Blog category: Sports Injuries

Latest news on injuries to sportsmen and women in the media

Should I keep running if my knees hurt?


There have been quite a few statements recently, both in papers and on social media, stating that if your knee(s) hurt when you’re running, then you should continue running, and suggesting that people who tell you to stop running A) don’t know what they’re talking about, and B) could actually be doing you harm!

So, are these people right? The answer is fairly simple. There ARE certain instances where the correct advice is indeed to stop (or at least cut down on) running, and there is simple but sound scientific evidence to back this up.

Not everyone is born to run

If you’ve got normal knees, if your posture and control are good, and if you’re not too overweight, then running can be fantastically good for you. However, it’s important to acknowledge that some people are just born to run… whilst some people are simply not! Some people can run for many years, into old age, with no significant problems at all. However, some people simply aren’t that lucky!

But my Uncle Bob carried on running into his 90s!
(Well, with respect… your Uncle Bob was a freak of nature… and you’re not Uncle Bob!)

No gain, without pain?

Pain is your body’s way of letting you know that there’s a potential problem. ‘No pain, no gain’ is absolutely correct when it comes to the pain of cardio fitness workouts. However, pain in a joint can often be a sign of a specific issue, and like many issues in life, if you simply ignore it then it’s probably just going to get worse.

How to find out the cause of your knee pain

The important thing here is to find out what, specifically, is causing your actual pain – as pain is just a symptom, not a diagnosis… and anyone with any significant knee pain that’s enough to bother them really needs a diagnosis before you can safely or sensibly offer any kind of advice, whether that be specific exercise advice or any kind of actual treatment.

A good physiotherapist will be able to diagnose many knee ‘ailments’ quite accurately. However, for anything where a patient’s symptoms are more severe / significant or persistent, and certainly where there is any concern at all, then you are most probably going to need imaging to confirm what the actual problem inside the knee might actually be.

The importance of imaging

Importantly, as a Knee Surgeon I only operate on about 25% of the patients that I see in clinic, with the other 75% not needing surgery, but potentially needing other non-invasive treatments instead. However, every patient gets a clear and specific diagnosis, and an appropriate treatment plan, and appropriate imaging is a key component of this.

The various types of imaging that we may send patients for can include:

  • X-rays
  • Ultrasound scans
  • MRI scans
  • CT scans
  • Bone-SPECT scans
  • Blood tests
  • Bone density scans

A high-res 3-Tesla (3T) MRI scanner

High-res 3T MRI imaging of a knee.

Common (but ‘non-damaging’) causes of pain at the front of the knee

A lot of the runners that I see in clinic tend to complain of pain at the front of their knees when running. Rather unimaginatively, this is sometimes referred to by some people as ‘runner’s knee’. However, this is not a proper medical diagnosis! Some people also use the term ‘patellofemoral pain syndrome’ – again, this is an over-simplistic catch-all phrase that again, isn’t really a proper specific diagnosis.

Many of the things that can cause knee pain when running can be relatively minor, and fairly ‘non-damaging’, such as:

  • Patellar tendinopathy
  • Quadriceps tendinopathy
  • Fat pad inflammation
  • Iliotibial band (ITB) friction syndrome

and these issues rarely ever end up needing any kind of surgical intervention, and they do not lead to an increased risk of future arthritis.

Articular cartilage damage (wear & tear) in the joint is more serious!

However, one very common cause of pain at the front of the knee is if there is articular cartilage damage in the patellofemoral joint – which means that there is wear and tear / thinning / loss of the smooth white shiny layer of cartilage that normal covers the joint surfaces; particularly on the back of the kneecap (the patella) and the groove at the front of the femur (the trochlear groove) in which the kneecap moves up and down as the knee bends and straightens. Articular cartilage has no blood supply and it does not grow back / repair / heal / regenerate on its own, and articular cartilage damage is something that only ever tends to get worse with time, not better. If the articular cartilage wears away completely, to leave bare bone exposed, then that is what we refer to as osteoarthritis in the joint – and this leads to increasing pain, stiffness and swelling, and a gradual progressive loss of function, eventually leading to artificial joint replacement surgery (which is a big deal!)

