The Clinic: Poor knee alignment

Question: I have moderate patellar subluxation [a partially dislocated, off-center knee joint] and over the years I've had tendinitis on and off in my left knee. I completed my sixth marathon in December and near the end of my training, I began to notice a grating feeling as I was climbing stairs.

Due to rotator cuff repair, I took 10 weeks off from running after the marathon, gradually built back up and now am running and spinning at the gym on a regular basis. My longest runs are currently nine miles.

I do feel knee pain at times going up the stairs, though I've done strengthening exercises, such as lunges and squats, for a number of years. My sports medicine orthopedist said the patellar subluxation was the root cause, though now he has also diagnosed arthritis in my knees.

I'm taking glucosamine/chondroitin sulfate and continuing the strengthening exercises -- presently weight-bearing straight leg raises. What sorts of outcomes have you seen for surgery to repair the subluxation? And assuming I'm able to stabilize the alignment problem in my knee and continue training, can running cause the arthritis to spread more quickly?

Answer 1: It's very important to increase the flexibility in your quads, ITB and hamstrings. This takes pressure off the patella. The strengthening regimen is good; now you must incorporate stretching. Most of us have some arthritis in our knees. This won't become worse with running. It's the lack of flexibility that could exacerbate the arthritis. Regular stretching is essential, and keep in mind that it takes a minimum of three months to really see flexibility gains.

I feel that surgery is not a good option for you at this time. It could take up to two years to fully recover, with compromised running performance. After such a long period of time, you likely would have found other ways to exercise.

Answer 2: An MRI will give you a look at the integrity of the bone coating inside your knee, which may help you formulate a long-term plan. To absorb shock, you may try wearing a Chopat band around your patellar tendon just below the knee. A physical therapist could try taping your knee to the inside to offset the subluxation. I would avoid hills for now.

Answer 3: This maltracking of the kneecap is very common, and causes the cartilage around the bone to prematurely wear away. I recommend light weight, high-rep, pain-free quad strengthening. Running won't make the arthritis worse, but you must be pain free. Avoid downhill running in particular.

American Running Association, Running & FitNews 2005, Vol. 23, No. 5

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