The London Marathon and your Knees. The Magic Cure!

As a chiropractor in Islington the months leading  up to the London marathon always causes the phone to ring with a number of runners having various injuries as they increase their mileage. Those that have planned well in advance generally adapt to the increase in mileage okay, but those that increase their mileage too quickly start to pick up injuries and unfortunately when there is a deadline looming ahead, easing off on the mileage isn’t always the option they go for.

Being a chiropractor in Islington I have had to tell the runner  that the best option if they want to start the marathon is to ease off the running and let the body recover. The body has a great capacity to repair and heal itself but you have to create the environment for this to happen. Pounding along the pavements isn’t going to allow this!

If only there was such a thing as a magical cure or ‘golden bullet’ for curing runners knee but there is certainly a lot more to the treatment of runners knee than stretching the ilio-tibial band and general quads and knee strengthening exercises.

The muscles involved

The quadriceps gets its name from the four bands of fibres that make up the muscle. Vastus lateralis (which is the biggest part), Vastus medialis and Vastus intermdius. The last component of the quadriceps is the Rectus femoris. The action of the quadriceps on contraction is to straighten the knee and vastus medialis is the biggest contributor to this movement. Vastus medialis inserts on the medial aspect of the kneecap and its action on knee straightening is to pull the kneecap medially. 

It is clear that with a tight ilio tibial band and generally tight quads the tracking of the kneecap is going to be compromised and patellar femoral pain a possibility so a coordinated approach needs to be undertaken in the rehabilitation of runners knee or in the treatment of patellofemoral pain syndromes.

How to assess function of vastus medialis

The muscle is often described as having a tear drop appearance on the inside of the bottom of the thigh and it is maximally utilised in the last 10% of the movement that straightens the knee.

1.Sit with your legs out in front of you and a rolled up towel under the injured knee (the      knee should be slightly bent) 

2.Put your fingers over the area of VMO (medial inside of thigh above kneecap height).

3. Push your knee down into the towel (so that your knee straightens and the foot lifts off the couch) 

3.You should feel a strong contraction under your finger

To compare the contraction of vastus lateralis and vastus medialis place a finger from the other hand into the vastus lateralis muscle mid thigh height and contract the quads and compare the timing of muscle contraction. If there is a difference between the two parts of the quads contracting a biofeedback approach to rehabilitation may be required.

Electromyographic biofeedback or EMG is probably the best way to focus the rehabilitation on improving the contraction of the muscle but a simpler solution is to maintain finger contact on the muscle during the rehabilitation exercises of vastus medialis and concentrate on the contraction. This is effective in helping you isolate the muscle but you do need to concentrate!

Exercises for strengthening Vastus medialis

Resistance leg extensions: don’t forget that VM only works in the last 10% of extension.

Deep squats: be careful of any existing injuries to the knee or to the back.

Split lunges: manage the back carefully during this exercise.