Fixing Runner’s Knee: Everything You Need To Know

Finn Melanson [00:00:02]: Hi.

Guest [00:00:06]: This is Tow, and I wanna welcome you to the run, to the top podcast.

Finn Melanson [00:00:13]: Hello, fellow runners. I'm your host, Fin Malanson, and this is the run to the top podcast. The podcast dedicated to making you a better runner with each and every episode. We are created and produced by the expert team of coaches at runnersconnect.net, where you can find the best running information on the internet as well as training plans to fit every runner and every budget. One of the most common setbacks in the running sphere is the onset of runners knee. Perhaps it's affected you at various points in the past. You're currently suffering from it at this moment, or you're worried that such an injury is right around the corner. Do not worry. Joining us on the podcast today is Ben Chateau, a licensed physical therapist committed to helping proactive runners of all ages understand how to safely self treat and manage common musculoskeletal neurological and mobility related conditions in a timely manner. so that they can reach their optimal health. In this conversation specifically dedicated to the diagnosis, treatment, and proactive avoidance of runner's knee, We discuss the common symptoms of runner's knee and how it's differentiated from other knee injuries, specific risk factors that make certain athletes prone to developing this condition. Whether there are scenarios where you can continue training through this injury, specific exercises that can strengthen and stabilize the knee area to aid in recovery, the most effective treatment options for this condition and the typical recovery timeline for renters need. And more, listen to this episode to get the lowdown on runners need what causes it, how it can be treated, and what you can do in training and in lifestyle to reduce your risk for this injury, and stay consistent with your running Today's episode is sponsored by Magnesium Breakthrough from Biopneider their industry leading magnesium supplement helps you sleep better and reduce stress. Head to magbreakthrough.com forward slash run to the top to learn more and save 10%. you're looking for the most effectively dosed electrolyte drink for runners, check out element. It's loaded with everything you need to replenish your electrolyte balance, and you can get a free sample pack. by going to drinklmt.comforward/runnersconnect. Alright. Ben Chateau. It's a pleasure to have you on the run to the top podcast. How are you doing? I'm doing fantastic. Thank you. Awesome. Well, we're gonna spend the bulk of this episode breaking down, runner's knee, no pun intended, and how it develops actions that runners can take to fix it, get back on the men to get back to running stuff like that. But, I do think just to familiarize yourself with the audience here. could you give a quick elevator summary of your background? What makes you interested in topics like exercise physiology, intersection with running, and and complications like runners in the inner space.

Guest [00:03:27]: Yeah. You bet. I'm a physical therapist by training. I've been a physical therapist since 2004, so I've been around a little while. my specialty is in orthopedics. I'm board certified in orthopedics for physical therapy, and I got into the running community probably around 2006 with a friend of mine, Eric, that got me into running, and I've I've been running ever since. I've always been interested in health and fitness and wellness. That's kinda been my MO since I was in junior high in high school. as you get a little bit older and as you're you're in the running, genre a little bit and also in the physical therapy genre, you you you can't not run across runner's knee. It's it's a common problem, a common scenario that develops there's a lot of reasons why that does happen. I know we'll talk about that soon. but all in all, you know, my background as physical therapist kinda led me into how the best treat renders me. And so when put with my practice, I've worked with all ages, all types, with this condition, and it's it's always a little bit challenging, especially with with runners because The one thing they wanna do is run, and the one thing that's bothering them typically is running. And so trying to find that balance of how can we do the thing we'd like to do and, and get better and and back at it?

Finn Melanson [00:04:53]: Well, and one thing I wanna ask you before we get into Runners' knee is I just find your background fascinating, and I'm sure that beyond just runners, me, you address a variety of ailments and setbacks among your running clients. And one of the things that I'm always wondering is the rate of change and the rate of progress in this field when it comes to identifying injuries, treating injuries, and getting people back to their preferred activities as soon as possible. in your experience in the last 10 to 15 years, can you say with confidence that we've made significant progress when it comes to addressing things like plantar fasciitis, runners, knee, IT band syndrome, stuff like that, or has progress kind of flatlined or even regressed? Like, what what when you think about the rate of change in this world, what what comes to mind?

Guest [00:05:49]: I've initially comes to mind when you ask that question is that it's a loaded question because you can answer it both ways. You can say yes, and you can say no, not really. And and the no, not really, is because the human body can only heal so fast So when you have an injury, there's only so fast that the the body's gonna naturally heal, and our job is to to optimize that response. Now we do lots of things that slow the response down, including improper training and just pushing through injuries that we shouldn't, but there are things we can do that increases it, but it it does have a at this point in time, there is a max, time limit And so how we treat things is much different than it was 10 years ago, 15, 20, 30 years ago, for sure, but is it substantially different sometimes? And I think it depends on who you're seeing, the sport, the injury, and so it's really varied across the types of injuries and the the types of, athletes, really. But so I would say, yes, there's been advancements, quite a few advancements, actually. and, no, there there hasn't been. I mean, there's still we're still humans, and we still have some of the same problems we've always had. and we just get to be a little bit more fancy with it. So there's always the newest, shinyest things, and they work but so did some of the old new shiny things. And so it's just a matter of having more tools in the toolbox to find how to best treat the individual.