Normal articular cartilage seen at knee arthroscopy (via keyhole surgery)

Worn away articular cartilage with large area of bare bone exposed.

The biomechanics of running and how it affects the knee joint

The patella acts as a fulcrum at the front of the knee joint, specifically increasing the moment arm (the ‘lever arm’ and hence the pull) of the quadriceps, particularly in early flexion, meaning that the pull of the quads is more effective at preventing the knee bending when the joint is loaded. Importantly, the forces involved that pass through the patellofemoral joint with knee loading are absolutely massive, and these forces increase as the joint is flexed and with the weight of loading, and also with impact. Patellofemoral loading has been calculated as being:

  • 3 x body-weight with ambulation
  • 3 x body-weight with stairs
  • 6 x body-weight with running and
  • 8 x body-weight with deep squatting.

Patellofemoral loading near extension.

Patellofemoral loading in flexion.

By comparison… patellofemoral compressive forces during ergometric cycling have been calculated as being approximately 0.4 x body-weight – that’s approximately x 14 less than the patellofemoral loading seen when running!

What to avoid if your knee joints are severely damaged

If you have got significant damage in a knee joint, particularly in the patellofemoral compartment at the front of the knee, then the most sensible exercise advice is to avoid anything that involves unduly heavy / repetitive patellofemoral loading. This means keeping clear of impact running, but also avoiding:

  • deep squats
  • heavy loaded squats
  • lunges and
  • heavy weights.

Can you build up muscle strength to ‘protect’ your knees?

Telling someone to ‘build up your muscle strength to protect your knee’ can sometimes be misguided and inappropriate….

If you’ve torn a ligament in your knee, like the ACL or the PCL, then it’s important to build up muscle strength and speed up proprioceptive reflexes in order to improve dynamic stability… and this alone may be sufficient for the patient to be able to avoid the pain, hassle and risks of ligament reconstruction surgery.

However, if you’ve got ‘wear and tear’ in a joint (i.e. articular cartilage damage / thinning / loss), then the last thing you want to do is to heavily and excessively load that joint. You can’t build up muscle strength and bulk without heavily loading a muscle… and you can’t heavily load the muscles around a knee joint without heavily loading the joint itself.

Therefore, if there is degenerative damage in a joint, then the best, safest and most appropriate approach is to avoid heavy loading and impact, and not to try and focus on building up muscle bulk, but to focus on light, non-impact, non-pivoting cardio fitness work instead.

What’s the alternative if you do have to stop running?

One of the challenges I face as a knee surgeon is sometimes having to tell a runner what they least want to hear – i.e. to stop running. This will be purely for their own good, because it will be the best way to stop / reduce the pain in their knee and make the knee joint last longer.

However, cutting down or even stopping running does not mean stopping exercise. Continuing with exercise of some shape or form is vital … but there are a lot of things that are good for your heart and your health that are better for your knees than running. This includes:

  • gentle walking (avoiding steep hills)
  • cycling / the exercise bike, with the seat up high and the resistance down low,
  • the cross-country ski version of the cross-trainer (not the Stairmaster), and
  • swimming, with mainly front-crawl / back-stroke (rather than breast-stroke legs).



1. Listen to your knees: if whatever you’re doing makes them hurt, then stop and try something else instead.

2. If you’re suffering from significant knee symptoms, then see either a physiotherapist or a specialist doctor / surgeon who can give you a specific diagnosis – you need a diagnosis before you can even start talking about specific treatment options.

3. Accurate specific diagnosis very often requires imaging, with X-rays and / or scans.

4. If you’ve got significant cartilage damage in your knee, then you’re far better off doing non-impact exercise, such as cycling, rather than running.

5. And finally, if a knee surgeon advises you against continuing with running, it’s normally for very good reasons, and they’re simply trying to help make your knee hurt less and last longer, and not just upset you purely for the sake of it!


