Tricks of the Trade – Knees

According to one source, one in five runners injure their knees annually. In this post, I review four “Tricks of the Trade” that will help you reduce or eliminate your knee pain.

Introduction
About 60 per cent of all runners are injured in an average year, and about one-third of those injuries occur at the knee, producing a yearly injury rate of one in five runners (‘Running Injuries to the Knee,’ Journal of the American Academy of Orthopedic Surgeons, vol. 3, pp. 309-318, 1995). I too have suffered from knee issues over the years. At one point, I was ready to “throw in the towel.” I was just “too old” to expect to run any significant distance. In this post, I review four “tricks of the trade” that will help you to reduce or eliminate your knee pain.

Note: While I am not a doctor, I have put together these four “Tricks of the Trade” to address problems with knees. Some knee injuries will not get better with the techniques listed below. I recommend that you consult your health care professional before making any changes to your workout regiment. Full disclosure: I will receive a small commission if you follow the links listed in this article and purchase a book or DVD.

1. It’s the shoes, Mike! It’s the shoes!!
That’s right, shoes make a big difference. After about 300 miles, the sole of your shoes will start to break down. This will reduce the sole’s ability to cushion the impact of each step. Since I run distance, marathon and above, I tend to run a fair amount, at least 20 to 30 miles a week. That means that my shoes are ready for replacement after about three months. If you run year round, that’s four pair a year! If you log your workouts, you will know when your shoes are ready for replacement.

There are shoes that have been designed to correct common problems such as pronation and supination (click on links for excellent articles on each topic). I pronate (also called knocked-knees meaning I tend to apply pressure to the inside of my soles). How do you tell if you pronate or supinate? There’s a really easy test. Grab an old pair of shoes and look at the heels. If there is wear on the inside (left side of the right shoe), then you pronate. If there is wear on the outside (right side of the right shoe), then you supinate. There are two solutions that I have employed here. The first is the shoe. I have purchased shoes that correct for pronation. I have purchased the ASICS Men’s GEL-Foundation 8 Running Shoe. The second solution is the lacing. I create a loop using the last two lace holes and pass the lace ends through these holds to improve stabability. Make sure you lace ’em up tight!

Increase Stability with Lacing Technique

2. Running Style
I’ve already mentioned pronation in the previous Trick and I have held out the shoe as the solution. There’s another solution: force yourself to run the right way. This is not easy. But, over time, you can correct your running style. Try this: the next time your are out for a run, look down and watch your feet. Are they both pointed forward or is one angled out (like mine)? Turn your foot. That’s right, turn your foot so that it points forward. Someone asked if this caused problems with my hip. The answer is “No” but this was my experience. You may have issues. So, make this change slowly, over time. Imagine looking down at a boat. Is your boat (your right or left foot) traveling north on the ocean or more to the East (right foot) or West (left foot)?

Here’s another issue. Again, while you are looking down, is the contact point on the inside of your shoe (pronation) or the outside (supination)? As I have mentioned already, without the right shoes, I pronate rolling on the inside of my shoe (my right shoe contacts the pavement on the left side of the sole). Again, using the boat analogy, this would be side to side motion. Imagine waves hitting the side of your foot and rolling it side to side. With the right shoes, you soles should roll forward with even side to side pressure on the pavement.

Finally, focus on foot landing. Are your feet landing on your heal? Well, they shouldn’t. They should be landing on your toes (see Pose Method of Running) or mid-foot (see 50/50: Secrets I Learned Running 50 Marathons in 50 Days). I run long distance events. I can’t imagine running a marathon on my toes. But, some people do it. I instead land on my mid-foot. This has worked for me. Back to the boat analogy, imagine waves hitting the front of your foot, causing it to rock from front to back.

You might think this is it. But it isn’t. I have left the most important running style Trick for the end of this section. Again, looking down at your feet as you run, make sure that your big toe never advances beyond your knee. If you are, you are guilty of “cheap speed”. Taking giant steps, may look impressive, but you are putting tremendous pressure on your whole body, especially your knees. Instead of pushing off with your rear foot, focus instead on increasing your cadence (sometimes called “turnover”). What’s cadence? The number of steps your take per minute. Instead of taking 60 steps per minute, try to maintain the same speed at 90 or 120 steps per minute. What does it look like? Like you are shuffling. And note, you will have to increase your arm movement as well to match your foot cadence. Not convinced? If you have a GPS watch and experiment with cadence, you will see what I mean. I radically improved my speed and still felt like I was doing the same amount of work! What? No steroids? No human growth supplements? That’s right. You can increase your speed for “free”. And, you will be putting less stress on your knees at the same time!

