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How to Beat Runner's Knee

Today I will share with you our formula for beating Runner's Knee. The method I developed many years ago and have continued to refine called
Target Tissue TrainingSM forms the foundation for overcoming Runner's Knee. Target Tissue TrainingSM is our unique, three-dimensional approach to solving any musculoskeletal problem and identifies the three key components of any injury:

1. Tissue injury
2. Biomechanics
3. Attitude

The problem of Runner's Knee is that your cartilage has become soft and weak. When your foot hits the ground, the reactive force, nearly 6 times your body weight, reverberates up your leg into your knee, then your hip and spine. Your joint cartilage, with help from your muscles, helps soften the blow of the force much like a shock absorber on your car. When the cartilage is too soft, the force travels into the bone and other soft tissues at a higher level and speed. The softer the cartilage, the sooner you will hurt.

Most physical rehabilitation programs for Runner's Knee, though well intended, miss the mark. The reason is that most practitioners either do not know how to strengthen cartilage or do not believe it is possible. Most academic programs still teach that cartilage cannot repair itself once injured or damaged due to the lack of blood supply. Once it is injured, it is a downward spiral. Of course this is not true, but conventional wisdom often prevails over scientific evidence.

Mechanical stimulation through physical loading and unloading keeps you alive. The entire cardiovascular system maintains its efficiency from the surging pressures of changing blood volume that distend blood vessel walls and heart chambers. The lining of your lungs depend upon a rising and falling amount of oxygen, while your bones need consistent and periodic vertical loads from walking, lifting, pushing and pulling to maintain their density. Mechanical stimulation is critical for life which means it is also important for your cartilage.

Cartilage has a very unusual make up. Once fully developed, the cells isolate themselves from each other unlike other tissues of the body which have direct cell to cell contact. Cell to cell contact greatly aids in responding to injury as the cells can send signals to other cells recruiting certain ones to clean up debris and others to begin forming new tissue. But cartilage cells only talk to each other through what is known as the extra-cellular matrix. This matrix is a complex mixture of proteins and sugars that act like a three-dimensional spider web. And its prey is water. The matrix is responsible for making cartilage stiff by attracting and binding water. The pressure from physical loading and unloading exerted on and within the matrix is transferred to the cartilage cells. This is how cartilage cells know what to do. If the pressure is too great, the matrix begins to come apart, water escapes, the pressure drops, and the cartilage cells have little stimulation (and remember, mechanical stimulation is what makes all tissues stronger which means you must use it or lose it). But, when the magnitude and duration of the pressure are correct, the matrix stiffens, new cells begin to form and the joint becomes stronger.

To strengthen cartilage, you have to first know how much pressure the joint can tolerate. This, in a sense, is a strength test of the joint. Just like you would determine the strength of your arm muscles when you begin muscle training, you also need to know the strength of your cartilage.

We accomplish this by using certain tools that reduce the effect of gravity. We need to know how much force you can comfortably place on your leg while performing a squatting motion. We use a Variable Incline Plane (VIP) in most cases to find this force. Each level of the VIP corresponds to a certain percentage of body weight. By raising or lowering the VIP, we can increase or decrease the resulting force on the leg and identify a pain free load level we refer to as your Load Tolerance. Identifying the Load Tolerance is a critical step. The matrix needs pressure but if you exceed your pain threshold the mechanical force on the matrix will be too great. The result will be a continued weakening of the cartilage.

For example, assume you are 6 feet tall and weigh 200 lbs and our Load Tolerance Test identifies your pain free threshold for squatting on your right knee at 120 lbs. This means that every time you go up a flight of stairs, you overload your knee by 80 lbs. (200 lbs. - 120 lbs. = 80 lbs.). If you jog, you overload your knee even more since jogging creates an increased load on the knee of 3-6 times your body weight. Since your Load Tolerance is 120 lbs., jogging over loads your knee anywhere from 240 to 480 lbs.(80 lbs. x 3 = 240 lbs.)! No wonder you hurt.

Biomechanics uses the laws of physics and applies them to the human body and analyzes the relationships between body parts. Your hip and foot help control the three joints of the knee. When your foot collapses too much (as in a overly pronated foot) or your hip turns inward too much (due to muscular weakness of the hip rotators), stress in the knee goes up and as a result over loads cartilage. In order for your knee to function optimally, you need strong hips and a stable foot. We use our biomechanical exam to tell us if your hips are strong enough and if your foot is stable enough.

Runner's Knee makes you wonder and worry. When can I run? Will I ever run again? To beat your injury, you need a positive mental attitude which is much easier to possess when you're confident about your plan. Hope flows in the river of truth. The truth is, in this case, your knee cannot withstand your full body weight. But, hope springs forth when you understand you can withstand 120 lbs. Hope is a frame of mind; an expectation that the future will bring something good to you or someone in your life even though you cannot see it now. Hope requires faith. They walk hand in hand.

Injured athletes respond best when the injured tissue is properly stimulated, biomechanics are optimized and worry and doubt are addressed. Target Tissue TrainingSM, Sports Center's triple threat to every injury, is how you beat Runner's Knee.

Make today count.


Doug Kelsey
Author. Teacher. Therapist.

Posted by Doug Kelsey on January 09, 2005 | Permalink

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