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8026 Views 16 Replies Latest reply: Jul 8, 2011 4:38 PM by LateRun 1 2 Previous Next
LateRun Amateur 11 posts since
Jun 24, 2011
Currently Being Moderated

Jun 24, 2011 10:40 AM

Do I Have Runner's Knee? What Can I Do?

I'm new to running. I'm 48 years old and never ran before in my life. I did C25K this winter and started running 5K runs (by myself) on March of this year. From March 8th to April 5th, I did 5K runs (on my own) 8 times with no problems.


Then, on April 14th, while running, my knee stiffened around 2 miles in after a mistep and I had to run/limp all the way home. Since April 14th, I have tried running a 5K five times and always have the same result. About 2 miles in, the knee goes and then I have to limp the rest of the way. (Note, the 2 mile mark on my route does have a incline to it.)


Afterwards, the knee hurts like heck and going down stairs is extremely painful. However, within time, the knee gets better, and days afterwards, I have no problems at all. When free of the pain after running, I can exercise (like squat) and walk with no problems. When I walk a 5K, I have no problems.


I went to an orthopedist and he did x-rays. He said that my knees are in great shape. No arthritis. No calcium deposits. No tears. He just suggested rest. But, when I rested for two weeks and tried to run again, the pain came back.


I went to a running store and they did a test on me. They said that I overpronate on the left leg - and it's just the left knee that bothers me - and sold me custom FootBalance insoles and special running shoes. But, when I ran with them, my knee still killed me...same old story.


Note, I am not heavy. I am 5' 10" tall and weight 170 pounds.


Am I just doomed here? I quickly learned to love running and hate to think that I will never be able to run pain-free. It does seem strange that I never had a problem before that day on Aprl 14th.


Is it possible that I have a tibial bone bruise or a meniscus tear? I'm still trying to get an MRI to figure that out. (Long insurance story there that I will not bore you with.) Or, is it just runner's knee and RICE is the only way to try and keep the pain down?

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    1. Jun 24, 2011 12:37 PM (in response to LateRun)
    Re: Do I Have Runner's Knee? What Can I Do?

    Take a look at this short article Knee pain: Treatment base on individual evidence.  What evidence did the did the shoe sales person provide you that you pronate excessively on the left?  If you pronate more on the left the cause of the excessive pronation could be in the foot.  However there are many other causes of excessive pronation such as weak hip muscles.  There are other treatments for excessive pronation beside shoes and shoe inserts.  Take a look at short article Pronation.  An important clue is that you have knee pain only on one side.  Take a look at short article Symmetry - Asymmetry: Problem Solving Repetitive Use Injuries.

    Damien Howell PT, DPT, OCS -

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    3. Jun 25, 2011 4:43 PM (in response to LateRun)
    Re: Do I Have Runner's Knee? What Can I Do?

    Apparently the Orthopedic Surgeon used radiographs to say the knee is normal.  Radiographs visualize bones, they do not visualize "soft tissue".  It is likely there is some soft tissue about the knee which is injured.  However knowing the specific tissue that is injured is not as important as knowing the consistent pattern of movement which is associated with the pain.  Take a look at this short article Diagnosis of Repetitive Use Injury. This article discusses use of diagnostic imaging, and identifying consistient patterns of movement which are associated with repetitive use injury.  Apparently the shoe store sales person found that you pronate more on the injured side.  Now the question is why do you pronate more on one side of the body. Excessive pronation can be related to alignment/weakness of the foot, but it can also be related to alignment/weakness at the hip joint.  Excessive pronation can be related to alignment/weakness at both the foot and hip. Perhaps a smart Physical Therapist can help you clarify your diagnosis and treatment.  Go to Find a Physical Therapist.  It does seem the Orthopedic Surgeon has "missed it".  Take a look at short article short article Who you going to call: Choosing a Healthcare Professional.  This article discusses choosing a surgeon to manage a repetitive use injury may not be the best choice.

    Damien Howell PT, DPT, OCS -

  • munchko Rookie 2 posts since
    Jun 25, 2011
    Currently Being Moderated
    5. Jun 26, 2011 9:45 AM (in response to LateRun)
    Re: Do I Have Runner's Knee? What Can I Do?

    Not really a response to the original question, but a similar question. I do have considerable osteoarthritis in both knees. I have variable pain - hurts more to walk down stairs than up, and also seems to be worse on wet days. My rheumatologist (who is following me for a different condition) told me I should not do exercises that put too much stress on the knees, such as squats and lunges. I didn't ask her about running, though. After a number of years without doing running, I'm interested in getting back into it. Any feelings about how running affects osteoarthritis in the knees?