Mr Ian McDermott, 24th Jan 2021

Kicking rugby players’ knee injuries into touch


According to the Professional Rugby Injury Surveillance Project, there were 447 match injuries that led to time lost from training and/or match play in the 2015-16 English professional rugby season. Encouragingly, there was a fall in match injury incidences but it remains a dangerous sport, with injuries to the knee – specifically Anterior Cruciate Ligament (ACL) and Medial Collateral Ligament (MCL) injuries – still some of the most common, only exceeded by concussions. Just recently, Rhys Webb was ruled out of Wales’ Six Nations team with a knee injury.

Unfortunately, knee ligament injuries in rugby are extremely common, and pretty much everyone involved in the sport will know someone who’s had some kind of knee ligament injury or knee surgery. The key factor in ensuring a successful recovery is to take the appropriate time out to rest and ensure players receive the right treatment for them.

It’s the nature of the game — high energy, full contact, hard impact. Part of the problem nowadays is that players are so big and so strong, and the speed of the game is so fast, that players are literally smashing themselves to bits. They’re effectively storing up huge problems for themselves for when they get older, with a terribly high rate of neck arthritis and major knee problems.

There are a number of different types of knee ligament injury that can be sustained from rugby, ranging from small things like a minor sprain of the MCL to major injuries such as an ACL tear. With higher energy injuries it’s actually possible to tear multiple ligaments and even dislocate the whole knee joint, which can be catastrophic.

Most knee ligament injuries occur unexpectedly, from someone landing on a player’s leg in a ruck whilst their leg’s in an awkward bent position, or from tackles from the side where the tackler’s shoulder impacts on the side of the player’s leg, where the forces involved can be huge.

In these situations, there’s pretty much nothing you can do to prevent a ligament snapping, as the forces can be like being hit by a car! However, to minimise the overall risk of any kind of injury, the most important thing is to train sufficiently in order to ensure that you’re as fit and strong as possible before you go onto a pitch. The stronger the muscles are and the faster your reflexes, combined with having good posture and good biomechanics, the less likely you are to sustain an injury.

In terms of what to do once you sustain a knee injury, the most important thing is to take knee injuries seriously! Fundamentally, with any significant injury, you should get it looked at properly, and if there’s any concern about anything potentially serious then the best thing is to be seen by a specialist (an experienced physiotherapist or a specialist knee surgeon) and to have a high-res high quality MRI scan (a 3T MRI) — to see exactly what the potential damage actually is.

If you’ve damaged your knee, you also need to consider very carefully the timing of when to return to play after injury. You should listen carefully to your knees, be gentle with your joints and avoid anything that hurts or aggravates your symptoms in any way.

Avoiding injury on your new-year health kick


Every January, the nation is overcome with people making New Year’s resolutions to get fitter, get healthier, eat less and lose weight, with around one fifth of Britons setting resolutions in 2017, according to YouGov. But whilst this is great in theory, those ramping up their activities too quickly are leaving themselves open to injury.

What you shouldn’t do in January is to simply just throw yourself headlong straight into a high intensity exercise regime that your body might simply not be able to cope with.

As you get older, many of your tissues become stiffer, less elastic and more prone to injury, and also your body’s ability to heal and repair itself after injury or stress reduces. Therefore, if you overdo things and if you do pick up an injury then this might inhibit your ability to exercise and end up simply being very counterproductive. It might even leave you with ongoing issues that will plague you forevermore in the future, leaving you really regretting what you did. You should therefore start slow, be sensible and gradually increase your training, in order to give the body time to adapt to the new stresses and to reduce the likelihood of injury.

Those most susceptible to injury are those taking part in what I call ‘the danger sports’, such as skiing and football. The most common injury I see from people throwing themselves back into exercise too hard or too fast is a tear of one of the meniscal cartilage shock absorbers in the knee. This can cause sharp pains, clicking, catching sensations, giving way, locking or swelling, and if the symptoms are severe or if the symptoms fail to settle, then this can often lead to the patient needing keyhole surgery, with a knee arthroscopy.

In order to avoid injury and potentially requiring surgery, the important thing is to start training gently, and just gradually ramp things up slowly and sensibly over time.

