Q. I am 40 years old. I have been a regular runner for many years, running three times a week, about 5 km each time. I really enjoy running but other exercises like swimming and cycling don't give me the same enjoyment.
Recently, I started running on slightly hilly terrain. After a few weeks, my knees started hurting and I couldn't even complete my usual 5km.
My family doctor has advised me to stop running, saying that my pain will not get better if I continue to do so.
Is it true that I have to give up running? Is there anything I can do to get rid of this knee pain so I can run regularly again?
A. Let me first congratulate you for having a healthy lifestyle that many people would aspire to. Having a run three times a week will have excellent health benefits like reducing your risks of stroke, heart attack, cancer, diabetes and hypertension, just to name a few.
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As an orthopaedic surgeon with special interest in sports injuries, I deal with a lot of patients who suffer from knee pain associated with running. The solution is not to stop running altogether but to find out what is causing the pain and how to treat it so that you can continue your active lifestyle.
You could very well be having runner's knee, or patellofemoral pain syndrome. The pain is usually felt around the knee cap (patella bone). It is due to irritation or softening of the cartilage under the kneecap causing pain, a grinding sensation and even swelling in the knee.
In your case, the pain started after you changed your running from flat ground to hilly terrain. Running on hilly terrain is an excellent workout because it is more physically demanding. However, doing too much too soon can lead to painful knee problems.
Whenever you are trying something new (like running on hilly terrain), it is always good to start slow and gradually build up the intensity with regard to mileage and gradient of the running tracks.
Proper warm-up like running first on flat ground and proper cool-down after the run with appropriate stretches are helpful in preventing injuries.
You should also pay attention to strengthening the muscles around the knees (quadriceps and hamstrings) and improving your flexibility through regular stretching.
Your painful knees should be treated initially with rest and if there is any swelling, icing and compressive bandage will help. It is not helpful to continue running when you have pain. Advice like "No pain no gain", "run through the pain" is not helpful at all and may even aggravate the injury.
Most minor knee injuries will get better with rest after two to three weeks and you can resume running after that.
If the pain persists beyond three weeks despite adequate rest, you need to consult a doctor.
The doctor will do a thorough examination and probably do some imaging tests like X-rays or MRI (magnetic resonance imaging) scans. After establishing the diagnosis, he will advise you on the proper treatment options.
The good news is that most cases of runner's knee can be treated without having to go under the surgeon's knife.
A physiotherapist can help; usually this involves core strengthening, correcting running postures, strengthening weak muscles and stretching stiff muscles, correcting alignment from the spine through to the pelvis, hips, knees and feet.
Surgery may be needed in cases where there is cartilage damage or severe malalignment of the kneecap. Cartilage damage can be regenerated surgically and malalignment corrected through specialised keyhole techniques.
Dr Tan Chyn Hong
- Dr Tan is an orthopaedic surgeon at Mount Elizabeth Novena Hospital