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    6. Jun 26, 2011 10:08 AM (in response to munchko)
    Re: Do I Have Runner's Knee? What Can I Do?

    munchko take a look at Osteoarthritis - Cartilage and Exercise. This article discusses the frustrating nature of cartilage and its relatively poor response to exercise.  Also take a look at Knee Arthritis and Muscle Strength - The Truth is Gray.  Hopefully these short articles will provide some direction on struggling with documented osteoarthritis in the knee and running.

    Damien HOwell PT, DPT, OCS -

  • JamesJohnsonLMT Legend 1,291 posts since
    Aug 23, 2009
    Currently Being Moderated
    7. Jun 26, 2011 1:59 PM (in response to LateRun)
    Re: Do I Have Runner's Knee? What Can I Do?

    It's true that x-rays don't show everything that is going on in your   knee, but a doctor as good as yours is can infer a lot from an exam and   x-ray image without actually having to see it. There is a small chance   they could have missed something when they looked at your knee, but   there is hardly any chance at all they would miss something major enough   to cause that much pain, if it was actually coming from your knee   joint. Knee pain is the most frequent complaint of runners, yet the   majority of knee pain sufferers I have worked with have clean x-rays and   MRIs. Clearly, there is another possible cause. Doomed? I'll bet there   are a lot of seasoned runners out there who wish they had your knees!


    One  important thing that top athletes often learn, is  the big difference  between having knee pain and having a knee problem.  As Damien  suggested, many knee pains are caused by something outside the  knee. In  fact, many doctors believe that most knee pain is caused  outside the  knee, but with malpractice insurance rates as high as they  are, doctors  are compelled to spend your time and insurance money  checking for the  most serious possibilities, so you won't sue them for  missing anything.  It's also what we expect them to do. I am very lucky  that my job only  involves checking for probable causes after doctors  have ruled out the  others, so I'll try to be your virtual assistant  today. Based on what I  see time and time again, your intermittent knee  pain is most likely  caused by one or more muscles, whose involvement  with knee pain is well  documented.


    It looks like you  managed to make it into  your late forties without this problem, until  you were recently bit by  the running bug. I started competing in 5ks  when I was about your age,  and encountered lots of pains within my first  few years as my body  adapted to the sport. Many years later, I  experience a  lot less pain  from running, now that I am in my late  fifties. I hope that  encourages  you to continue on, as long as your  doctors say you are  healthy  enough to run.


    One thing  that probably helped me in the  early days, is that I did not start out  my running career by hitting  the pavement cold-turkey. After patiently  listening to well-meaning  advice that running was going to ruin my  knees, I purchased a small  mini-trampoline and began to jog in place on  it for several minutes a  day, working up to about a half-hour per  session. I held on to a  counter top nearby for stability, so I suppose  you could compare the  strategy to what they now call a "rebounder," which is a mini-trampoline  with bars to hold onto. The idea was to condition my knees for impact  before hitting the road.


    Since I was on my feet most of  the time anyway, a  month or so of this activity gave me the confidence  to test running on  the pavement. I started with miles, not 5ks. My  first and second mile  attempts took me over 12.5 minutes to complete,  and were much harder  than jogging in place. I called my folks back home  to say my goodbyes,  just in case this activity would kill me, because  it sure felt like it  would. Over the months I was able to get into the  8s, and set my goals  for a 7, which I eventually did, after running  slower at longer  distances, including the 5k.


    I too would  encounter  knee pains along the way, sometimes limping through entire  races. While  that was a dumb thing to do, I eventually mended and  continued my quest  for a six minute mile. By the time I broke that mark  a few times I had  experienced a few more aches and pains, but it is  most likely that all  of these were related to running too fast or too  far. Still, I was  becoming stronger. Goals make us try very hard, and  our failure to reach  them can still result in beneficial adaptations,  along with a lot of  pain. I think that after trying several times to go  beyond 2 miles  without pain, you will succeed, but there are a few  things I have  learned along the way that I would like to share with  you, about how  these pains are often caused and how to handle them  easily, so you can  continue to train safely. Running hurt can make you  run sloppy, and  running sloppy can result in the kinds of real injuries  you fear.

