Rocks Are Hard

This week I got a nice little reminder that rocks are hard… Who’d have thunk it?

For years I’ve been teaching sports injury therapists about the importance of early and correct management of knee injuries, particularly for runners. The reason being that there is a design fault in the human body… but I’ll talk more about that in a minute.

Very early Monday morning I was just finishing off the last couple of kilometers of a hard and fast hill training session on my favourite downhill trail. It is narrow and technical single track and the only way to run it is at full pace – so much fun!

I’d just come out of a tight right hand corner and onto a straight section where I can open up the speed a bit more. Smiling to myself and loving life, I was admiring the scenery when SMACK, I caught the tip of my toe on a rock and I instantly ate dirt. Face first I went onto the loose gravel and skidded a couple of metres along the ground. My first thought was “I’m pretty sure I have ripped a hole in my right hand (not good when I was due to treat my first client of the day in just a couple of hours – going to be difficult without my hand!)”. Yep, small hole in the base of my hand, what else have I done? A quick survey of my body which was only wearing shorts and a t-shirt showed that I had also taken skin of my right hip, thigh, the back of my right arm from wrist to shoulder blade and my left knee. It was soon apparent that my left knee was going to be my biggest concern. Yes it was bleeding, but I was more concerned about the fact that bending it at all caused quite a bit of pain.

A quick hobble down the remaining trail, another kilometre or so of road and into my car for the short drive home. By the time I got home and showered, I realised that I must have cracked my knee pretty hard on a rock as there was fluid pooling around and behind my patella.

Ok, enough of my tail of woe, what about that human body design fault…?

Whenever we experience pain the knee, and it can be from just about any source, there is a neurological reflex that occurs. This reflexive response causes the Vastus Medialis muscle (VMO) to switch off or become inhibited. I say this is a design fault because an inhibited VMO can lead to improper tracking (lateral movement) of the patella when we flex and extend our knee. This in turn causes irritation on the back of the patella, inflammation and more pain, which in turn results in further inhibition of the VMO – and the cycle continues. Very frustrating and it serves no real beneficial purpose for us.

The lower part of the Vastus Medialis muscle has a section of muscle fibres that run at an oblique angle to the patella (knee cap) and work to maintain the alignment of the patella as the knee moves. The oblique angle is where the VMO gets the letter “O” from, Vastus Medialis Obliques. This muscle which is often identified by the tear drop shaped bulge that you can see on the inside of the knee of a well developed leg, is absolutely critical for the healthy and pain free function of the knee.

Breaking the cycle of VMO inhibition and pain can be relatively straight forward if you get on top of it early. The speed at which this problem can progress however, is what I was reminded of this week. By Wednesday I was surprised to discover that my left VMO was now half the size of my right. In only 2 days I had lost around 50% of the muscle and I know that if I did nothing about it, the next thing to happen would be that I would lose the ability to actively fire (contract) the muscle. When this happens, the road to recovery becomes that much longer.

To start the rehabilitation of my VMO, the first step is to retrain the recruitment pattern of my quadriceps. HERE is an example of how this can be done.

Once the firing pattern is correct, I then progress to building endurance and strength. This part of the process can be a bit more involved because it requires an understanding of exercise progression and matching that progression to your current state of ability.

Runners, and anyone that has had this problem known as Patellofemoral Syndrome – or Runners Knee, would probably be familiar with how time consuming and expensive it can be to go through the rehabilitation process. This is why I created the Runner’s Knee Program. This is the exact program I’m following to get my knee back in form as quickly as possible and it is also what I use on the runners that I treat in my clinic.

If you are currently experiencing knee pain and you are wondering if this is the same problem you have, here are the classic signs that you have Runner’s Knee:

  • Pain behind or around the patella when squatting or going down or up stairs
  • Crunchy sounds in the knee when squatting
  • Swelling under or around the patella
  • An urge to keep the knee straight when sitting
  • A clicking behind the patella when straightening the knee

You don’t have to have all of these things present, but if you have 2 or more, there is a good chance you are developing Patellofemoral Syndrome.

Remember that pesky design fault I was talking about before? That trigger to switch off your VMO can come from anything that causes pain, including bumping your knee on a the side of desk or like me, falling over while running. It really doesn’t take much to set it off. Keep this in mind the next time your get knee pain and be on the look-out for the early signs of Runner’s Knee.

Until then,

Run long.


Shaun Brewster.



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