Finn Melanson [00:07:23]: Well, like in the case of Runners' knee, if we look at that specifically, is there anything either in the diagnosis category or treatment category or prevention category that is like a new tool or a new insight in 2020 3 that you feel was either murky or nonexistent in, you know, the 2010 to 2013 range?

Guest [00:07:49]: Yeah. I would say the answer to that is yes. If we we continue to evolve on on on what's causing that particular injury and and pain. And I would say 10, 15 years ago, particularly the hip was something that was not was not thought of as, such an important structure that causes runners need. And and what I mean is there's a lot of it's been known for a while. The hip weakness can be associated with runner's knee, and in particular hip abduction and hip external rotation weakness, but the way we've gone about treating that I think really has advanced over the years, it's really common practice now. that if you're coming in with a knee injury of any type, but particularly with an overuse injury that looking at hip strength and hip mobility is a must. And and I don't think it was as mainstream today, or I don't think it was as mainstream 15 years ago, as it is today. I think the other big advancement is in some of the the bracing technology that's that's coming out for the longest time, there's only one style of brace that was available. And now there's, other options for bracing that are very unique to assist with this condition because this is really a repetitive motion type injury and how we change the position of the tello or the kneecap will affect your recovery and your sense of pain. And there's there's some new ways to to go about affecting that change. And what's nice about that is when you when you affect that change, there's an immediate response and that that's not that has nothing to do with the healing response. It just has to do with, hey. We just removed the the one thing that was causing you the pain. It's like taking the the sliver, you know, or the splinter out of your finger. You know, you removed that problem, and now the pain already feels better. You still have to heal the skin around it where it was, but, it doesn't hurt anymore.

Finn Melanson [00:09:50]: It's so interesting that there's new found emphasis on proper hip function. when it comes to addressing, like, what are the underlying or, like, upstream functional issues that are potentially either causing or exacerbating the issue? Like, for me, with all the massage therapists that I've been to or PTs that I've been to, they've all said, you know, look, your deep hip rotators are or a ticking time bomb. Your TFL is a ticking time bomb, you know, fix these things. And then everything downstream will get progressively better. And, so that that's just a reminder to me. as we're recording this interview on, you know, in in late July 2023. I I've got a a bit of runner's knee in my left knee right now, and I haven't done my pitch and stretches. I haven't done my dynamic exercises to, you know, establish better range of motion in the hips. So that that's a good reminder.

Guest [00:10:44]: I think before we get into Oh, sorry. I I also add to that that as silly as it sounds saying that now that, you know, you have to address the knee. I can tell you 20 years ago when I started practice, that was not necessarily the case. You know, we were it was all about the, what we call the VMO or the the medial quadricep and that was the key to fixing runner's knee and and maybe a new pair of shoes or, you know, some orthotics were kinda thrown in there too, but the hip was not as big a as big a deal as it is now.

Finn Melanson [00:11:17]: Fascinating. Well, I think to set the table for the rest of the conversation, it is important to establish, like, the terminology that we'll be using when it comes to the injury itself prevention, treatment, etcetera. And I I think we should start with what exactly is runner's knee and how it develops. So given that this audience, you know, these are folks that are training for 5 ks, 10 ks, up to the marathon distance mostly on the roads. Some people are on trails, and they're interested in primarily maintaining consistency and achieving PRs, stuff like that, how would you define, this issue?

Guest [00:11:58]: Well, runner's knee is a really a nonspecific term for anterior or front of the leg knee pain. And so it it can be located in in lots of different areas and still be quote unquote runners' knee. It's really the only thing I would the caveat with that is it's it's typically associated around the kneecap or around the patella. So it can be underneath. It can be to the sides. but it it's usually associated with the kneecap itself. If you're getting pain at other areas of the knee, like the side of the knee or the back of the knee or maybe the the patellar tendon. Those are those would be different conditions that are likely leading to that and not renters need. So renters need and for our definition and purposes is really anterior knee pain. And most of the time, that's gonna be associated with, patella tracking and patella function, and that's where you're doing the pain. odd thing about it is it doesn't mean that's where that's the only place you feel the pain. pain likes to migrate and and travel. sometimes, especially as it gets worse. And so you might feel pain in and around the kneecap and down the leg or other places, but it's the the point of origin talking about, which is the anterior knee pain in the runner's knee.