    If  I understand your post correctly, you have  been running a lot of 5ks,  either in training or competition, within a  very short period of time.  If you push your running muscles hard  enough, you can cause enough minor  damage to result in a major change  in how a muscle, or group of  muscles, functions - without actually  tearing it, or causing any other  visible damage. You may even force a  change in how a small portion of a  muscle contracts, which is enough to  create a big difference in how it  acts on a joint. The most important  point I want to make, is that your  brain can do a super job of making  you FEEL pain in an area that may  eventually suffer damage you CAN see,  if you ignore or suppress the  pain. This miracle can occur long before  there is any real risk to your  knee joint, so it is good that you are  asking questions now, rather than  toughing it out until it is too late  to avoid surgery.


    You  mentioned a misstep. Did you slip  on something, or were your muscles  tired? While there may be a link  between that incident and your pain,  there may be no direct connection.  Sore muscles can stop working  properly without a misstep, after  becoming vunerable for some other  reason. When RRS critiqued your  slo-mo video, did they note what kind of  over-pronation they were  talking about? A physical therapist like  Damien can tell you a lot more  about your body mechanics after viewing a  slo-mo video. The hip  muscles he mentioned can rotate your leg into a  position that is not  favorable for preventing excess motion of the foot,  more stress on your  knee, and tiring of the muscles that stabilize it.


    Chances  are very good that the over-pronation  has taken a toll on some of your  muscles, but the pain in your knee may  not be directly related to that  either. In my case, the knee that  bothered me most was on my stronger  leg. One thing I found out about  that leg, but was in denial about for  years, is that it appears to be a  bit longer than my other leg. There  are many reasons why this could be,  but it turns out that most people's  legs appear to be unequal in length,  which may be why they tend to  hurt a little more on one side than the  other.


    Another  reason for one-sided injuries that  runners frequently encounter, is the  fact that most of the roads we run  on are not perfectly level. If they  were, rain water would pool up on  them. Even if your legs were  perfectly even, running on that slanted  surface can produce the same  results as a longer leg. The leg on the  upward side (or the effectively  longer leg) has to make some adaptations  to avoid dragging the toe.  This may involve some lateral movement  and/or rotation of the leg that  stresses the knee during this movement,  and after impact when it has  more work to do, before the knee is in its  strongest position. The leg  on the down side (or shorter leg) may have  to lift a little further to  keep you level, stressing the Achilles  tendon more, which is what  happened in my case.


    What I decided to do, after years of  experimentation with knee braces, ice packs, arch supports, and  orthotics,  was to settle on a minimalist fix to correct the leg length   discrepancy. A thin, flat, tough gel sole in the shorter side equalized   things to the point that I didn't have unequal injuries any more,  since  both of my legs now had exactly the same job to do, with no  unequal work  on either side. While all this helped to eliminate the  cause, it was  not the only thing I had to do to address the symptoms.


    When   a muscle, or a small portion of it - even a group of muscles - is   compromised, they rarely forget this insult easily. Even if a runner   takes a couple weeks off, as in your case, returning to the pavement   often produces the same results, as if there had been no rest at all.   This concept is what keeps therapists busy, that we have to train and   condition our muscles to "learn" how to act. Once "they" learn something   wrong (a lot of these adaptations are in the brain, not the muscle),   that behavior has to be unlearned. The trick I have learned over the   years is how to erase that muscle memory in order to allow it to   function normally. In effect, you can "reset" the relationship between a   muscle and the brain that controls its tension, and it's not hard to   do.


    Before you attack your muscles willy-nilly, it's a   good idea to figure out which muscles may be causing the pain that feels   like it is coming from your knee. First, you have to be specific about   which part of your knee hurts, because at any given time, one or more  of  a dozen muscles may be directly controlling your knee pain.  Fortunately  for us, this happens in well researched, predictable  patterns. Most of  the visual therapeutic materials for mapping these  pain patterns is  copyrighted and can't be shown directly here, but I  will do my best to  discuss it in my own words so you can reap the  benefits. Rest assured,  I've paid big bucks for this knowledge!


    Open  this link  as a visual aid, and you can press backspace or click the  back/forward  arrows in the upper left on your (PC compatible) keyboard  and/or browser  to flip back and forth between the images and this  post...    If you can bookmark it and open it up in a separate window, you can   alt-tab to flip back and forth between this text and the visual aid   link.


