You may have heard the phrase, “The way to a man’s heart is through his stomach.” This may be true for many men and maybe even some women. For many female athletes though, especially runners, the way to their heart is through two pain-free knees during exercise. As a runner, I wanted to be able to run as much as I could without worrying about how much my right knee would “complain” the next morning. An avid exerciser for more than five decades, I rarely had to limit workouts due to injury. That all changed after turning 50 years of age.
After 50, I limited running on concrete surfaces due to foot pain, stopped using the rowing machine due to knee pain and limited sprinting due to right knee pain and swelling. After altering my workouts in an attempt to avoid motions that hurt, I realized I needed expert help. I made one of the more than 19 million visits to a healthcare professional because of knee pain. This is more than visits due to low back pain, hip pain and ankle pain combined.
I consulted a physical therapist about my knee pain. My physical therapist evaluated my running mechanics, tested the integrity of the ligaments supporting my right knee joint and measured my range of motion and muscle strength of my knees and hips and ankles, and then she compared these assessments to my non-painful joints. I was expecting her to say that I had some chondromalacia or osteoarthritis due to my age. Instead, she diagnosed me with muscle weakness in my right hip in the muscles that pull my leg out to the side. Surprise!
Instead of some degree of overuse or aging deficits, I was suffering from neglecting to strengthen some very important muscles for proper leg alignment during running and any other activity that requires single-leg stance on my right side. I thought I had been strengthening everything I needed to by running, biking and using elliptical machines. While all of these types of exercise were appropriate for aerobic conditioning and some degree of strengthening (depending on the resistance on the equipment) none of them worked my legs in the lateral planes of motion (out to the side), versus forward and backward motions. I assumed that I could strengthen all the muscles needed to run longer by simply running longer. I felt pretty silly when my physical therapist explained to me that my weaker right hip muscles were becoming fatigued as I ran, allowing my right thigh and knee to tilt inward toward my left leg and knee, resulting in poor patellar tracking and anterior/medial knee pain. I felt silly because I am a physical therapist and should have realized this. I knew that knee injuries were common in female runners, but I was unaware of how often hip instability was the reason for these injuries.
My therapist designed a strengthening program for my right hip, including resisted side stepping in a squat position, side-lying hip raises with exercise band resistance, and single-leg squats standing on a stool and lowering my body down as the right leg flexed or bent. Research shows that lower extremity strengthening can make significant gains in as little as three weeks. I added these exercises to my routine, slowed down my running speed to allow more double limb stance time (less time on only my right leg) and shortened my runs. No more running through the pain.
For the next four months, I slowly increased my runs from one mile pain-free distances to three and a half miles without pain. The way to my heart, which for me was a pain-free knee, was through my hip! Now that I have reached my goal for pain-free runs for three plus miles, I still pay attention to strengthening my hip muscles.
I want to be pain-free running, climbing stairs, standing on one leg to pull on my pants and doing anything else that I want as I age. I may never have totally pain-free knees, but I will never forget to strengthen my hip muscles that help with normal leg alignment! Seek help from a medical professional if you are experiencing knee pain during activities of daily living or during exercise. Here is to happy hearts and happy knees!