Finn Melanson [00:13:12]: And what happens if you don't address this issue? Like, What are the consequences long term? How quick or how delayed is that feedback typically? Cause I I have known people admittedly myself included that have been running through this for a while or are in the process of running through it. So talk about that too, if you don't mind. Yeah. I would say in my experience, it rarely gets better on its own and and partly because we don't stop training.

Guest [00:13:42]: Now there's a couple of ways this will happen for people. 1, the pain will continue to escalate to a point that they have to stop running or 2, we start doing we start changing the way we run to accommodate for the pain. So we we continue to have a low level amount of knee pain, but now we're not running the same as we were maybe 6 months or or a year ago. as we are now. And so it either shuts us down completely because it gets so severe, and I have had a case that was that severe. and, of course, here in the middle of training, and I'm I'm gonna finish my marathon one way or the other. And I did, but it was not pleasant. or we ended up changing what we're doing. The The other side of that, though, is histologically, like what's happening to the tissue is you're creating a chronic state of inflammation. And And once it goes from, like, a tendinitis or, type situation to more of a tendinosis where the histology actually changes in the cartilage and it becomes more and more challenging to, heal from. It's not just an acute injury anymore. It's a chronic injury and chronic injuries are always a longer recovery time.

Finn Melanson [00:14:58]: Another question I have is just how you differentiate or how how a runner can self diagnosed if that's even the proper course of action. But, like, how would a runner based on the symptoms of runners need differentiate this from other potential knee injuries or knee ailments?

Guest [00:15:16]: Yeah. This is a good question because sometimes the treatments are the same. and a lot of times they're not. And so knowing what you're doing or what what kind of help you might need is really important. So the first thing that I I would say is where exactly is the pain? If the pain is in or around the kneecap, there's a good chance it's runner's knee. If it's behind the knee or the sides of the leg, it is not runner's knee. something else. It could be the meniscus. I mean, there's lots of other things that could be bothering you, but it's not true runner's knee. Another way to to really tell is when do you get the pain? So you you tend to get worse pain, maybe going downhill or going downstairs you'll get worse pain sitting. oftentimes sitting like at a night, like with your knee at a ninety degree angle, Well, the pain slowly will just kind of start to escalate, where if you're keeping your leg at maybe a 20 degree angle where it's just got a slight bend to it, it'll feel significantly better. those are 2 telltale signs of runners needing also when you palpate or touch around the kneecap or in your kneecap, 10 should have some wiggle to it if you can push it far enough to the side where you can just feel the edge of the underneath side, it will be painful there, and that is definitely a clear sign of runners need.

Finn Melanson [00:16:50]: I'm sure there are many categories that contribute to the risk factors of developing renters need, like, couple that some people in the audience myself included my think about are just overuse. So, you know, ramping up mileage volume too quickly. some people might say it could be a function of improper gate and maybe you're overcompensating in in one way or another and it's contributing that way. other categories too. When you think of all of the risk factors that contribute to runner's knee, how do you rank them in in which ones do you tend to focus on because they're the most common

Guest [00:17:26]: Yeah. That is you were correct about all those, and those are all risk factors for runner's knee. I would say I would tend to rank them, kind of equal. I think when you're talking about overuse that is a general term because what's overused to me might not be overused to you. So it's about volume of training and and volume increase. So if you're if you're a fifty mile a week kind of person, then increasing your mileage by 5 in a week is probably not gonna earn you much. You know, that's just a it's a 10% increase. It's an increase, but not too much, but if you're you know, if you're just starting off and you're a a 3 to 5 mile a week person and you just doubled that in the next week, That might be too much for you. And, again, there's body shapes and sizes and running surfaces that all have to be factored in and and running services are a big deal. you know, most of us, you know, live in a city or a town, and so there's some street or concrete running. and that's a lot harder on us than trail running. Now you don't have the variations of the roots and branches and depending on the trails, but it's definitely a harder surface. And so that that impacts you. So I would say volume increase and then you're back to the biomechanics. and that typically goes back to the hips. The hips and feet, and you you can't discount the importance of the feet because they're they're the base and they work in anything that happens to them works up and the hip is kind of top and anything that happens there is gonna work its way down. So that's why the knee ends up such a such a focal point for runners is we're kind of a it's the middle ground for the for the abuse and for the for the errors to happen in the biomechanics from the foot or the hip that's kind of taken the taken the hit.