3. Weight lifting
Let me start off by saying I hate weight lifting. I would rather stick needles in eye, than go to the gym and lift weights. But, I can say that focusing on the lower body can have tremendous results on your running in general and your knees. One weekend I ran 13 miles. I was tired. But, nothing out of the ordinary. The next weekend, I ran 15 miles. The last two miles nearly killed me. Why? Because, as I fatigued, I lost my form and failed to run with good style. Without going into a lot of detail, weight lifting strengthens the muscles that allow you to run the “right way”. Thus, you can run further with good form. What sorts of exercises should you do? Instead of listing them here, let me recommend a book (reference: The Body Sculpting Bible for Men and The Body Sculpting Bible for Women). How often do you need to lift? I would say, once a week. Note that lifting will also build the leg muscles that don’t get used as much while running. Some believe that this will reduce injuries. I tend to agreed. Note that the book that I have references includes upper body (not a bad idea) and core exercises (essential for runners). Tip: Instead of bringing the book to the gym, type up notes on each exercise and then just bring the notes. Another tip: Alternate between a pair of exercises and you can cut the time it takes to complete your workout in half!

4. Cross Training
Here’s another tip. The best way to reduce or eliminate knee problems is to not run. What? That’s right, reduce your miles and instead, use other forms of exercise to build endurance and strength. Another story: After the Long Beach Marathon in 2006, I had terrible “shin splints”. I went to the doctor and told him I hurt myself while running a marathon. (Each time I visited my doctor, he asked how far a marathon was. I told him, 26.2 miles. And each time I said it, he looked up to heaven and remarked, “Wow, that’s a long way”.)

Since it hadn’t healed after a month, I thought I had a stress fracture. We got it X-Rayed. But, my bones were in fine shape. When I returned to my doctor, he explained that the contact point between the muscles and the bone sometimes become inflamed. And, because of the low vascularization, the healing process can take a long time (it took three months). He told me that running is really hard on your body (he said it over and over again). He recommended that I take up another sport, at least as long as my shins hurt. He recommended swimming or riding a bike. Both are low-impact sports. I reasoned that I wouldn’t be giving up running. I would instead just be temporarily substituting other forms of exercise to maintain my fitness and wait for the healing process to take place.

After about 6 weeks of swimming, riding and lifting weights, I started to walk. I had no pain walking. Later, I started to run-walk, always ensuring that I stayed below my pain threshold (this is very important). Gradually, I reduced the other sports and increased my running, stopping or slowing down if I had any pain. Note that the cause of my shin splits were improper shoes and using the wrong running style. But, this regiment, allowed me to heal and maintain my fitness. Try this protocol if you have knee pain.

Even though I primarily consider myself a runner, I only run twice to three times a week. If I run three times a week, I will run mid distance first, speed workout at the track (reference: Ready, Set, Go! Synergy Fitness) and then a long, slow run on the weekend. I ALWAYS take one day a week off (sometimes two). And, if I run a race or complete a long training run, I will take two or three days off and significantly reduce my running for the next two weeks.

(Updated) 5. Suppliments
I’ve come across a fantastic product that doesn’t require a perscription, won’t cost you a lot and is VERY effective (at least for me). It’s ordinary Flaxseed Oil. You can pick it up at your local market and try it out. At the time when I discovered this solution, my knee pain was increasing. Interestingly, the dose makes all of the difference. I took one a day for a few days and nothing happened. Then, I took two a day same thing – nada. But, when I got to four a day, I noticed a big difference. In fact, I had almost no knee pain at all. Since Flaxseed is actually really good for you, I didn’t worry about taking more. After a few weeks, I backed off to two a day and this is where I stand today. Note: once your knees stop hurting, it is easy to stop taking this product because your knees won’t start to hurt right away. As a result, it is easy to “fall off the wagon”. Not surprisingly, when you start taking them again, it takes a few days to kick in. I found that I need to put them in the bathroom next to my toothbrush to help me to remember to take them. One other thing I recommend is to follow the Scientific Method: If you see improvement with the Flaxseed Oil, stop taking it for a week to make sure the results you are seeing can be traced back to this change and not something else. Once your knee pain returns (assuming it does), repeat your experiment by ramping up your dosage in the same way you did the first time.

Photo credit: Postbear