Non-surgical management of overuse knee injuries in runners.

Seventy-three injured runners (45 men, 28 women) who presented with 83 running-induced overuse knee injuries were managed conservatively. The regimens utilized focused on quadriceps and hamstring muscle retraining and the control of functional overpronation. Patello-femoral pain syndrome (42 cases) was by far the most common problem. The next most common problems were iliotibial band friction syndrome (10), patellar tendonitis (9) and popliteal tendonitis (5). The most frequent etiological factor was a sudden increase in training mileage. Following the initial visit and at regular intervals throughout the recovery phase, quadriceps and hamstring capacities were determined on a Cybex II isokinetic unit at 60 degrees/second and 180 degrees/second. Significant differences (p less than 0.01) in Cybex scores were observed between strong and weak extremities in males and females for both muscle groups at both velocities. The mean Cybex scores and the differences with muscle groups between strong and weak legs for the subjects were similar to those reported for healthy non-athletes. The treatment protocol followed four basic principles: control of pain; rebuilding of muscle strength and endurance; improvement of bio-mechanical efficiency and gradual reintroduction of training. No significant changes in the differences between strong and weak leg Cybex scores occurred between the initial and final evaluations, except in the male group when the hamstrings were evaluated at 60 degrees/second (p less than 0.01). In the 82 cases managed non-surgically, 1 poor, 8 fair, 36 good and 37 excellent results were obtained. The authors believe that the significance of disturbance in quadriceps and hamstring function to the etiology of overuse knee injuries may be increased in runners who over-pronate.