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Guest [00:21:43]: Another loaded question. and then you'll have people screaming on all sides of the aisle, based on this answer. I'm gonna say I'm gonna say yes. And, again, I'd like to take a a moderate approach to these things. I've used minimalistic shoes. I have not gotten no shoe, at least out of the hard concrete. and I've used built up shoes and it it really is dependent on the person and their body structure. what I can tell you is if you have used a, you know, a very built up shoe high cushion and then you try to go minimalistic and you don't taper yourself into it, something is gonna happen, and it's not gonna be good. And so whenever we're making adjustments to running style, whether it's our gate, or the footwear we're using, it really needs to be done in a a gradiated graduated approach because our tendons and our cartilage and our our bones do not respond as quickly as our lungs and our muscles to stressors. And so if we stress them too hard, too fast, something tends to to wear out or or at least light up as far as getting a little overused. So shoe choice does matter a lot, especially if you have a real extreme arch either direction, but there's not one be all end all shoe choice for someone. if there was, we'd all already be wearing that shoe. And so it really it really varies to personal preference and body weight and size. And so it's a little bit of a guessing game, but whatever you do, don't change extremes without a a smart approach to it. seen that lots of times when it was real popular to go, kind of barefoot running and some of the other minimalistic shoes. Like, people just switched. And, of course, that was not a good choice going from fifty miles with a built up shoe to fifty miles with a minimalistic shoe.

Finn Melanson [00:23:42]: So putting your putting your, adviser physical therapist hat on in this scenario, let's say someone in the audience recently developed runners knee in that moment, are you advising them to stop running and to seek medical attention or to develop some sort of, like, mobility or strength routine, or are you saying to them, Yes. Continue running, but here's a laundry list of some corrective actions that you can take either in the early mornings or the evenings depending on your running schedule so that your training is relatively uninterrupted, but we're also addressing the issue. Like, how do you how do you typically think about that? Although I assume there probably are a variety of you, experiences among athletes?

Guest [00:24:30]: Yeah. I think I know that my thoughts on this has changed over the years, especially once I became a runner because then I understood. I understood the other side of it. Like, it's gonna have to be really bad before I'm not gonna get my run because we've got our goals and we got the things we wanna do. If if we can catch it early, I really don't like having people stop their training. we if I would rather modify in some way or decrease the volume, but keep them going than to completely stop. And so we always try to find a way forward to to train at least at some level. And if it's really severe, it might be that they were in the pool for a while. because I don't, you know, we don't wanna lose our fitness and we, you know, bore our minds for not being able to train, but on average, I prefer people continue to train, just tapered back. Initially, I tell them maybe, you know, try 8% reduction, and then we're gonna go immediately into, like, like, what happened? Like, the the first thing that I always wanna know is, like, what was the throwing. Like, what was that pivotal moment? Like, you were fine, and then now you started getting pain. So what what is different? Have you not changed your shoes in the last, you know, 5 years? Have you just increased your training volume? Have you are you on a weight loss program and you're you're losing too much? Are you a weight gain program and you just put on more pounds and you realize, like, where is the trigger here and what can we do to address that and then what can we do to get the pain under control very quickly so you can continue to train. So it's really a a multi pronged approach. And, the the other thing that has been new for me and my treatment with patients is just utilizing, some different bracing techniques that can allow the pain to be reduced so the volume can stay relatively the same while we address the biomechanical factor that so that the brace is kind of that that temporary fix where we can make a more permanent fix, through biomechanics, and that's usually through strengthening exercise?

Finn Melanson [00:26:43]: You mentioned catching it early there at the beginning of of, the discussion. And I think I'm curious. What does that time frame look like exactly? Like, is it under 24 hours? Is it within a few days, a few weeks? Like, How do you distinguish catching it early from, you know, really being mired in the thick of a runners in the experience versus like Oh, I've been nursing this for years and have never sought medical attention.

Guest [00:27:10]: Yeah. That's a good question. And I and I think all of us that have run and run for a while or even those that have started running, you know and you feel that there are times when you don't feel so good at first. You know? I I I'm joking with some of my friends that aren't runners. I'm like, yeah. I don't start feeling good running until I'm three miles in. You know? I'm finally like, ah, okay. Now now we can go for a while. And I think a lot of us have that experience. So we get some little aches and pains. We just kinda have to dust off and keep going. So knowing your body is really important in knowing like, hey. I'm always just a little slow in my warm up or always takes me a mile or 2 to really get my groove and feel good. or, you know, I know that I'm gonna be doing hills today, and I haven't done hills in a month. So I'm gonna be a little bit sore tomorrow in the next day. So understanding where you're at and your training and how your body responds to training helps guide you versus, you know, and after that last run, my knee started to hurt and now it's hurting more, and I'm not even running, and I didn't run yesterday. I didn't run today, and it's hurting a little bit more. It's not really going away. That's when you have to start thinking yourself. This is not my typical a campaign that goes away that I'm used to dealing with. This is something different. So why why am I having that? And the sooner you can identify that, the better is but from a time period point of view, you really wanna catch that within the 1st 2 to 3 weeks. is my, my advice on that. And then and that's based on how your, your body's gonna respond to an inflammatory response. And so if we can catch it early in that 2 to 3 week cycle, it's easier to intervene, than it is later on, but really the 3 months is kind of a critical number after that. So if you're going past 3 months and it's it's still bugging you, now you're getting to more of a chronic state, and that oftentimes tends to be a little harder to treat. So initially pay attention to your body and know what's what's just a typical acre pain. You can catch in the 1st 2 to 3 weeks are good. 3 months

