Time to ask for help

Clarke’s knee pain was getting worse after each track session, so he finally admitted it was time to get some expert advice. He’d put off coming to see us because he was scared we’d tell him to stop running.

We’re in the business of helping people achieve their goals, so we had some good news for Clarke.

He told us he had a history of knee pain that would flare up from time to time, usually during or after running.

Okay, so what can we do for Clarke?

First up, we need to understand the problem from the patient’s perspective. How often does Clarke run? What type of running does he do? Why is it important to him? What are his running goals? What other types of activity does he do each week at home and at work?

Next, we do a thorough assessment to get a good understanding of Clarke's injury. We need to understand where his pain is coming from and how he moves. We start to build up a picture of his strengths, weaknesses, flexibility and muscle activation patterns.

Eventually, the conversation goes something like this:

“You’ve got patellofemoral pain.”

“Patello-what?”

“Patellofemoral. It’s a pain-limiting condition, which means that as long as you’re not doing anything to aggravate the pain, you can stay active without making the injury worse. The trap with this sort of pain is that most people don’t realise it’s treatable, so they carry it for much longer than they need to – the average is 20 years.”

“Woah, 20 years?”

“Yeah. But that’s not going to be you, because we’ll treat it by helping you to strengthen your body to support the knee. Most people don’t take the time to do that. Or, they hit a patch when the pain has gone and overload themselves by doing too much running, too soon.”

What's next?

Having diagnosed the problem, we need to work out what sort of running Clarke can keep doing, safely.

Looking at his weekly running plan, we take out all the hills and interval sessions. We adapt some of his longer, harder runs to shorter, easier runs. This is really important. We’re keeping the loading on his body at a manageable level. It means we’ll have a strong foundation on which to build his running back up again once the pain settles.

Then we add in some rehab exercises to start correcting the knee issues. The first exercises are easy to the point of being boring but they’re crucial for switching on muscles that he will then be strengthening. We explain to Clarke how the exercises relate to his running goal. He needs to understand why he’s doing them.

Moving forward

Clarke leaves with a clear set of goals and a healthy dose of optimism.

At the next session, we’ll check on his progress, add some new strength exercises and review his running technique. We’ll gradually start to increase his runs.

The goal is to get him running again without pain. As with most runners, his greatest challenge will be a little bit of patience, but the payoff will be worth it.