Ask the sports doctor

Problems and complaints Specialist advice

Hi, I am a 38-year-old female and I have took running 4 years ago to help control my weight and to relax after work. However I am now very frustrated due to a recurring knee problem. I try to train sensibly and do not run too many miles at one go, but I gradually build up over time. However, once I start running longer than one hour, my patellar tendon starts to bother me and eventually becomes extremely painful after running. Each time I visit my GP, I am told to rest, stop running and given antiinflammatories, which does help to make it better. This has happened on four different occasions over the past years. I get very disheartened each time, as I end up losing fitness and putting on weight and I become moody when I cannot run. I’m sure there must be another solution to this problem.
RG, Gharghur.

Dear RG, Unfortunately this is a common scenario. There are two issues to tackle here. One is the cause of the injury and the other is the way one deals with injury. You mention that you only took up running in the past years and are struggling with a patellar tendon injury. This tells me that probably your running technique, including the gluteal muscle strength and activation patterns need to be addressed in order to achieve a long-term solution for you. Unfortunately, opting for ‘rest and anti inflammatories’, although you may feel they are helping you get better, are actually not ideal. When one ‘rests’ many take this to mean stopping all physical activity. Ideally, your doctor outlines what you can be doing in the meantime to maintain fitness, (eg. cycling, aquajogging, swimming etc), so the term should rather be ‘relative rest’, where you are still keeping fitness through different methods, but the running per se is either reduced in volume and/or intensity or possibly avoided altogether in severe cases. During the ‘relative rest’, addressing the causative factor is crucial to prevent a recurrence of the injury. This is where the running movement patterns, the gluteal activation and foot landing patterns need to be addressed.

Hence whilst you are allowing the patellar tendon to heal itself during the relative rest, you are working on an ‘insurance policy’ to help prevent recurrences so that your running schedule can continue uninterrupted.

“When one ‘rests’ many take this to mean stopping all physical activity. Ideally, your doctor outlines what you can be doing in the meantime to maintain fitness”

I welcome readers to write in to me with any problems and complaints you wish to receive specialist advice on. Any interesting cases will be discussed, in anonymity, on these pages. Here is your chance to ask for free advice!

I will await to hear from you via email so as to discuss your own interesting case next month.

The medical advice provided is intended is for educational purposes and not for self treatment. Should you experience similar symptoms, you are advised to contact your doctor/specialist for individual specific advice.

Dr Danica Bonello Spiteri