Finn Melanson [00:29:23]: and longer, it might be a harder thing to deal with. One thing I'm curious about, and it just comes to mind because I'm a part of many Reddit running communities and core running communities and Facebook groups. And one thing I have done in the past is if I have an ongoing injury, I'll throw a comment or a question there like, hey, have been dealing with runner's knee for the last, you know, 3 or 4 weeks. It's not getting better. Does anybody have any recommendations on how to treat it or or where to go, stuff like that? And I'm probably making a first mistake by resorting to those groups to try to solve medical issues. But the reason I bring it up is because I'm I'm I'm curious if there's any disagreement or controversy, even within the PT community or the greater medical community, like, when it comes to the diagnosis of this injury or the treatment of this injury, could you talk about any potential disagreements that are worth acknowledging and maybe responding to in any of these subcategories of the issue?

Guest [00:30:25]: Yeah. I think there are for sure disagreements. And the reason why is because it's it's a difficult condition to to treat And the reason why it's difficult is there's multiple, factors that that will lead to this condition. And so from from a I don't wanna speak far doctor friends, but from from a physician standpoint, it's it's difficult for them to treat because it's not something that you can just have surgery on to fix. It's not a meniscus tear or an ACL tear where there's an obvious injury. Surgeons can go in, fix it. You'd do your rehab, and you're good to go. because of the location, blood flow isn't very good. And so taking oral, anti inflammatories, things like that is helpful but you still have them biomechanical problem that's gonna continue to irritate it. So you're kinda just like throwing water on a fire that's, you know, it's gonna need more than that. And, again, injections don't work very good either for that that same reason. So from a medical standpoint, you know, a physician's standpoint, it's difficult thing to treat. And then depending on your belief system as far as if you're a massage therapist or a physical therapist or a chiropractor, you're gonna see the world through a little bit different eyes where, you know, the chiropractors oftentimes are really looking at hip and spinal alignment. And that is a thing, and that definitely is a contributing factor PTs tend to either be like it's all about the feet or it's all about the hip. And, honestly, it's both. You know? And so it it gets really confusing. And if you throw out a question in the Reddit group, you're gonna get a 100 different answers because everyone had a different experience that kinda worked for them and they're excited about it. And so it's real. You don't see you don't see a lot of, like, agreement on things that research wise, exercise based treatment is the only thing that has a decent amount of research behind it, and then it's you're back to what kind of exercise. And it's really about, the hips and and having that that glute medias and and external rotation strength to to stabilize the knee and really the tracking of the of the kneecap.

Finn Melanson [00:32:43]: Yeah. And and talk about that exercise based treatment because that's one of the main topics I wanted to get into you with is just like when you think about the specific exercises out there, stretches if you believe in in stretching, how do you typically initially advise runners to help strengthen and stabilize this knee area to aid in recovery? Yeah. What do you what do you see as the most effective treatment options in that area?

Guest [00:33:11]: Yeah. I think, again, my my take on this has changed over the years as I've I've grown and learn. if if you have quadricep weakness, that has to be addressed because if it's not giving you, like, if you're not having trouble with it yet, you you will in some way, shape, or form. so you can't ignore the quadriceps, but putting that aside, I spend most of my time with my clients teaching them exercises for glute, you know, abduction hip abduction strength. And it's not just about being quote, unquote stronger in the glutes it's really about how can you use that strength to control your femur and the leg position because the femur and the long bone in the leg thigh bone depending on if it's rotating in more inwardly or more outwardly is going to affect the way the patella or the kneecap is tracking. And and so addressing that issue, tenants, in my opinion, been the most effective. And so it's it's teaching the exercises, but I would say most of the time when I have clients come in and say, oh, I've been doing my clamshells, and I've been doing this. And I don't understand when I watch them do it, they're not really doing it correctly. They're they're using different muscle groups than we should be using. They're going too fast and not really focusing on positioning of it. So it just becomes, something that you gotta, you know, check the box and hurry and do and they're not being as intentional with it and and feeling the muscle work the way it needs to work so you can pay attention to it. And so clamshells is always the most obvious, and I'm sure everyone on this podcast has done them at some point. and I would say 75% of the time they're not done correctly. People go too fast and they're using the wrong muscle. And so I will make sure they curl up in a little bit more of a a fetal position, and I like to do what I call fives where it takes them 5 seconds to come up. a 5 second hold and a 5 seconds back down and and typically within two reps, they're feeling it and they should feel it kinda deep in the buttock. if they're not feeling it or if they're going, like, opening their leg all the way and they're they're rotating in their spine at any way shape or form, then they're not doing it correctly. You're getting a lot of overflow there. So it's really not opening the leg very high, for the clam and it's going slower and controlled and then, like, where do you feel that? Cause if you if you don't feel it deep inside that hip, you're not doing it right.

