The Right Stretch

Pain in the Knee

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I have been power walking for 4 years and completed the Comrades last year. In December I decided to start running and have since completed a few half marathons. I now have this pain below my left knee when I stand up. I can barely walk. When I start running I hobble the first few hundred metres. It usually then warms up and I run with no problems. But when I stop running the pain sets in again. I have been to a physio who told me that it is not Runner’s knee as I initially suspected. I am now in pain whenever I stand, even though I have backed off training. I have iced the area and covered it with medicated patches, but nothing seems to work.


ANSWER
Knee injuries can be very difficult to manage and treat and seldom resolve on their own. A correct diagnosis is always needed before a treatment and management program is started for any injury. I suggest seeing a sports physician or knee orthopaedic specialist so a full clinical history and examination may be performed to establish the actual cause the pain.


Runner’s knee or anterior knee pain or patella-femoral pain, is only one possibility that could be causing the pain that you are feeling. Runners and walkers by virtue of their chosen sport will have some degree of cartilage damage to the patella-femoral joint, which can present in many differing pain patterns. Typically pain presents when walking up and down stairs or when rising from a seated position.
Meniscal injury should also be considered. Chronic degeneration of the menisci may present in any endurance athlete as pain and swelling of the knee, or locking or catching of the knee through extension and flexion of the knee.


Tendinopathy pain is due to chronic degeneration of the involved tendon, which is typically stiff or painful when immobile and resolves with movement. This is due to chronic overloading of those structures leading to micro-trauma, poor healing and degenerative scar tissue build up.


Having established the correct diagnosis, the management program should then include:
• Offloading and rest of the affected area
•  Stabilization and protection of the knee joint
• Symptomatic relief
• Promotion of healing
• Intervention where needed (conservative vs. surgical)
• Correction of any bio-mechanical issues
• Education of the patient in preventative measures
• Gradual return to sport



Modern Athlete Expert
Gavin Shang
Sports Physician at the Rosebank Centre for Sports Medicine and Orthopaedics in Johannesburg. Holds a Masters degree in Sports Medicine and has worked with numerous top local and international sports people over the years.

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