time.