Finn Melanson [00:35:50]: And with, like, clamshells, for example, is this part of an exercise protocol that you would only use in like, a rehabilitation type environment from the condition or, you know, I I used the phrase, like, part of this complete breakfast for Cheerios and wheaties. Like, is it the case that you would have clamshells as a part of, like, a a warm up or a cool down routine independent of the injury. Like, how do you think about that?

Guest [00:36:15]: Yeah. I I think of it kinda like eating healthy. I I don't start eating healthy once I already have heart disease. you know, I'd rather not get heart disease and start my eating healthy now. and the same for some of these things that we we know Runners knee is very common. So if there's something we could do that wouldn't take much time to help prevent it, I'm I'm always encouraging that I'm not a big fan of doing it before the run necessarily. I don't wanna fatigue the muscles that tend to already be a little bit tired if anything, I would do it after my run or on an off day runners. I think you know, runners like to run, but I think it's important that there's always just a little bit across training, a little bit of extra body work to take care of ourselves and and running every day probably is not a good choice for most of us. There's always the Dean Carnassus and, you know, folks like that, they're just like bulletproof but that is not that's not normal. We read about them because they're amazing. And the stuff they do is amazing. my writing is not amazing. And I'll I'll tell you, I cannot run 7 days a week and not have injury. And so on the off days is when I I would tell you know, all my clients, let's throw something else in because I do like to exercise every day and be active every day. I just physically can't run every day And that's my body. And there's other people that can run 5 days a week can be fine on more of a 3, 4 day week kinda guy.

Finn Melanson [00:37:47]: how about weight lifting in general? Does weight lifting have a role to play in, you know, for example, building out the stabilizer muscles and all of the ways that you can increase stability around that in the area?

Guest [00:38:01]: I think weight lifting from a health and fitness point of view should be, everyone should do it. I would say there's a lot of controversy see about weight lifting, particularly with runners. And, you know, when you see the high level marathoners, they sure don't look like they weight lift, but you know, it we're not we're not those those folks. And if we wanna be more bulletproof weight lifting, is important for a vast majority of us. And I would say even the the elites do some weight training, and you don't need to get extra fancy with it just sticking to the basics. squats, deadlifts, you're good. you don't really need to do more than that, all the the fancy one legged things, instability stuff. I'm not a big fan because when we're weight training, we're just working on strength. And so we don't wanna we don't really wanna introduce unstable surfaces or anything like that. And and this is very controversial on the physical therapy realm, but that's it's a different type of training. when when we're doing things that are unstable, we're doing more perceptive work. We're we're training in a different way. When we're trying to just train strength, we need a stable surface and we need to progressively overload it to get stronger. And that's how it works. That's how it kinda always works. So, yeah, I think it's really important And then based on the type of athlete you are, you spend more time weight training or less time weight training. Now you're not gonna see body builders out running long distances because that's not the type of athlete they are, but you see soccer players or basketball players or runners, you know, so it it it's variable according to your sport, because sport specific training is, important.

Finn Melanson [00:39:44]: One of the last questions I have for you is just how long it typically takes to recover from this issue, is there a wide range of potential outcomes, or do you find that if you address it in a certain way, you can pretty accurately forecast how quickly someone's gonna be back to running pain free.

Guest [00:40:07]: Yeah. That is a excellent question. And that, again, I have changed my tune on this a lot. The the standard answer would be 6 to 8 weeks. and that's just based on physiology and how fast, tissues heal that are, you know, irritated and inflamed. But the the truth of it is with runner's knee and people tending to not stop using or doing the activity that is causing them pain. It tends to take a lot longer to get past it. I mean, 3 months, 4 months, 5 months sometimes, and that's not fun. And that's no good. recently in that, but recent, you know, in the last 3 to 5 years, I keep mentioning the brace. I I I've been bracing more and and using, a particular type of brace that eliminates some of that irritation so that you can move more pain free. And then you can exercise. You continue to train, and you can do your other exercises. with as much pain. And now that speeds up the healing a lot because you've finally, like, eliminated the the irritant that's that's causing the inflammation. And until you address that, you're kinda always, like, plug in holes in the sinking boat. You know? So at first, we gotta let's, like, get out of the water for a second and and address the those irritant and the pain and the pain stressor. And then as your body is growing and changing, cause if we're exercising and doing exercise based approach, your muscles Take time. Right? And initially, you'll you'll get a training response because your body figures out how to utilize its muscles better and more effectively and more efficiently, but then it's old school strengthening, and that's gonna take some time for the muscles to grow stronger. and to change some of those patterns. And so during that time, we don't wanna stop training, and we don't wanna have pain. And so eliminating the pain and and then letting the body, you know, physiologically recover and grow stronger from the training, that's still kind of back to that 6 to 8 week process. So I usually will put people in a protocol for 6 to 8 weeks, depending how severe it is, but I'm finding that they can get back to, you know, pretty high level training in a few weeks, you know, 2 to 3 weeks because we can we can decrease that pain really quickly and not continue to irritate the area while we make, you know, prolonged, you know, changes.

