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Don't Let Pain Below the Knee Stop You from Enjoying Your Summer!

Posted on July 2, 2014 at 4:30 PM

Finally, we are getting some nice weather here in Ontario! This means more people are getting out and becoming active. Whether you are active year-round and started to gear up the activity or have just started exercising again, you will want to take a moment and read the following Newsletter so that you can avoid injury this summer! 

The beginning of summer, when many people become more active, is a time of the year when injuries are very prevalent.  Often injuries are from over-use/repetitive stress or from increased intensity. I wanted to go over four injuries from the knee down that are very common this time of year because of this increase in activity. Hopefully,this can serve as a guide as to what to do if you experience these pains and/or to avoid any pains below the knees this summer!


First, we often find patients complaining of pain in the front of their knee (behind their kneecap). I’m speaking of Patello-Femoral PainSyndrome (PFPS). This occurs when either abnormal forces (e.g. increased pull of the lateral quadriceps with acute or chronic lateral patello-femoral dislocation) or prolonged repetitive compressive or shearing forces (running or jumping) on the knee joint. Basically, the patella (kneecap) grinds on the underlying femur bone. So, as we bend the knee, if the kneecap/patella is not tracking/moving properly in the groove or if there is too much pressure on it (i.e. from overly tight and/or imbalanced muscles) then inflammation starts to occur underneath the knee.

The pathognomonic feature to this is that the patient will describe the issue as painful when going up the stairs but markedly worse when he/she is going down the stairs.   As well,note that it is often from an overexertion. So, if you were cycling or runningyou might have to scale back from the intensity, dial down the tension, and/or stretch yourself/see a professional for deeper stretching techniques.


The second common injury we see below the knee is Shin Splints. In fact, just about every runner has experienced this pain in the front of their shins at some point in their lives. So, the infamous muscle here is the Tibialis Anterior (TA) muscle which runs on the outside of the rather pointed bone (i.e. Tibia) that forms the shin from your knee to the inside of your ankle approximately.  With Shin Splints, the muscle is experiencing micro-fibrous tears from again overuse of the TA muscle and/or increased intensity of activity.  This could have occurred from possibly the wrong shoes or having to run up hills for example, causing one to lift his/her feet higher and faster than previously. Generally, a patient will explain that it is painful to touch the outside of the shin and even find it difficult andtiring to walk or run after a certain amount of time.  So, in this case, if you find yourself suffering from this pain, I recommend seeing your Chiropractic Doctor or equivalently a Sports Medicine Doctor to diagnose the issue and help with recovery.  It will be very important, however, to let the body heal because there are actual tears in the muscles and they need to repair themselves. Unfortunately, this is one issue that won’t simply “go away”or repair itself while you are continuing to train intensively.

The third injury I would like to address is Plantar Fasciitis. This is very painful and affects the heel and underside of the foot. The plantar fascia is a fibrous tissue that runs from the base of your heel down to your toes. It helps to support the foot and helps to keep the arch in our feet, which dissipates the ground force load on our body (i.e. joints, spine, etc.). Again, this occurs from overuse, increased intensity of exercise,but this time other factors such as weight and age can affect the fascia similarly. So, when you don’t have sufficient arch support (i.e. flat shoes, lack of strength in the muscles of the foot which help to hold the foot’s arch) or you are bearing too much weight, you will get micro-fibrous tears as with Shin Splints.

In this case, the pathognomonic feature is that the pain gets worse when you go from rest to increased movement (i.e.worse when you wake up and start walking). After a few minutes of walking/running the pain will often reduce/stop but as soon as you stop and rest for 20 minutes, it’s those first few steps you take that will bring back that pain to which you will find yourself hobbling on that ankle. So, finding the proper shoe for the activity is key. See a professional to help you get that activity dependant, supportive shoe. As well, to get rid of the pain and possible scar tissue build up, your Chiropractic Doctor and/or a Sports Medicine Doctor can help definitively diagnose your issue and treat the fascia to help speed up recovery of the tears/scar tissue build up in your heel/base of foot.

The fourth and final common injury below the knee that I see in increased frequency at this time of the year is Achilles Tendinopathy. The Achilles tendon is a tendon made from the confluence of muscles that run along the posterior/back portion of the leg (i.e. the calf).So, when we are exerting ourselves at a greater intensity and placing strain on the calf muscles this tendon ends up creating, yet again, micro-fibrous tears.This can cause inflammation and pain. It makes one more susceptible to an Achilles Tendon Rupture (i.e. full tear) which can take months to years to recover from. In fact, at that point, depending on how badly the tendon is torn, one might have to have the leg booted/casted for a while or worse undergo surgery. 


1)    SLOWLY RAMP UP! Prepare your muscles for this increase in intensity.

2)    For Patello- Femoral PainSyndrome:

Strengthen the Vastus Medialis Muscle. The quads are made up of four muscles and so with Patella Femoral Pain Syndrome we end up having an imbalance in the pulley system of the quads pulling on the patella/kneecap which is why we get bad tracking, pain, and inflammation.

3)    For Shin Splints:

Strengthen the Tibialis Anterior Muscle. Begin with Toe tapping. Keep heels on the floor and lift the front of the foot off the floor.The key is endurance, so, if you are able to do about 80 of those in a row then you are probably able to start running/activity again without injury.

4)    For Plantar Fasciitis:

Proper support and Stretch the Plantar Fascia. If you can get your hands on a golf ball use it! Place the ball under your foot and roll it from your heel to your toes. Make sure you are on a surface that is not slippery or the ball will slide too much.

5)    For Achilles Tendonopathy:

Stretch the Achilles Tendon. Before you exercise do a dynamic stretch by standing with the balls of your feet on a stair. Then drop both ankles off the stair with a count of two and then lift both ankles up until youare on your toes with a count of two. Repeat that movement ten times. After the exercise, cool down with a static stretch for the calf muscles. While standing, hold onto a high enough table or have hands on a wall and step back with your right foot keeping your ankle on the floor. Hold that there for 15 seconds. Note, that if you do not have a stair for the first dynamic stretch then you can do the static stretch but lift the ankle up until you are on your toes and back down holding each position for a count of only two seconds.  Also note that the theory of dynamic stretching (i.e. jumping, lunging, etc. to increase blood flow and moving the muscles) before exercising and static (i.e.holding the stretch to elongate the muscles) stretching after exercising is true for all activities to help all muscles warm up, cool down and to prevent injury.

These stretches and exercises are not the be-all-and-end-all because they are only one of several that are needed for each injury. See your Chiropractic Doctor if you have previously or currently experience the pains that I discussed above. Chiropractors have the education and training to help you avoid injury and diagnose your injury in order for you to recover from any pains.

If you have any questions about the above blog and/or wish to learn more about injuries of the rest of the body send your comments to [email protected]. Or, if you would like to make an appointment please call 905-853-1490.

Dr. Alexandra Bouharevich, DC, MHK, BHK

Chiropractor, Rehabilitation Specialist, and Graston Technique Provider


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