KNEE PROBLEMS FOR TRIATHLETES

Mike Leahy

founder of Champion Health Associates and inventor of Active Release Techniques®.

At most Ironman races we have a team of ART providers who work at the race and help athletes prepare in the 3-5 days prior to race day. After doing this for over 25 years, we have come to know what the major issues are and how athletes can overcome some of the issues commonly faced. One of the more common issues is lateral (outside) knee pain that gets worse over the course of the race.

There are several causes of lateral knee pain on the run. The most common is internal rotation of the femur causing a lateral load on the knee. The second most common is insufficient motion of the lateral meniscus (cartilage).

PROBLEM 1 – LATERAL LOAD

Because we spend so much time and effort on the bike with the hips flexed the hip rotators and flexors get a little “locked in” at that position. When we stand more upright and begin to run these muscles can cause the femur (upper leg) to be a little turned in (medial). When this happens the knee is subjected to a lateral bending load on heel strike. This causes stress on the ligaments on the side of the knee that gets worse as you run. In short, you don’t have to have a real “injury” to end up with lateral knee pain on the run.

PROBLEM 2 – INSUFFICIENT CARTILAGE MOTION

In the second example full meniscus motion is essential. Warning signs for this condition include:

• clicking or popping knee
• knee feels unstable on stairs or stepping off a curb
• knee locks in any position
• any surgical procedure
• knee “gives out”
• knee pain on the joint line

The meniscus moves relative to the femur and tibia during gait. When the meniscus does not move completely during knee flexion or extension it tends to get “pinched.” This pinching can cause soreness and may cause the meniscus to swell. Once this happens the problem accelerates. It is also common to have all the muscles that attach near the side of the knee tighten to the point of being painful. As you can see from the illustration above there are many attachments on the side of the knee near the meniscus.

FIXING THE ISSUE

So what can we do about these two problems? In the first case we change the functional length of the shortened muscles. In order to do this the fascia and muscle tissue must be physically changed and not just stretched. This can be done in 1-4 visits and we expect immediate changes in texture, tension, movement and function. It is common to see the rotation of the femur to be corrected on the first visit.

In the second case we must get the meniscus to move more completely. We do this by placing the knee and meniscus at its end range position then use manual pressure to make the meniscus move a little farther. Surprisingly this can often be done in one or two visits giving a complete resolution of the problem.

If you understand the mechanics of how it happens, lateral knee pain in the runner can usually be fixed in very short order. It is not usually necessary to take time off from training or competition.