    Some of the top muscular producers of back-of-knee pain are the upper fibers of the bulging upper calf muscle Gastrocnemius.   It is special in that it controls both knee and ankle flexion, but   performs most of these tasks most effectively when the knee is locked,   because its reach spans both joints. When you are running, it helps   initiate the upward movement of your heel as you leg moves rearward,   after which it runs out of leverage. It performs a lot more work while   standing or climbing, to lock the knee and keep you from falling forward   (as when going down stairs). A tiny muscle that assists these actions (Plantaris)   is located right in the back of the knee itself. Both muscles can   produce knee pain where they are and farther down, the lower fibers of   the Gastroc often producing pain all the way down in the the arch of the   foot (one of the primary causes of arch pain). Another small muscle in   the back of the knee, the Popliteus, goes from the rear of your   Tibia to the outside bottom of your Femur. This strange arrangement is   necessary to slightly rotate the knee joint and unlock it, after   standing with knees straight. Sudden twisting movements can irritate it.   You can see how this muscle's function allows the other two to flex  the  knee by unlocking the knee, and the "firing order" of these muscles   changes, depending on what you are trying to do.

    Another back-of-knee pain culprit is the powerful outer hamstring (Biceps Femoris),  which would also be involved with rotating the leg outward, as many do  during pronation.  Unfortunately, many of us sit on it all day, which  keeps it in a  shortened state and starved for blood flow. All of the  muscles I have  mentioned so far can produce back-of-knee pain when you  stand straight  and lock the knee, because even though none of them  perform this  function, they are stretched to the max when you do. This  is one of the  true tests of whether or not they are sore. Gastroc and Plantaris are further stretched when you stand on your heels with toes up, knee locked.


    Outer knee pain is often due to problems with the outer Quad (Vastus Lateralis),   and running can really make this muscle painfully dysfunctional,   without actually damaging it at all. Lots of people confuse pain in this   muscle with ITB (Iliotibial Band) syndrome, since the ITB runs over  top of it and attaches in a spot where this muscle often hurts most.  When people think they are foam-rolling ITBS, the V. Lateralis is  getting a treat underneath, and often is the reason the pain goes away.  The ITB, which is blamed for many runners' knee pains, is actually best  addressed by relaxing the Glutes and pelvic hip flexor/abductor Tensor Fasciae Latae,  which is not the latest Starbucks sensation, but a narrow muscle on the  front of the pelvis whose primary purpose is to keep the ITB tight,  because a loose ITB is worthless. On the other hand, the inability of  Gluteal and TFL  muscles to relax can produce 24-hour pressure on the  side of the knee,  resulting in compromised tissue at that sight. The  description of your  symptoms, with knee pain after two miles, might  point to TFL problems if you had been running for many years. I dont  think that a few months of 5ks are enough insult to cause that much  dysfunction in your ITB  system, but it could hammer the sensitive outer  Quad and the calf  muscles (mentioned above) in very little time,  because they are not used  to this new kind of stress.


    Front of knee pain that is not coming from the joint itself, is usually from your inner quad, the Vastis Medialis,   which is known for creating the sensation that your knee is going to   give out. Sometimes it actually does, though the apparent muscular   weakness does not necessariy mean the muscle is actually weak, or has a   neurological problem. It's usually because your brain will refuse to  use  it when it becomes sensitive from overtraining or other causes, and  the  lack of support can lead to a lot of falls. It doesn't take much  to  affect it in this way, but it is easy to fix.

    Another quad muscle is the only one that spans both the hip and knee joints. Called the Rectus Femoris,   it is on top of the others and runs straight up and down the top  center  of your thigh. The upper fibers can produce deep knee pain and   discomfort that actually feels like debris under your kneecap. When  people  report these symptoms and scans come up empty, these upper  fibers need  to be checked and disarmed. The lower fibers can produce an  aching pain  above the knee. While this muscle does not have the  disabling effect of  the V. Medialis, there is nothing to exclude any  number of these muscles  from going down in a domino effect, multiplying  your symptoms and  probable solutions. Symptoms of "runner's knee" are  often little more than bum Quads, but they can cause real knee damage if  left to themselves.

    Sometimes a slip or fall that spreads your legs can strain your Adductor muscles, which include Adductor Longus and Brevis.   These are located up your inner thigh, but can send pain to the front   of your knee, as well as to your groin. The Adductors also function as   hip flexors, so your running can tire them until a simple misstep can   finish them off. Once again, a muscle can become painful and   dysfunctional without any actual damage being done. People may want to   see actual physical damage or swelling when they feel pain, but most   pain is invisible. Imagine how many cars would be on the road if the   idiot lights came on after the damage was done. The early warning system   in your body is even smarter than the one in your car.