Finn Melanson [00:42:37]: Last question or last topic that I'd love to discuss with you is just the products that are on the market that can aid in recovery prevention, stuff like that. And this is a fascinating area for me because I've dealt with the issue myself. for a long time dating back to, like, the late 2000s early 2010s at various points. I've used those classic patellar tendon bands to stabilize the area, reduce pain, but I just became aware of this new knee product I'm still a bit unfamiliar with it. Can you talk about this option and and, yeah, what the value proposition is and what makes it a practical solution for runners that are either dealing with the issue ongoing or maybe even think about it in preventative terms?

Guest [00:43:23]: Sure. So when I I I'm a big fan of this product as well, and I've been using it, I think, gosh, almost 4 or 5 years now. with my clients. And and the reason why it's different compared to a lot of other things out there, the typical knee brace, whether it's just a compression sleeve, or it's the style where you you kind of slide on the neoprene brace. It's got the little doughnut circle in the middle. all of those are even just taping the knee in general, all those are more compression based, braces or and there's also a a renter's knee, clinical brace where they're they're buttressing. They'll take they'll take that same kind of neoprene brace maybe with some stays on the side, and they'll have Velcro where you you'll have this, stay where you you're actually physically pushing the kneecap into a a different position. and and they're all kinda looking at it from a different from the same point of view. And that is the kneecap is rubbing against the femur, and it's causing pain. and so we're doing something to change that position. So if we're if we're putting a different compression on there, we're changing the position that ECAP is functioning in short term. The problem with that is we've we're still gonna have the same biomechanical issue. So now we put a brace on there and it's rubbing in a different spot. And so it doesn't take very long before you're running in that brace and you're like, god, this thing is starting to hurt me now too. Like, it felt good for the first you know, 2 or 3 times a wore it. Now it's starting to hurt, and that's because we're you still have the same problem. Your your knee, your patella is is rubbing and kind of friction is giving you pain, and the brace just changed the the friction point and the and into a new location. And so those braces don't get worn for very long, and and people don't really like coming in, in my opinion, they're not very successful. The new knee brace and it's spelled nunee, you need, you know, what could happen. Spelling, interesting spellings for everything you say. it is different because it is is really trying to use distraction, instead of compression to change the position kneecap. So the way it's designed is try to to kinda give additional space between the kneecap and, or the patella and the the femoral condyles. And so that is completely unique with any other bracing system out there. It's it's a it's really simple. Mike, the engineer that designed it, you know, it's really not a complicated design when you see it and you're like, well, that's interesting. It's not some gigantic, huge, bulky per race. but nobody wants to run with a giant huge check-in, you know, bulky brace. And and this is taking away some of that compression and allowing the need to free float just a little bit more. And and what's interesting is we don't we don't need like a whole lot of space between those two you know, the back of the kneecap and the from Wakanda, we don't need a lot of extra space for them to to freely move. We just need enough that they don't rub and cause pain. So if it's a half a millimeter different, perfect, that might be enough. we're not asking for, like, you know, some centimeter increase or something crazy that would never happen. We just need just enough space that things can float and and and glide like they're supposed to. And then when that stressor is gone, the pain is alleviated, and you can continue to train while you're on your hip strength or getting new shoes or any other biomechanical factor that needs to be addressed that started the improper tracking to begin with.

Finn Melanson [00:47:11]: When should you wear this, new knee product?

Guest [00:47:17]: Well, I have started with with my clientele, I'll start them right away. And it what's nice about it is if it's gonna work, you're gonna know the first time you put it on. So if you put it on and you feel anything different, any type of change or relief, it's it's doing its job. Is everyone gonna get a 100% relief? No. I mean, there's not one product available or one medication available or one surgery that that causes a 100% relief. But if you can go know, even 25%, 50%, 75% better, then that gives you that much more time. You can continue to train even if you have to back your volume down even to a little bit and do the other things that you know, long term are gonna be important too. So it's just it's an immediate feedback kind of system. And then if you put it on and you're like, I'm not sure this is working. Well, like most things, you know, makes you put it on correctly. but I have I've not really found anyone that doesn't have at least a little bit of benefit from it. If it's true, runner's knee, Though I've had people that have had severe long term runners knee, and it only gave a partial benefit, but it was one of the tools we used. And I had I remember one gentleman. We used it on on both of his knees, and he could barely even pedal a bike anymore. And as soon as we put it on, he was boom. It was amazing, and he had had problems with his knees for years. And so that just became his standard. We we still did the regular rehab, but he never stopped wearing those braces as far as I know. I haven't seen him in a couple years now because he was good to go.