It’s also important to incorporate regular cardio fitness exercise into your weekly routine, and not to be just a ‘weekend warrior’ – doing no exercise during the week and then pounding your body with high intensity exercise or competitive sport at the weekends. If you’re starting a-fresh or if you haven’t trained for several years, then it’s also really helpful to go and see a physiotherapist or a biomechanist for an assessment and for specific personalised advice first, before you train with any ‘bad habits’ and before you potentially pick up any injuries — as prior preparation and prevention are always better than injury, rehab and regret!

Why you shouldn’t accept ‘soft tissue injury’ as an appropriate diagnosis


I see lots of patients coming to see me who’ve injured their knee playing sports and who end up going to their local Accident & Emergency Department as a result.

Too often, they’re told that there’s nothing wrong, or they’re simply told to just rest their knee and see their GP. They may even be sent for an X-ray and then told that they’ve got a “soft tissue injury”, which means nothing, except that there’s no fracture.

Unfortunately, sports knee injuries are being treated like they’re just not important, and people therefore aren’t getting the diagnosis and treatment they deserve. In the long run, this results in further damage to their knees and them subsequently needing further or more major treatment in the future.

Fred is one such patient, who I recently treated after he damaged his knee. Fred says:

“I suffered an injury to my knee which felt major so I went to A&E immediately. After seeing the doctor they said I had done ‘some ligament damage’ and it would repair itself within six weeks. I went away with some crutches and a physio appointment in six weeks-time, which I was told I probably wouldn’t even need. 

“Keen to get back on my feet ASAP, I went to Covent Garden Physio who quickly then referred me to Ian McDermott. After explaining how I sustained the injury to Ian he put me in for an MRI scan. It turned out I had actually dislocated my kneecap, torn the MCL and sprained my ACL. The injury will take three to six months to fully recover from and with regular physio.

I feel very relieved to now know the extent of the injury and that now it has been properly diagnosed, it will repair properly and prevent any further long term damage, that would have happened had it been left.”

Unfortunately, Fred’s case is not uncommon, let alone rare, and I see many patients with very similar stories. It’s no longer good enough for these types of injuries to be seen as insignificant, especially when these patients are usually very active people who are keen to return to their sports and hobbies.

If you’ve injured your knee and you’ve been told that you’ve suffered a ’soft tissue injury’, ensure you have your knee injury investigated properly, that you see an appropriate specialist and that you receive the correct diagnosis and therefore the correct appropriate treatment plan. This will avoid causing further damage and enable you to return to your activities in the appropriate timeframe.

Avoid the most common injuries this skiing season


The widespread issue of wearing a helmet when skiing has seen increased attention in recent years. But whilst this is great to see, the most common skiing injuries occur to the knee, and not enough people are preparing themselves for the additional strain they’ll be placing on their knees this winter sports season.

The Royal Society for the Prevention of Accidents states that approximately 10,000 UK skiers and snowboarders are admitted to hospital every year with injuries following their winter-sports holidays. There is no part of the body that is immune to potential harm, but the most common skiing injuries occur in the knee, with tears and ruptures of the ACL (anterior cruciate ligament) being the most common.

However, you can prepare your body for the additional strain and therefore help to prevent sustaining an injury whilst you’re away. Skiing is very physically demanding and it puts a huge strain on your muscles and joints, especially on your knees. If you’ve been inactive since your last skiing holiday, you won’t be well conditioned or prepared and you’ll be putting yourself at greater risk of injury.

You should therefore do plenty of training before you go on your ski holiday, starting now, and work on getting into the best possible shape before you end up at the top of a long steep slippery slope!

Additionally, once you are on the slopes, you should ensure that your bindings aren’t too tight. One of the main dangers on the slopes is actually falling at low speed, when the bindings fail to release. When this happens you then have a six-foot-long ski creating a massive lever arm twisting a 10cm-wide joint, and it’s this twisting that normally tends to tear the ACL.