    Inner knee pain

    This one can involve some of the muscles we have alreay covered. Two of the Quads, Vastus Medialis and Rectus Femoris,   can be responsible for pain here, and though their health is  important,  there are other support muscles that can produce serious  inner knee  pain. Adductor Longus, which we covered above, can  also be  involved. Two long, skinny muscles that start on the inner  knee, but run  over and above the other muscles mentioned, like a couple  of ropes, one  to the outer hip (Sartorius), and one to the pubic bone (Gracilis),   function as secondary hip flexors, but also abduct and adduct   (respectively) your thigh at the hip. Both of them can shoot pain into   the inner knee under stress, though they both tend to exhibit that pain   along their length, which is the giveaway. Lots of people think they   have medial meniscus problems, but wind up finding problems in some of   these muscles. A clean scan is your cue.

    Sartorius can be   set off by a twisting slip or fall, or by hip flexor stretches. It can   hurt while standing and feel better when sitting down, when it is   relaxed.

    Gracilis pain can be very persistent regardless of   position, but can we walked out. Because it rides over the Adductors,   it can become problematic when the other Adductors are in trouble, even   if there was no trauma to the muscle itself. Muscles are often very   sociable with each other, working in groups and backing up each others'   problems in a pain-fest of sympathy strikes. Viewing these body parts  as systems can save a lot of time over considering them separately.


    Now   that we have looked at a number of potential victims of whatever cause   led to your pain, I will show you how I fix them so you can begin   healing and continue training. Except in extreme cases, we are mostly   made up of muscles, some of which are quiet and faithful servants like   the heart, and some of which are quite sensitive, complaining at the   slightest provocation. Most of the muscles you use to run are sturdy and   pain free, but susceptible to overload and overuse. When the muscle,   via its many nerves and specialized neurons, sends suspicious patterns   of sensation back to the brain, it can result in a guarding reflex that   tightens the muscle and makes it less useful. Even well-conditioned   muscle can become exhausted to the point of failure to function, which   is why our mightiest athletes often collapse in a heap. An elite   marathoner may be forced to train easy for months after a win, but for   most of us, the simple stresses of daily living, or moderate exercise,   can cause similar dysfunction. As with our sports heroes, it is a   mistake to assume that these muscles are not well trained just because   they do not always work when we want them to. All muscles need recovery   time, but just taking a break does not necessarily equal rest and   recovery.


    Unlike our brains, there are a number of muscles  that  do not get to rest and recover every night. The heart is a  perfect  example of this, but there are other muscles in the body we use  to  position ourselves for work, or hold posture, even while we are  sleeping  or sitting watching TV. If that weren't enough, our muscles  are the  main source of our body temperature, which is almost always  higher than  the surrounding air. They have to work to produce this  heat. It's not  unusual to wake from a long sleep even more sore than  you were before,  and we can never assume that our muscles are relaxing  along with the  rest of us. They may not complain all the time, but they  may when we try  to use them for a demanding task, like the sudden urge  to run 5ks. It  takes energy to move a single meter, but 5,000 of them  in a row is an  incredible amount of work. Sure, we feel great  afterwards, and want to  do it again, but that does not mean our muscles  are not in need of a  major va-cay. There is a lot of damage at the  cellular level you cannot  always feel, and it takes more than time to  fix. The most important  thing to know is that simple rest is not always  the rest you need.


    If  you were to look at your  recovering muscle cells under a microscope  after vigorous exercise, and  contrast them with what you might find in a  world champion marathoner,  you would see a difference in how these two  types of muscles react to  training. Depending on how fit you are, you  would see varying degrees  of smearing of muscle cells, as they rupture  and are broken down to be  reabsorbed into the blood stream. The longer  you have been sedentary,  the more of this reconstruction will result  from even a modest amount  of training, as your weaker, more  economy-minded muscle cells are  destroyed and replaced by stronger,  hungrier ones. However, anyone at  any level of fitness can have this  process going on at any time. The  fitter you become, the more abuse it  will take to push your muscle to  the point it locks up (or fails to  function) and forces you to let the  reconstruction take place. Two  important messages I want you to take  away from this are (1) the muscle  does not need to be locked up to heal  (it may even slow the process),  and (2) it may remain locked up  indefinitely until you unlock it with  the proper therapy. Just resting,  stretching, or exercising are not  enough.


