Wednesday, May 21, 2014

Ok Runners, how far can you drive on a flat tire?

Have you ever driven on a flat tire?
I did once, we were stuck in the middle of nowhere and the only way to get help was to stick it out. The faster we went the harder the car shook. I thought the whole thing was coming apart, but thankfully we didn't have to go far. In this post we're going to relate the flat tire to the muscle imbalances/functional limitations that living in today's society creates (which were discussed in this post).
Why do I see so many "Runner's knees"?
It's no secret we are a sports based practice, and as such we see all types of athletes. One of the injuries we address on a daily basis is "Runner's Knee" (Patellofemoral Pain Syndrome or PFPS) which is a problem with your knee cap/knee joint.
The back side of the knee cap (patella) is lined with soft and smooth cartilage, exactly like what you see on the ends of chicken bones. The patella fits right in to the groove in the front of the knee, "Runner's knee" occurs when the patella is pushed out of position from imbalances in the thigh (quadriceps) muscle over a long period or overuse (1). Since the knee cap is designed to operate in it's groove, when it doesn't the cartilage gets inflamed and degenerates.

The return of the bad neighbor.
In a recent post we discussed how glutes get "turned off" (It's all in the hips), from sitting too long or overdeveloping the front of our bodies(muscle imbalance), and it's effect on lower back pain.  Guess what-hip weakness also causes our knee to react and  over time develop incorrectly, that's right MUSCLE IMBALANCE strikes again! 
This illustration shows the effect of a weak glute on the hips and subsequently the medial collapse (valgus collapse) at the knee..
A. Normal glute support B. Weak glute 
The body makes it work, even if it's bad for it.
We cannot build strength on poor movement, but the body will sacrifice quality for mobility.
Endurance is a form of strength and the body will adapt to the new, poor movement. Unfortunately the result is over development of the lateral knee muscles (IT band syndrome) and improper tracking of the knee cap (patella). This situation in essence is "driving on a flat tire"; sure, you can run on it but how fast are you going to drive? How far? When will you "car" finally call it quits?

Anyone have a spare tire?
Knee problems are very common and are on the increase (2). The answer to maintaining your running/exercise routine lies is finding the faulty link through functional testing. Surgical intervention or knee replacement is devastating to any workout routine  (and has a low success rate).  Since we don't have interchangeable parts, consider making muscle balance a part of your over all workout.

We welcome shares, the more we can reach with this knowledge the less will suffer and anguish. 

Dr. Serafim is a Rehabilitation and a Strength and Conditioning Specialist. He lives and works in the Exton PA area and has devoted himself to furthering his understanding of movement related disorders, and is level 2 functional movement screen certified. He teaches continuing education and operates a private practice. More information can be found at and feel free to like us at our Facebook Page page.

1.Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

Gregory R Waryasz12* and Ann Y McDermott13

 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004.

2. Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data.

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