For those unfortunate enough to injure themselves, you should not feel pressured into going ahead with surgery straight away in a hospital abroad as it’s very rare that there’s so much damage that immediate surgery is really a necessity. It’s actually far better to make sure that the knee is properly protected with a decent brace and to use crutches, and then to get the knee properly assessed once you get home. You’ve then got time to do your research, making sure that you get to see the right/best person, and ensuring that you’ve got a clear and specific diagnosis of exactly what’s actually damaged in your knee. Only then can you really be in an appropriate position to discuss all the various potential options and all their associated pros and cons, before you then decide to proceed with any actual treatment. It’s important that you get answers to all your potential questions before you then make a measured decision about what potential treatment route you’d like to take.

If you’ve sustained a significant knee injury then this is normally fairly obvious, because there will have been major pain at the time of the injury followed by the knee swelling up, and you won’t feel able to continue skiing. If you fit into this category then you’re going to need an MRI scan (not just X-rays!) and you’d benefit from a full and detailed assessment from a proper specialist knee surgeon so that you can then go down the most appropriate treatment route, whether that be surgery or rehab.

It’s easy to get carried away skiing, taking in the breathtaking views and enjoying the exhilaration, but you should also ensure you’re aware of your surroundings and most importantly, remember to suitably prepare yourself for your holiday.

Football is the most dangerous sport for knees

With the new football season well underway, knee injuries are a threat to both active players and retired footballers.

Tragically, some Premier League footballers may be forced into early retirement, most notably in the case of Owen Hargreaves. If played with caution, the majority of players will normally be able to cope with the physical demands of high-end sport, but many won’t – and they often only find out once the damage has already been done.

It’s key to understand that football is dangerous for the knees as it involves constant impact and twisting on a bent knee, combined with excessive forces when there’s a hard tackle. On top of this, as people start to get a bit older there’s often a tendency to move away from 11-a-side football on grass to 5-a-side football on Astroturf. But 5-a-side football involves even more twisting, turning, cutting and pivoting, and Astroturf tends to be more slippery and more dangerous than grass.

The most common injuries I see in consultation with footballers are tears of the anterior cruciate ligament (ACL rupture), medial collateral ligament (MCL) sprains (partial tears) and meniscal cartilage tears (tears of the cartilage shock absorbers in the knee). I also see a steady flow of retired footballers who tend to present with premature onset osteoarthritis in their knees, and they’ve often had multiple injuries and multiple previous operations in the past but have still continued playing and pounding their knees regardless.

The older you are, the more degenerate your joints tend to become and hence the less able they are to cope with the stresses of sport. Add all this together and you’ve got a recipe for a lot of knee injuries and a significant increase in knee surgeries.

I recommend seeking medical advice from a qualified physio or osteopath if you’ve got any concerns about your knee. Then, depending on the advice given, the next step is often to get a quality high-res 3T MRI scan of your knee and an opinion from a dedicated knee specialist (a consultant orthopaedic surgeon specialising specifically in knees).

If you’ve got any kind of significant structural damage in a knee joint, then ignoring it and just continuing to pound the knee risks making the damage even worse – and the worse the damage is in a knee joint, the harder it is to ‘fix’, and the bigger the likelihood of this eventually leading to arthritis in that knee at some stage in the future.

If you’ve damaged your knee, you need to consider very carefully the timing of when to return to play after injury. You should listen carefully to your knees, be gentle with your joints and avoid anything that hurts or aggravates your symptoms in any way.

Football is great for fitness, for health and socially, but it’s not great for your knees. If you’ve got good genetics, train carefully and regularly, and manage to avoid injury, then you might remain lucky – and you might be able to continue playing football right up until a ripe old age. However, you need to take care with your knees. When you’re young you tend to think that you’re invincible. It’s only later, when you’re older, that you discover the true consequences of repetitive joint injuries from when you were younger, by which time it’s too late, as the damage has already been done.

High-intensity interval training without the intense injuries

High intensity exercising has continued to grow in popularity in recent years due to its fat-burning, muscle-building effects. But whilst this form of exercise is great for those who don’t have a lot of time or space, with such an intense workout comes a lot of stress on the body, and more and more people are injuring themselves during their HIIT training.