Finn Melanson [00:48:55]: I'm just thinking about potential questions that or objections that people in the audience might have. And maybe one of the questions or comments that comes to mind is whether a product like this because you're not addressing the issue at least upfront with those, like, clamshell exercises that you talked about. I'm sure that this is obviously meant to work in concert. But just as a stand alone, is there any concern about this product, encouraging people to avoid fixing underlying structural issues or, for example, does it encourage bad biomechanics and where compensation issues become a factor at some point? Like, are there any common objections like those that I mentioned that you might, want to address here?

Guest [00:49:42]: Yeah. I like this question. I haven't really thought about it in this way, but I really like that question because the answer is mostly no, and the reason why it's mostly no is I don't like to get a 100% answers on anything. And on top of that, you're you're not gonna damage yourself by wearing a brace. You've already have the pain. You already have the irritation. And if the brace improves that or takes away in any way, that's good. There's there's no way that's not good. and if you get a 100% pain free and you decide, you know, I'm not gonna actually do any of these other exercises I'm just gonna wear this brace because I'm a 100% pain free. That's probably okay because if you're not having pain, you're not having the same issue you had before, and so you're not gonna compensate with your running in a weird way. You're gonna be able to train at the level you wanna train. and you're you're fine. So if you're not getting pain and everything else is the same, you're wearing a brace and you just wanna continue to wear a brace, I don't see any harm in doing that. They'll accept for the fact that you're always gonna have to put the brace on. And if you're okay with that, then I don't see a a big problem with that. If you're, like, a lot of people and you're like, you know, I'm willing to wear this for a while, but I don't really wanna have to mess with it for the rest my life, then, yeah, you should probably look at the other factors that might be contributing to that. But because you've eliminated the the issue which is, you know, the rubbing, the extra friction and you're not putting that friction somewhere else. You're not just transferring the load inappropriately somewhere else. I don't see a a big risk for doing that other than you'll just probably have to keep wearing the brace. though, if you were it really depends on why you got the runners knee. I've I've had clients that were tapering way too fast or, you know, tapering up way too fast. and they their body just needed a little bit more time to accommodate for that. So they they wore the brace. They had their pain reduction. they were able to taper up appropriately and get their body used to the mileage they're now running. They stopped wearing the brace, and they were okay because their body was accommodated to that distance. And so there really wasn't a biomechanical issue. It was a volume issue and, you know, there's always a point where we can over train ourselves. And so I think there's some caveats to that question. But in general, I would say, no. Not really.

Finn Melanson [00:52:17]: Well, Ben, it's been an absolute pleasure to have you on the show. You've provide the audience just a ton of value. And I think it's always a good thing when at the very least the audience becomes aware of potential aids in this runner's knee issue, products, services, etcetera. So thank you so much. we've covered a lot, but is there anything that we have not covered. And I'll give you the final word here. Is there anything that we have not covered, whether it comes to the injury itself, prevention, treatment, exercises, etcetera? that we should discuss before we go?

Guest [00:52:51]: Well, first, I wanna thank you for letting me on the podcast. It's it's been fun talking about this topic. I've I love talking about it. It could go on forever about it. I I would say One advice I have is if you're having pain, you do need to address it, and there needs to be some common sense what you're doing. Like, there's lots of lotions and potions and gimmicks out there. And, you know, runners take their sport really seriously, and we don't wanna get bogged down at things that aren't effective. And so it's talk to the talk to the local running shops and and places that see a lot of injuries or get to talk to a lot of people and don't just necessarily go randomly on the internet. Like, you know, groups like yours, or people that have really been around a while, their advice is gonna be better than just people off the street that aren't runners. They don't quite understand our mentality and our craziness at times. And so I think that's really important and and just know that you don't have to, like, have pain all the time. Like, they're it can be fixable, and that not give up. I get all the time. My clients are like, they're kind of on the edge of, like, I don't know if I'm gonna be able to run it anymore. And I I don't wanna be the person that says you can't run anymore. We just have to find a way that we can make it happen, and there is always a way to make it happen if if a person wants to. And so I just wanna encourage everyone. Like, don't don't give up if you're having some pain. There is a way to keep running if that's you enjoy doing. and and just just keep having fun with it because that's what it's all about.

Finn Melanson [00:54:32]: Thanks for listening to the run to the top pod guest. I'm your host, Fin Malanson. As always, our mission here is to help you become a better runner with every episode. Please connecting with me on Instagram at wasatchfin, and the rest of our team at Runners Connect, also consider supporting our show for free, which the rating on the Spotify and Apple podcast players. And lastly, if you love the show and want bonus content behind the scenes variances with our guests and premier access to contests and giveaways, and subscribe to our newsletter by going to runnersconnect.netback/ podcast until next time. Happy trading.