    If you are  like most of us in this forum, you are  somewhere between the two  extremes of fitness. Only the ones at the top  of their game are going  to be able to go out and run some easy 100 mile  weeks to loosen up. The  rest of us would be destroyed by that, so one  man's meat is another's  poison when it comes to exercise. You've got to  start at point "A" and  work through the entire alphabet of fitness to  get to point "Z" without  causing serious damage to yourself. Yes, there  are a few examples of  people who have gotten off the couch and run sub-3  marathons, but they  have to have already been exceptionally fit for  some reason, genetic or  otherwise. In our species, we all start with  muscle tissue that is  mostly the same. The man who most recently held  the world record for  the marathon used to run 10k to school and back  when he was a kid, and  he is still an awful overpronator. His muscles  are so strong he can do  all kinds of crazy stuff and survive it. Bill  Rodgers had a really  short left leg, but back-to-back Boston  championships. I, on the other  hand, needed a small thin gel pad in my  shoe to balance me out enough  to even qualify for Boston as an old man.  It doesn't mean we aren't  capable of great feats of endurance, but that  we will have to take a  little more care of ourselves than that guy over  there stretching his  leg onto the roof of his car.


    Let's  go to work... If you  have reviewed and researched the muscles I have  discussed, we can start  trying to fix them so they will become less  painful first, more mobile  second, more relaxed around the clock third,  and eventually, healed  and strong, ready for more aggressive training.  If you go back to the  home menu on that muscle tutorial I linked, you  can check out the  section on how mucles actually contract, which I will  not re-create  here. Most of the information you need to know to take  proper care of  your body is spread all over the place, and rarely all in  one place. As  always, they charge money for the good stuff. I will do  my best to sum  it up for you. First, an overview of the complete  picture.

    Muscles  are referred to by names that give us a  roadmap for locating them  individually, but they are sometimes  interwoven in ways that combine  function, as in the Quads. Within these  muscle organs are sometimes  multiple bellies, different motor nerves,  and sections of fibers that  have slightly different functions and can  produce different types of  pain. Some spots in these muscles may feel  painful to the touch, others  only when pressed, and others may display  pain in another part of the  body when we press them or they are tight.  There are many cases when  there is no pain, but dysfunction, and cases  when there is pain, but no  dysfunction in a given area. Troubleshooting  muscles can be like a  walk through a House of Mirrors, but there is a  certain logic to it if  you have the patience to learn. Most healthcare  professionals do not  have the time to commit all of this minutia to  memory. The only reason I  have the time to go on like this, is it's the  only part of healthcare I  really have to concern myself with. What keeps  me sane is that the  application is thankfully, very broad.


    There is a  tremendous variety of symptoms that muscle  tissue can display when it  is not working right. I believe you are  encountering one or more of  these symptoms, even if there is something  wrong that is out of my  scope of practice. Painless structural flaws and  painful myofascial  pain often run concurrently, which can be quite misleading. In most  cases, muscle pain (myofascial  pain) involves a very small part of a  muscle or the fascia that  surrounds it. A small area is all it takes to  disrupt normal operation  of the entire muscle and cause it to stiffen  or to contract weakly. You  can find these spots by scanning your  muscles for tight fibers. I  usually check mine with my fingers and a  little soap and water in the  shower. It helps to better define what is  lurking under the skin. You'll  get better at this with experience, but  starting now will equip you to  deal with other "injuries" you will  encounter as you continue your  running.


    Myofascial pain  usually involves one or more areas in a muscles fiber(s)  that contract  involuntarily into a mass that may feel like a rubbery  lump of varying  size, sometimes shifting location or changing its  tension as you press  on it. These spots are sometimes warm to the touch,  and exhibit  increased electrical activity when measured by equipment  for the  purpose. They are easy enough to find that nobody really needs  to put a  scope on you to find them, although there have been some  advanced  imaging systems developed for the purpose. Such equipment would  be more  widely available if an interview and fingers weren't so much  cheaper.  While areas of contorted tissue will usually stand out a bit  and feel  sensitive to the touch, they will often "refer" their pain to  the end  of the muscle or beyond, depending on how the nerves are wired  and the  brain interprets them. Most pain patterns are common,  repeatable, and  due to the same portions of muscle being in spasm. You  can usually take  a given set of symptoms to the bank, as being caused a  certain way.


