What you need to know to be able to run and jump to your heart’s (and knees’) content

By Kara Thom

The propensity for knee injury makes sense when you consider our body’s biggest joint—this complex junction for the tibia (the lower leg bone) and the femur (the upper leg bone), two big muscle groups (the quadriceps and the hamstrings) connecting via four ligaments, and two tendons that connect bone to muscle. It’s like a spaghetti bowl in our body’s highway.

Although there are numerous things that can go wrong, knee injuries fall into two subgroups: those that occur from overuse and those caused by trauma. Sports that require a lot of jumping, twisting, lateral movement, or quick starts and stops can easily throw the knee out of its normal plane or range of motion, straining one of its many connections or, worse, severing one. These “noncontact” tears, as they are referred to because they don’t result from a collision with another athlete, are common among soccer and basketball players.

Noncontact tears in the anterior cruciate ligament (or ACL, responsible for keeping the tibia in line with the femur) are common among female athletes, who sustain this particular injury two to eight times more often than men. Because of this, noncontact ACL tears are heavily scrutinized, but so far no studies show any standout reason why women succumb more often.

“The female knee has been measured every which way, but studies don’t show anatomy to be the cause,” says Ronald Grelsamer, MD, an orthopedic surgeon and knee specialist at Mount Sinai Medical Center in New York City. He says that hormones have been implicated, too (possibly relaxing ligaments and making the knees more vulnerable during ovulation), but nothing has panned out from the research.

For now the focus is on neuromuscular imbalances—especially equalizing and improving quadriceps and hamstring strength—and poor biomechanics (that is, girls can jump—it’s the landings that need work).

“Current thinking is that women tend to run and jump in a more stiff-legged fashion,” Grelsamer says. “They don’t use their muscles as much to cushion themselves.”

Some of the training to prevent noncontact ACL injuries involves practice jumping and landing with an emphasis on bending the knees. Sheila Dungan, MD, assistant professor in the department of physical medicine and rehabilitation at Rush Medical College in Chicago, says the culprit is often weak outer hip muscles. “When rehabbing girls, we strengthen the abductor muscles to help drive the correct position of the knee when landing.” These muscles, she adds, also affect movement in the kneecap. Too much movement can cause pain. Stronger muscles help stabilize it.

Strengthening and engaging the hamstrings, quadriceps, glutei, and core provides good all-around protection for the knees and prevents overuse injuries as well. Runners typically experience knee pain; and as Dungan points out, running is a series of jumps and landings.

Overuse knee problems, which plague men and women equally, include pain under the kneecap, tendonitis, and knee pain related to other common injuries such as illiotibial band syndrome (pain or tightening of the muscle that runs from the outside of the hip to the outside of the knee) and plantar fasciitis (inflammation or pain in the bottom of the heel). Because the knee serves as a hinge between our hips and feet, problems there often get deferred to the knee. So knee pain may not really be knee pain: the knee just gets stuck in the middle.

Or we might assume “middle age.” Surprisingly, overuse knee injuries don’t increase with age so much as the amount of wear and tear we place on them.

Grelsamer says that he sees patients of all ages with overuse injuries. “It has to do with a person’s constitution, their activity, and how good their equipment is.” He compares the body to an airplane, which aerospace engineers refer to as being “out of its envelope” when flying more miles than it’s designed for. “Everyone has their own biological envelope.”

You’re pushing that biological envelope when you feel pain. Most athletes endure moderate pain now and then, but if you experience pain and are already cross training, have backed off of or modified your activity, tried over-the-counter anti-inflammatories, iced the area, and updated your footwear, the next step is a doctor appointment, which may or may not help, especially if the diagnoses is “chondromalacia” or “patellofemoral syndrome.”

“That is medical double talk for I don’t know what’s wrong with you,” says Grelsamer.

Chronic, undiagnosed knee pain often leads patients to demand an MRI (magnetic resonance imaging scan), which can lead to arthroscopic surgery to repair microtears in the meniscus. This, Grelsamer says, is rarely the source of the problem. In fact these microtears—which most people have—could be left untreated. “Chances are if you get an MRI, the doctor is going to say you have a torn meniscus even though it may be only a tiny change in the cartilage.”

Grelsamer says that these patient-driven MRIs are music to an orthopedist’s ear. “If the weatherman were paid by an umbrella manufacturer, most days would be partly cloudy with a chance of rain.”

After the unnecessary surgery, the doctor gets to punt the patient to a physical therapist, who may or may not solve the problem. That is the nature of “patellofemoral syndrome”: if it’s hard to label, it most certainly will be hard to treat.

“The outcome of ACL pain is easy to define,” says Dungan. “But what exactly is kneecap pain?” It’s usually a combination of things, she says, but because the factors vary from person to person there’s no right answer for all people like there is for a torn ACL. “You can’t lump everyone with the same symptoms together, so you can’t study it,” says Dungan.

If you do have an MRI, make sure your doctor has first examined your feet and hips and you’ve tried alternatives like bracing, physical therapy, and different shoes. Your doctor should spend time listening to your story before the exam; and if an MRI is necessary, the doctor should look at the images with you. If the doctor recommends surgery, get a second opinion. After all, just north of that knee is a brain. Be smart.

The Rundown

Help for Your Knees

• Strengthen the gluteus medius and the gluteus maximus (your bum). These muscles act like the steering wheel for the femur and can cushion the knee when landing. Work the gluteus medius by placing minibands around both ankles and walking laterally. Deep squats, with knees parallel to the floor, will target the gluteus maximus.
• Strengthen core muscles. Strong abdominals and lower back will help control the lower body.
• Strengthen the feet: curl, point, and flex feet; and walk or run in sand.
• For good tissue maintenance, stretch the hip flexors, illiotibial band, hamstrings, quadriceps, and “glutes.”
• If you’re prone to knee problems, reduce the duration of your activity and increase intensity. You can also cross-train with another activity until the pain goes away.