Knee pain is a common complaint of many runners, leading them to succumb to pain medication, anti-inflammatories, knee braces and other contraptions just to push through the miles. From elite runners to fitness walkers, an individual is many times told they have bursitis, tendonitis, arthritis, chondromalacia patellae, iliotibial band frictional syndrome, or some other diagnosis due to something they've done wrong, or overdone. In the past I've talked about issues such as gait, inflammation, and the importance of the adrenal glands for optimal health and fitness. This article will put these concepts, as well as a few new ones, to place in perspective regarding what I think is a very misunderstood and commonly misdiagnosed area of the body: the knee.

To hopefully make this simple, I'm going to address the knee in regards to four areas - the front, back, inside, and outside. The balance of the muscles around the entire joint is essential for the knee not only for normal function but for maximum power and strength.

The quadriceps, or the thigh muscles, stretch from the front of the pelvis into the lower leg where they make up your patellar tendon. This is where a lot of people get tendonitis below the kneecap and bursitis above the kneecap. The integrity of the quadriceps and their balance with the hamstrings is of utmost importance. Back when I talked about gait, I discussed that those with fatigued (or inhibited) quads will run with a very high kick when they push off. Another early warning sign that there is something suppressing the quads is a feeling of weak knees or thighs when climbing stairs, or being unable to stay in a squatted/kneeling position for a while without pain and/or discomfort in the thigh or knee itself. Children with a certain type of quadriceps problem are given the diagnosis Osgood-Schlatters Disease (or Syndrome) and told they have to deal with the pain and it will eventually go away as they grow. This is a very common, and very unnecessary problem for a child to have. If the muscles around the knee are evaluated correctly and the correct treatment is applied, this problem usually "miraculously" disappears.

Deep inside the lower front part of the thigh muscles, right over the femur (thigh bone) lies a very small, but sometimes very troublesome muscle called the articularis genu. It is many times overlooked in knee problems, especially those chronic in nature, and can be a major culprit in those with bursitis-like problems. Bursitis must be treated differently than tendonitis, though often a person is given a pain and/or anti-inflammatory for any problem, hoping for the best. To heal the bursa, one needs optimal calcium metabolism. Not only does this mean that you need to have calcium available, which many do, but you need the proper balance of fats to drive the calcium into the soft tissue to heal the bursa. It is the fatty acid balance that most people lack.

Optimum fatty acid balance means two basic things - don't eat any harmful fats and make sure you get a balance of the good ones. Harmful fats are the partially hydrogenated fats, commonly referred to as "trans" fats. They are listed as shortening, margarine, and as partially hydrogenated corn, vegetable, or any other oil on a package. They cause a lot of inflammation and block essential enzyme reactions from occurring while they prevent the good, anti-inflammatory fats from doing their jobs. You only eat them "now and then" you say? Well, you shouldn't eat them at all because the half-life is a whopping 51 days. So after 102 days you've still got 25% of the stuff in your body…you can do the math the figure out how much longer it'll stay around causing problems. This pretty much ends the debate whether to eat margarine or butter. If you're still eating margarine because someone told you it was good for your cholesterol, then it's now time to change and get the laboratory made trans fat out of your kitchen- in all your foods.

Having a balance of "good" fats means eating healthy sources of the essential Omega 3 and Omega 6 fats. Most people are deficient in the Omega 3 because it is primarily from fish and flax seeds. Omega 6 fats are plentiful in most vegetables, nuts and seeds, and legumes. Although olive oil is a great fat to eat and should be included in your diet, it is not considered an essential fat because it is Omega 9 by nature. So a good amount of both Omega 3, (even if you have to supplement with flax or fish oil), and Omega 6 fats, and a diet absent of trans fats will allow you to fight inflammation and recover faster, as well as lower cholesterol and heart disease risk. And, for the purpose of this topic, it will allow you to push calcium into your tissues to heal the bursa. On a side note, two other symptoms of inadequate calcium metabolism due to poor fatty acid metabolism are calf cramps, especially at night that resemble charley horses, and cold sores/fever blisters, including herpes simplex infections.

Tendonitis of knee is a usual complaint of many runners. The diagnosis is commonly given to any pain around the knee that isn't in the meniscus or the actual muscles. Pain along the iliotibial band, or ITB, is a major complaint that forces many runners to stop their activity all together, sometimes for many months. The pain, known as ITB Frictional Syndrome, is a stabbing pain over the outside of the knee, and sometimes on the outside of the mid-thigh region. Athletes are told to ice it and take some anti-inflammatory medication. However, this rarely speeds up the healing time as you may well know if you've dealt with this miserable injury. As I've talked about before, the use of these drugs causes a major amount of sulfur depletion in the body, and this is the stuff you need to repair the cartilage that is injured. Instead, this problem can usually be treated quickly and without the use of medication by looking at the balance of the muscles contributing to the pain. The inside of the thigh muscles, the adductors, and the outside of the thigh, the abductors, are commonly found to be in a tug-of-war battle with one another. While one muscle isn't working as well as it should, usually on the inside in this case, the other muscles/tendons on the outside, such as the ITB, is in constant spasm, never being allowed to relax through the normal gait pattern.

Likewise, pain on the inside of the knee is just as common, especially at the area called the pes anserinus which is just to the inside of the lower part of the knee. This is where three muscles come together to make up a lot of the support of the inside of knee. When these muscles are not working as well as they should, they leave the medial meniscus open for problems due to the improper biomechanics of the joint. The imbalance of these muscles, and often pain and/or weakness of the inside of the knees is usually associated with adrenal gland problems. Commonly a person will have the discomfort along with other adrenal related symptoms - dizzy when standing up, a craving for salt and/or sugar - a history of shin splints or plantar fasciitis, sleep problems like I've discussed before - just to name a few.

The muscles of the back of the knee cannot be forgotten as they often are. The hamstrings as well as the calf muscles are two of the major players here, but there are others that become injured and need special treatment. With the great distance these muscles extend on the back of their leg, they are very important not only for the knee, but the foot and low back. These muscles not functioning well give way to the athlete who commonly has a foot problem, then a knee problem, and then a low back or hip problem. As soon as one problem clears up the next one shows up - a sign of the problem manifesting itself in different regions of the body, but usually from the same origin.

Proper pronation of the foot, the major source of shock absorption, and in general the muscles of the foot, are extremely important for the health of the knee. If they're not functioning optimally then the knee takes a lot more stress than it can handle, leading to problems. Therefore, next time I'm going to address two more common athletic complaints, shin splints and plantar fasciitis, and how to look at them from a different perspective.