Osteoarthritis (OA) of the knee joint: Contrary to popular (non-runner) belief, runners do not get arthritis any more frequently than non-runners.  But arthritis is a fact of life.  We all get some arthritis as we age.  How we deal with it is our choice.

 History:  The runner is usually over 40 years old.  They will usually have increased pain and stiffness when they wake in the morning which decreases within 30-60 minutes after getting out of bed.  They will have increased pain with any weightbearing activity.  The pain will decrease with sitting.  You may have a sensation of grinding with knee movement.  You may have some previous injury when you were younger, but not recent injuries.  You can have OA in one knee or both knees.

Self-Examination: Here are some indications your knee pain is because of osteoarthritis of the knee:

1)      You may actually hear your knees grind when going downstairs or when you complete mini squats.

2)      Your knees are stiff and sore when you first get up in the morning and get better within 30-60 minutes after you start walking around.

3)       Your pain increases the deeper you squat.  Pain may increase as you stand up from the mini squats.   

4)      You probably have decreased motion into knee flexion and/or extension. 

5)      Osteoarthritis is almost accompanied by decreased knee strength. 

6)      If you sit and gently place your hand on your knee, VID you can feel the grinding as you extend and flex your knee. (We can hear it crunch ☹.) 

Treatment:

1)      Manage the pain:

a.      NSAIDS will help.  There are quite a few prescription medications specifically for OA which can help. Ove-the-counter analgesics can help with your soreness.

b.      Kinesiology taping to stabilize your knee may help until you get your strength back.  LIN

c.       Over-the-counter knee sleeves with a patellar cut-out may help.

                                                              i.      More expensive is not necessarily better.   Knee sleeves are pretty generic and fit a general group of sizes.  Taping may take more time to apply, but it will fit YOUR knee versus a generic knee.

d.      Continue running but avoid aggressive speed work and hill repeats, especially downhill running.

                                                              i.      Occasionally get on a treadmill and run for a while. Listen to yourself run.  If you land really heavy on one knee (it doesn’t matter which one) then your running mechanics are suffering.

                                                            ii.      If this happens it is time to see your physical therapist or athletic trainer for some exercises to restore your running mechanics.

e.      If your knees are always pretty sore when you get up in the morning you can complete a few moments of heel slides in the bed to reduce the pain with your first steps.

2)      Restore full motion to the knees:

a.      A lot of patients with osteoarthritis of the knee have tight hamstrings and/or quads.  Make sure you include stretching all your muscles as part of your training program.

b.      The single-knee-to-chest stretch is good to keep your motion.  VID

c.       Exercises on a bed such as child’s pose can help increase knee flexion LIN

d.      Be especially sure you stretch our quads.  Any excessive pressure on the knee when you are sitting will make things worse. VID1  VID2

e.      Stretching does not have to be part of your warm-up or cool-down.  But it HAS to be part of your training program. LIN

3)      Begin non-weightbearing exercises to restore strength without all the pressure on the joints

a.      Most exercises involve minimal movement of the knee joint to reduce pressure on the joint as it recovers

b.      My favorite is KISS.  Keep it simple Sam (Or Samantha)

                                                              i.      The basic knee exercise is the static quad setting with your knee fully extended.  About 10,000 per day.  Okay, not that many, but you get the idea. LIN  LOTS

                                                            ii.      Other great exercises you can do at home are: Straight leg raise, Short arc quad and, Static hamstring sets VID

c.       You will not be at this level very long; we just need to increase your strength while minimizing stress on your knee.

4)      Begin body weight exercises with emphasis on control versus strength and power.

a.      Apply the kinesiology tape to your knee before you start your weight-bearing exercises.

b.      These are done slowly, with a short range of motion, and STOP BEFORE IT HURTS.

c.       Wall-slides, sit-to-stand, static lunges, lateral step-ups, etc.  LIN

d.      If you can, complete these in front of a mirror so you can watch your knee stay in track above your foot.

e.      As soon as you can perform the mini squat without pain, you can progress to your regular strength training program.

                                                              i.      If you have access to a gym I usually recommend your first strength training exercises are done in a machine to keep better control of your knees as you gain control of your strength.

                                                            ii.      Knee flexion, knee extension, leg press, etc VID

f.        As your strength AND CONTROL return you can progress to free weights

g.      Continue to tape your knees before your hard workouts.

5)      Correct running mechanics.

a.      Gradually return to your previous running.  Start on relatively flat ground or even on a treadmill.  The best part of returning to running with a treadmill is that you can actually hear your footsteps.  Also, a lot of treadmills are in front of a mirror so you can see your hands move and your feet move.  If your arms or legs swing weird, you may want to have a physical therapist complete an evaluation before you return to full running.  Listen and ‘feel’ how you run.  Is one leg hitting the ground harder than the other?  Does one arm swing differently than the other?  Until you can run without pain and with fairly symmetrical running mechanics, you are still at risk of reproducing your old injury or creating a whole new injury to another part of your body.

b.      As soon as you can run without pain and without a limp you can return to your normal running routine.

6)      Return to running speedwork and hills.  After you have been able to run on flat ground for a week with your with your normal training and have not had any pain, you can begin to add speed and hill training to your program.

7)      My favorite step, get back to full running!  Have fun.  Eventually you will bust something else and be back to the website to fix that. 

8)      If you follow the steps on the website for 2-6 weeks (depending on how badly you hurt yourself the first time and on how long you tried to ‘run through the pain’) and your problem does not resolve, then call our clinic for an appointment and we can do something Dr. Google cannot do.  We can complete a hands-on evaluation, in-person evaluation to determine the cause of your pain.

NOTE ON TREATMENT FOR OSTEOARTHRITIS OF THE KNEE:  treatment for osteoarthritis (OA) of the knee depends on the state of the degeneration.   OA is a progressive disease and gradually worsens with age.  YOU can control this process with correct exercise intervention and weight management.  Intervention for knee OA may include treatment from a medical doctor including the use of steroids, PRP injections and other treatment options.