    Working  on these spots does not involve  much more than that. You simply need  to find them, apply varying degrees  of pressure depending on  sensitivity, and hold that pressure long  enough for the tight fibers to  "melt" under your fingers. Sometimes a  little circular movement helps,  and sometimes static pressure is less  irritating. Sometimes the order  in which you address each area matters.  You get better with practice,  and often have to repeat these actions  enough times to get plenty of  that. Whether you need to repeat this, and  the frequency of treatment,  is often dependent on the length of time  the syndrome has been present,  its severity, how much subsequent rest  from activity you are getting,  and whether or not you can gently move  the tissue to re-educate your  brain about its potential for movement.  Your brain has a lot to keep  track of, and often allows such tissue to  remain in a dysfunctional  state until you bring it to your brain's  attention, front and center.  This means you must often confront a wee  bit of pain, and sometimes a  lot of it. I've had conditions that felt  for all the world like a  broken bone, and it is usually worst the first  time you go in. A little  patience soon tells the difference between a  real injury and  myofascial pain.


    So, why is there such  pain, and why  might you feel it in your joints? There is a lot of  settled science on  the subject, but more to be learned about the exact  chemistry and  neurological component. Much of the problem has to do with  the  breakdown of tissue that we discussed earlier, and the need to  stimuate  increased circulation and evacuation of waste product. Any time  there  is microtrauma to tissues that are served by blood or lymphatic  flow,  the cells of your immune system are attracted to the area to begin  the  process of reconstruction. Unfortunately, the original pain and   dysfunction is not enough to bring this action about. Part of the   problem may be physical, in that there was possibly a small blockage   that lead to the dysfunction in the first place, and we essentially   "break" this up. There may also be the neuromuscular component, in which   the brain's perception of sensation results in altering motor nerve   activity. Part of the solution is without question psychological, since   an intervention is being made. It is a well established fact that  people  are capable of psyching themselves into muscular dysfunction,  and the  further pain and damage it may cause. In this case, making  something  feel better accomplishes more than it would seem.


    One   thing is for sure: when muscle loses abnormal tension in any or all of   its fibers, it rests better. The time off that you take, then   accomplishes something. You sleep better, with the satisfaction that   something has been changed. Your hands were in that tissue just as   surely as if a scalpel had been used, without the great potential for   damage more invasive procedures entail. While the fix is not always   instantaneous, it often is. I have seen huge improvements in tone,   function, and perceived pain within a few seconds. Most of the time, it   is an ongoing process, as is the stress that leads to dysfunction in  the  first place. In my view, it is an ongoing reality, and required  skill,  of the athletic lifestyle.


    Doctors take a  Hippocratic  oath to "do no harm." That means, if push comes to shove,  they will  usually advise you in such a way that you will not be  encouraged to harm  yourself. If a physician looks at a set of symptoms  and follows a  differential diagnosis, myofascial pain may be down the  list of  potential severity. It almost always is. The reason is  obviously what  can happen if they make the wrong call, and you go out  and break your  leg. Give them credit for scaring you away from that  possibility  sometimes. There could still be a problem caused by  impingement of  spinal nerves, and that can be teased out by working  with a physical  therapist. Based on the progression you report, the  symptoms would have  been likely to occur during other activities, if  that were the case.  Nerve-related pains can be brought on by activity,  but activity is not  necessary needed to bring on false nerve generated  pains. Movement-only  related activity is usually muscular in origin,  but can still involve  pressure on nerves. If you still have fears of  structural flaws, an  ultrasound image may be cheaper than an MRI, and  there are dye-injected tests that reveal more detail if required.


    The reason why your doc is so good, is that he has acheived  enough  comfort with his material that he does not need to do this as  much, and  has the integrity to avoid pumping your insurance money. If he  tells  you there is no medical problem, and that it will eventually go  away on  its own, he is probably right. What I have covered here, is the  gap  between an acute medical condition that requires aggressive  treatment,  and one that can be taken care of at home. Though thousands  of pages of  medical literature have been written on the subject, it  usually does  not meet the test of urgency required for acute care, and  you often  cannot get insurance to cover treatment without a special  addendum to  your policy. This bothers me enough that I spend a lot of  time trying  to teach people how to handle it themselves. I was once  where you are  now, but thanks to patience and a lot of research, not any  more. It  didn't take me all day to write this, and I still have time to  enjoy  the 15-miler I had planned for today. I'm sure you'll be able to  do the  same someday. I know this is a lot to cover on a Sunday  afternoon. but  I'm sure you'll do fine.