If carried out correctly, most people will normally be able to cope with this type of training, but some won’t – and often find out once it’s too late after the damage has already been done. I see a lot of people in the clinic with knee pain that has developed after high intensity workouts. Pumped up on endorphins from the burn of the exercise, many people only notice a slight twinge at first. However, afterwards they might develop pain, some swelling and stiffness in the joint. The cardinal sign that there could be an actual issue inside a joint is if the joint itself swells up.

The high intensity bit is exactly that: ‘high intensity’. Exercises such as squats, lunges, burpees and squat thrusts all put large forces across the knee with the knee in a bent position. Specifically, when you land on one knee with the knee in a bent position, the forces between the back of the kneecap and the front of the knee can be as high as seven times your body-weight, which is massive.

The range of knee injuries caused by HIIT workouts can be varied and also serious. The most common knee injuries that I see in the clinic are tears of the meniscal cartilage shock absorbers in the knee, and damage to the articular cartilage layer that covers the surface of the bones in the joint – particularly affecting the cartilage on the back of the kneecap.

If you have any minor knee symptoms, you should seek medical advice and if knee symptoms fail to settle, or if you’re getting significant pain in the knee or any actual swelling in the joint, then this could be a ‘red flag’. The best person to see when this occurs is an appropriate knee specialist – specifically a Consultant Orthopaedic Surgeon who specialises in ‘soft tissue’ knee injuries.

HIIT workouts are effective and a genuinely sensible approach to finding the most intense, time-efficient and effective way to keep fit and strong. But what’s good for your muscles, heart and general health isn’t necessarily good for your joints, and it becomes a balancing act between the two. The macho approach of ‘no pain, no gain’ is fine for younger people and people without joint problems; however, if you’ve got any kind of damage in your knee joint then it can be dangerous. Instead, you should listen carefully to your knees, be gentle with your joints and avoid anything that hurts or aggravates any knee symptoms in any way.

Avoid getting served an injury this tennis season

Each year, tennis courts across the country experience a surge in bookings as a result of the warmer weather and ‘Wimbledon fever’. But whilst it’s great that more people are inspired to pick up their racquets, they must also be wary of the injury risks the additional strain is placing on them.

Some insight shows that the rate of tennis injury in the general population is five injuries per 1,000 hours of participation, with lower limb injuries being the most common. Knee injuries are very common in tennis, and I see a steady flow of tennis players in clinic every summer, ranging from people who play just occasional friendly social doubles right up to elite professional tennis players.

Tennis is a tough sport. It involves constant impact, cutting and pivoting on a bent knee, which puts huge forces on the structures inside the knee joint. When you land on one leg with the knee bent, the forces between the back of the kneecap and the front of the knee can be up to seven times body-weight, and when you pivot, the torsional forces and the strain on the ligaments can be massive.

The range of knee injuries specifically in tennis players can be wide: sometimes people tear the meniscal cartilage shock absorbers in their knee from twisting. If the knee twists too much then it’s possible to tear the anterior cruciate ligament (ACL). Others will suffer overuse injuries like patellar tendonitis.

The warning signs to watch out for are sudden sharp pains, catching sensations, giving way, locking or swelling. If a joint swells up then that’s a cardinal sign that there’s something wrong. The best way to see whether or not there might be an issue in the knee is to get a decent high-res (3-Tesler) MRI scan and an opinion from a recommended knee specialist.

However, one of the best ways to avoid injuries in the first place is to ensure that you’re as fit and strong as possible when you play. This means going to the gym at least twice a week and working on general strength and fitness. The best way to pick up an injury is to be a ‘weekend warrior’ and to do no exercise all week, be unfit and out of condition, and then play a hard game of tennis at the weekend.

Enjoy the tennis season this summer, but if you are unlucky enough to injure yourself whilst playing, the most important thing is to get a clear, specific diagnosis of what might be causing any pain. Just listen to your body and if you have a gut feeling that there might be something wrong, then get it checked out. This will enable you to know whether it’s just something minor that’ll probably simply settle with just time and rest or whether it’s something more significant that could get worse and lead to further damage if left untreated.