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849 Views 3 Replies Latest reply: Apr 21, 2012 6:44 PM by JamesJohnsonLMT RSS
FrodeAndersen Amateur 9 posts since
Jun 6, 2011
Currently Being Moderated

Apr 19, 2012 7:21 AM

Double knee issue - or cause and effect?

Howdy,

While in training for my first half marathon I have had a (slight I hope..) setback. I did 5Ks and 10Ks last summer and was ramping up to the longer distances this year. I was about halfway through my training schedule when I started having issues with my left knee. When I was 9 I broke my femur (snapped it in half while skiing.. cool x-ray!) and had to spend time with a pin through my knee pulling it apart so that it would grow correctly. I have always been a bit nervous about that knee ever since. Anyway, now I have had ITBS and am treating that with stretches, foam roller and targeted strength exercises. When the ITBS pain started going away I also noticed pain on the inside of the knee. It seems a bit towards the lower knee down towards the calf. Just this morning I came awake with a jerk in bed which pushed the heel down into the mattress and that definitely caused some pain. It used to also hurt badly if I put my right foot behind the left and pulled the left back to take my shoe off.

 

Anyway, am I seeing a slight meniscus problem here? I don't think it is bad enough to be completely torn (and I have no pain behind the knee itself). Or am I seeing strained tendons from running tensely with the ITBS? I did run a 5 mile race (not the smartest but part of a trilogy I *really* want to do later this summer..) with it a couple of weeks ago.. I have stopped all lower body workouts for now and am only gently stretching the ITBS issue since I am concerned the stretching is hurting the inside of the knee.

 

Any input would be appreciated!

  • FootFlux Rookie 7 posts since
    Aug 13, 2010
    Currently Being Moderated
    1. Apr 19, 2012 9:18 AM (in response to FrodeAndersen)
    Double knee issue - or cause and effect?

    I think you should really consult your doctor or a physical therapist on this issue, especially since you have history of an injury in the affected area.

     

    Doing a roller exercise on the outside of your thigh to stretch the IT band should not put stress on the inside of your knee.  I do those stretches all the time, they are pretty safe. Definitely take some time off to heal, at least a week, maybe two.  Also be sure to have recovery days as part of your training. I had some pain behind my knees after my first marathon for a few weeks, my doctor said it was ok and I just needed more time to recover.





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  • JamesJohnsonLMT Legend 1,146 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Apr 21, 2012 6:44 PM (in response to FrodeAndersen)
    Double knee issue - or cause and effect?

    You mentioned tendons, meniscus, bone, etc., but what about the muscles? They would be involved in every action, like kicking off a shoe, and are likely to be involved in almost any knee pain in some way. Several muscles act on the knee and produce pain that is felt in the knee. You mentioned exercises and some stretches, but if increasing your mileage led to knee pain, these measures are simply more exercise piled on.

     

    Distance has a way of teasing out some very fine imbalances in form and anatomy. I had knee injuries from one skiing accident, and two broken bones in the other leg from a motorcycle accident, but I never really had any issues playing team sports, skiing, or tennis due to these problems, until I took up running. The first year was not so bad, but mounting asymmetrical injuries led me to the discovery that one of my legs was slightly longer than the other. Putting a slight lift in the other shoe, and fine-tuning my footwear eventually got rid of the knee pain. Even though I still run distances up to 50k, my overall training load has dropped some for better recovery. An occasional sore muscle or cramp is all I get any more.

     

    With respect to your account, driving the heel into the bed, voluntarily or involuntarily, and pulling the shoe off with the other foot might point to your Gastrocnemius muscle, which flexes the knee when the leg is straight. This muscle crosses the knee to attach to either side of the femoral condyles.

     

    If you tend to overpronate, or have any tendency to externally rotate the hip, the medial head of the Gastroc is more likely to become injured from overuse. Tight hamstrings and quads from overtraining are also likely to come into play, since stiffening here makes all involved muscles work harder. Your squats and lunges could have led to this knee pain by stiffening the medial quads. There could be residual problems going all the way back to age 9 in your Sartorius and Adductor Longus muscles, dormant until you pushed the mileage barrier. Let's Isolate these other muscles in the following steps:

     

    The Sartorius is used to allow your legs to cross into the Lotus position (sitting "Indian style"). The adductors are all activated when you press your knees together. When you straighten your knee, the medial quad (Vastus Medialis) is the bulbous muscle just above and to the inside of the knee. Press into the belly of it for a reaction. It sounds like your Gastroc symptoms subsided, but the moves covered above with your shoe and when you woke in bed are examples of strain potential.

     

    If you haven't been examined for over-pronation, have your gait analyzed as soon as possible for this fault in form. There are potential issues with your foot structure that can cause overpronation, external rotation, and knee pain. You can't always exercise your way out of structural problems, but there are methods of orthotic support that can help.

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