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Injuries Related to Being Active with Diabetes: Part 4 (Knee and Shin Injuries)

Oct 6, 2009


by Sheri Colberg, Ph.D., FACSM

Knees and Shins

Knees are a critical joint for movement. They are made up of a conglomeration of tendons, ligaments, meniscal padding (cartilage), a joint capsule, a sliding kneecap (patella), synovial fluid, and more. Your athletic knees can get all sorts of aches and pains, including chondromalacia patella, iliotibial band friction syndrome (IBFS), ligament and meniscal tears, and shin pain, to name a few. The origin of each is different, although most of the treatment of these injuries is similar. 




Chondromalacia Patella
Also known as patellofemoral syndrome, this overuse injury is the most common cause of chronic knee pain. It results from poor alignment of the kneecap (patella) as it slides back and forth over the lower end of the femur, or thighbone, whenever you bend your knee. If you have this, your patella tracks abnormally during bending, sliding toward the lateral (outside) edge of the femur instead of straight. You may feel some discomfort in your inner knee area related to the resulting inflammation that is made worse by activities like running, jumping, climbing or descending stairs, and prolonged sitting with bent knees (like in airplane seats). If you’re experiencing pain, you’ll want to avoid activities that irritate it and use ice and NSAID therapy. One thing that can help is selectively strengthening the inner part of your quadriceps (front of thigh) muscles with resistance training. In addition, you should avoid doing full squats (bending your knees to a 90-degree angle), particularly when you’re using weights; do quarter squats instead.

If you have "runner’s knee" and are unsure of the cause of the pain, you can start by assuming that it is this overuse injury and treat it as such. Treatments include rest, icing your knee, doing quarter squats to strengthen the quadriceps muscles, stretching your iliotibial band, replacing your running shoes every 350 to 500 miles (550 to 800 kilometers), and possibly getting orthotics for your shoes.

Iliotibial Band Friction Syndrome

Iliotibial band friction syndrome, also known as ITBFS, is an overuse injury that causes an ache or burning sensation on the lateral (outside portion) of your knee during physical activity. ITBFS is common among runners and cyclists. The iliotibial (IT) band consists of tough fibers that run the length of the outside of your thigh, attaching to your buttock muscles (gluteal muscles) and tensor fasciae latae (TFL, or hip abductor muscle) at the top, crossing the knee, and attaching to the tibia, or shinbone, at the lower end. Its primary function is to act as a stabilizer when you move around, whether walking, running, or cycling. Running on a sloped surface (such as always running on one side of the road) can aggravate the IT band because doing so tilts your pelvis, as can excessive pronation of your foot, leg length discrepancy, lateral pelvic tilt, bowed legs, and tight gluteal or quadriceps muscles. Apparently friction occurs as or just after your foot hits the ground when you’re running; downhill running reduces the knee flexion angle and can aggravate ITBFS, whereas sprinting and fast running increase it and are less harmful. Treatment includes rest, ice, correcting your training errors, wearing good shoes and orthotics, and gentle stretching, particularly of the iliotibial band itself and gluteal muscles.

To stretch out your IT band, cross your right leg over your left while standing and extend your left arm against a wall or another stable object. Push your right hip in the opposite direction while leaning your weight to your left toward the wall. Your right foot should remain stable, but allow your left knee to flex. If you’re doing it correctly, you’ll feel the stretch in your right hip and down the outside of that leg.

Ligament and Meniscal Tears

Although usually more of an acute injury, tears in either the ligaments supporting the knee or the cartilage (meniscus) cushion there require prolonged treatment and often surgery. Ligaments are more easily injured in sports that require starting and stopping rapidly or quick directional changes, such as basketball. The anterior cruciate ligament (ACL) and the medial collateral ligament (MCL) are the most often injured, but the posterior cruciate (PCL) and lateral collateral (LCL) ligaments can also be injured. During an acute injury, you will often hear a loud popping noise that may or may not be accompanied by pain. An MRI scan is usually required to confirm these tears, and nowadays arthroscopic surgery, which is minimally invasive, is used to treat partial tears.

If you tear the cartilage in your knee, you have usually torn a meniscus, which is a small, C-shaped piece of cartilage that serves as a cushion between the thigh (femur) and tibia (shin) bones on both sides of your knee; the lateral meniscus is the outside one, the medial one is on the inside. You can tear your menisci alone or along with one of the ligaments (most often the ACL) as a result of twisting or pivoting with your foot planted, by decelerating, or by a sudden impact. Manual tests can determine whether it’s torn, but often the tear must be confirmed (and treated) arthroscopically. 

Shin Splints 

Although not a specific diagnosis, shin splints result from generalized pain that occurs in the front of the lower leg along the tibia (the shinbone). This injury has a number of different potential causes, but it is most likely a cumulative stress injury that occurs from overtraining or excessive running on hard surfaces, resulting in inflammation in those areas or stress fractures in the tibia or fibula (lower leg bones). Your bones can heal themselves over time, but if you don’t rest them after a crack starts to appear, they can fracture. If you’re a beginning runner, you have higher risk for developing shin splints and stress fractures because you are probably not accustomed to the high impact of running.

How can you tell whether you have shin splints? Watch out for pain on the medial (inside) part of your lower leg that gets worse with running or other weight-bearing exercise (especially when done on hard surfaces). Other symptoms are an aching pain that lingers after exercise, as well as increased pain with activity such as running, jumping, hill climbing, or downhill running. Taking all your jogs along the edge of the ocean on the packed sand running barefoot is a sure way to get rid of this overuse injury! Generally, icing your shins after workouts, taking NSAIDs, and resting are effective ways to treat it. Return to your activities gradually, using pain as your guide. Get new, well-cushioned shoes with adequate support to lower your risk. Also, make sure to stretch properly, warm up effectively, train moderately, progress your workout schedule conservatively, and avoid running or jumping on hard surfaces or for long distances on tilted or slanted surfaces. If the pain doesn’t subside using these treatments or if you have a single point of intense pain, consider seeing a podiatrist with expertise in lower extremities and diabetes to pinpoint the exact cause.

In my next column, you’ll learn more about specific foot and ankle injuries.

This column is excerpted from Diabetic Athlete’s Handbook (2009), which contains essential exercise-related information and examples for Type 1, Type 1.5, and Type 2 diabetic exercisers of all ages. More information is available at www.shericolberg.com.