  • munchko Rookie 2 posts since
    Jun 25, 2011
    Currently Being Moderated
    8. Jun 26, 2011 5:18 PM (in response to Damien Howell)
    Re: Do I Have Runner's Knee? What Can I Do?



    Thanks for the informative articles. It's pretty clear that there are no clear answers. My understanding is that the propensity to develop osteoarthritis also has a substantial genetic component. For now, the pain I experience is pretty sporadic, although my knee joints are pretty noisy when doing movements like extensions. Although I haven't been running on a regular basis for a number of years, I do tap dance on average 4 days/week, which also gives the knees a bit of a pounding. I haven't been able to see a clear correlation between activity level and knee pain.

  • JamesJohnsonLMT Legend 1,291 posts since
    Aug 23, 2009
    Currently Being Moderated
    10. Jun 27, 2011 5:19 PM (in response to LateRun)
    Re: Do I Have Runner's Knee? What Can I Do?

    I think your friend's wife (the PT) is  right, and you will recover from this problem as soon as we find the  trigger for your knee pain. Word in the PT community is that flat track  running is much easier on ITB symptoms, if that's what you have.


    If  this pain is on the outside of the knee, don't fear. You are not likely  to have classic ITBFS this early in your running, but it's not unusual  to have similar symptoms in the area.


    I  used to have  problems with my quads locking up in marathons, usually  somewhere  between 16 and 23 miles. I would have to stop, rub it out,  and walk-run  the rest of the way in. I don't have the problem anymore,  even under  those extreme conditions (I've run over 30 miles a few  times), which is  why I am confident you can overcome it too.


    Rather  than  use a rolling pin (!), try this while sitting in the car: Reach  down  with the fingers of your left hand to your outer quad, all the way  up to  the back of the knee joint. You should feel the thick outer  hamstring  tendon on the very bottom. move up until that tendon is just  below your  fingertips, as you sink your fingers into this crevice  between the quads  and hams. Gripping the outer quad muscle firmly, lift  it upward  slightly while curling your fingers under the muscle. If you  feel  sensitivity in there, there's your problem.


    Try that  and get back to me. Meanwhile, there are many potential snags along the  ITB route from the glutes and pelvis to the knee, many of which are felt  at the knee, because  that's where this power-train ends. Though you  feel the pain there,  where the tension begins is more important. Get  yourself a tennis ball  or something round and soft (no rolling pins,  they're too hard and  potentially damaging). Find a soft place to lay  down like a couch, firm  mattress, or a yoga pad on carpet.


    Place  the tennis ball under your glutes and roll your body gently over it  until it reaches the upper pelvis in  the rear. Take note of any  sensitive spots you find, and spend a  little more time loosening them  up. A stretch before releasing a muscle  can make it worse, but a stretch  after releasing a muscle can make it  better. Just keep the pressure  from the ball moderate, and the  stretches gentle. A series of slow  2-second stretches in a set are more  therapeutic than one long stretch.  This ain't yoga, it's rehab. Next, run that ball up from the outer knee  to the  front of the pelvis, just below that bony knob you feel when your  hands  are on your hips.


    IMPORTANT When  you work your legs with any kind of roller, ball, or massage  device,  make sure you glide from bottom to top ONLY. The veins and  lymphatic  vessels of your legs have one-way (semilunar) valves in them that do not  like pressure going the wrong way. It can collapse them and cause CVI and varicose veins. Those valves are there to keep fluids from rushing   toward your feet when you run, which is also something nobody wants.

    In   the image on the right, we see first the correct return of fluids, how   they are prevented from returning, and what happens when they are   damaged (many thanks to for the above images).


    Many  thanks to for this brilliant image of the ITB in all  its glory, and the important muscles that tension it (from left to  right, Glute Max, Glute Medius, Tensor Fascia Latae). You can see the  outer quad and outer hamstring underneath... Roll all those babies!

    We will probably find that the overpronation could be a factor in your case. I found that the first metatarsal of my  foot was a bit shorter than the second (see #8 in picture below, for  exaggerated example), which turns out to be very common, but not optimum  for distance running. I glued a small quarter-sized pad of thin gel  material under the part of my insole where the ball of my foot goes. It  seems to help with foot stability in a lot of people, and can minimize pronation and knee problems if your foot is like this. You have to line up the  bones in cross-lighting to check if yours is like this, and it doesn't  matter how long the toes are. It's where the ball of the foot is in  relation to the bones next door that counts.

    (thanks to for bone image)...

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