Nov
Knee’d Help
Q: I’m forty- something and have been running for a few years. The inner sides of both knees have been hurting while training for about a month. I’m getting ready for my second marathon. What’s causing this pain? What should I do?
A: Pain on the inner side of the knee should be taken seriously. Start with the usual first steps: decrease mileage; cut out speed and hill work; cross train; replace worn out shoes; anti-inflammatories; stretch; and ice. If you are not much better in a week, you should be checked out by a good sports medicine specialist.
The three most likely causes of inner (or medial) knee pain are: meniscus tear, pes anserine bursitis, and osteoarthritis. Let’s take a look at each of these.
Meniscus Tear
The medial meniscus is a “C” shaped cartilage that sits between the thighbone and shinbone on the inner side of the knee and works like a shock absorber (figure). It can handle most pounding forces; however, what it cannot handle is a twisting force (like twisting on a planted foot while running on trails or on a track). Most people who injure the meniscus do not remember when they did it. Pain from a medial meniscus tear may cause swelling and locking. The pain may be worse when you bend your knee all the way back (as in squatting). Your Sports Medicine specialist may get an MRI to confirm the diagnosis.
Medial meniscus tears may be treated with a good rehab program. Joint aspiration and injection may also be tried. In some cases, surgery is needed in order to avoid further injury to the joint.
Pes Anserine Bursitis
Several muscles join to form the pes anserine tendon which attaches on the inner side of the lower knee (figure). As you run, this tendon rubs against your shin bone and creates friction. Anywhere in the body where friction builds up, we have a friction absorber called a bursa. When that bursa gets overused (by training too much, too soon) it gets red, angry, and inflamed. Then it is called bursitis.
A specific stretching and strengthening program may help pes anserine bursitis if caught early enough. Anti-inflammatories and PT modalities, like ultrasound, are generally useful. A cortisone injection into the bursa heals most runners with this problem. Injection into this area is quick, effective, and nearly painless.
Osteoarthritis
Most knees older than forty have a little arthritis, or cartilage breakdown. The amount of arthritis you have depends on how badly your parents had it; your weight; whether or not you’ve had previous sever knee injuries; and other factors. 90% of people with knee arthritis have it worse on the inner side than on the outer side of the knee. Arthritis typically causes morning stiffness, and pain with running. Other joints, especially in the hands, may also be affected. Your Sports Medicine specialist will probably get an x-ray of you knees while you are standing to determine your degree of arthritis.
While there is no quick fix or easy cure for knee arthritis, there are many things you can do to lessen the symptoms and even slow the progress of the disease. Non- weight bearing training, like swimming and riding, should be the cornerstone of your workouts. Running should be in moderation, depending on how sever your arthritis is. Keeping your quadriceps strong is also important. Acetaminophen (Tylenol) is effective and fairly safe.
No doubt, you have seen the advertisements for glucosamine containing supplements. The bottom line on glucosamine is that it probably helps slow cartilage breakdown. The dose that works is at least 1500 mg daily. Most people don’t take enough. Most of the varieties available have other supplements (like chondroitin, MSM, or SAM-E) added to them. These other supplements are not likely to give much additional benefit.
An arthritic knee may benefit from injections into the joint. There are 2 different types of shots available. Cortisone shots work well; but only for about 3 months. Repeating these injections regularly can have adverse side effects.
A newer type of injection, called viscosupplementation, is a good alternative to cortisone shots. Viscosupplementation is effective for 6-12 months. Unlike the cortisone shots, it can safely be repeated when necessary.
