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947 Views 2 Replies Latest reply: Sep 16, 2012 7:21 AM by AliciaGriffin RSS
RunnerJess5 Rookie 1 posts since
Oct 25, 2011
Currently Being Moderated

May 31, 2012 9:19 AM

Knee injury or Patellar tendinitis?

Hello all.

 

I have been running for about 2 years now and have been running races for about a year and have never had problems with my knee.  I was on my last 12 mile training run for a upcoming half marathon and around mile 8 my knee started to have a little twinge of pain. By mile 9 I was done, only able to walk home. There was no sounds of popping nor did it feel like it was grinding together, there is also no swelling. The sharp pain location is on the outside of my right knee slightly below the knee cap. I took the week off from running and by the time my half came I felt good and gave it a whirl. Half was going well, no pain at all for the first 4 miles and then the twinge started again. At mile 7 I pulled out of the race. I saw a ortho doc a week after this happened and he did x-rays and found nothing wrong. He wants to hold off on the MRI and has said it is most likely a injury from over usage. I took 3 weeks off at his request and did nothing as far as exercise goes. I got the all clear to try and run yesterday and it didn't go well. The first mile felt really good, no pain at all. Shortly after mile 1 the twinge started and a few minutes later it was back to being a very sharp pain. I'f I had some sort of tear, wouldn't that hurt as soon as I tried to run? I am finding it odd that I can still run say 1 plus miles before any sort of pain starts. But once it starts, there is no trying to run through it. I attempted that during my half and as the miles went on it got progressively worse. After my half it would get better with each passing day and going down steps was/is the only thing that seems to bother it from time to time. It doesn't happen everytime I do steps. I was thinking about getting the jumpers knee band to see if perhaps it is more of a tendinitis issue.  I have properly fitted shoes and have run in the same brand of shoes for well over a year. I buy new shoes every 3-4 months and do plenty of streching pre and post runs. This issue started about 5 weeks ago. 

 

Any advice/thoughts on this is greatly appreciated! I'd love to try other things before scheduling my MRI.

 

Thanks!

  • JamesJohnsonLMT Legend 1,127 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. May 31, 2012 10:22 AM (in response to RunnerJess5)
    Re: Knee injury or Patellar tendinitis?

    Even if an MRI shows something "wrong," it does not explain why. It is helpful to understand some of the underlying forces behind repetitive motion injuries, and what can be done about them. A good working understanding of these principles often makes expensive medical interventions unnecessary. Always address the cause first, or you will be chasing symptoms until the cows come home.

     

    Stretching is a two-edged sword. It helps to mobilize and warm healthy muscle, but further strains tight muscles that are already strained. This can backfire by causing defensive tightness in portions of the muscles stretched, even if most relax. A balanced and synchronized muscle group helps, an unbalanced muscle or group that fights its own motion is often aggravated by stretching. The extent of tightness or injury is key, and other avenues of relaxing the muscle(s) or portions thereof should be pursued first. Stretching of repaired muscle is the icing on the cake, not the means to the end.

     

    The typical explanation for side-of-knee pain is ITBS, or Ilio-Tibial Band Syndrome. The thinking is that an extension of your knee stabilizing muscles, called the Liotibial Band, originating in the muscles of the hip, attaches on the side of your knee, and suffers from the repeated friction on the side of the femur, caused by endurance running or other endurance sports involving knee motion. There are holes in the theory, but the fact remains there is pain in this location as a result of extended movement.

     

    While tests may indicate inflammation in the area, what needs to be appreciated is the reason why there might be a need for the excessive stabilization that can cause strain here. You could be running tired or sloppy, or have a component of your running stride that requires too much motion in this area for you to recover from. The first place to start is to have your running stride analyzed for excess motion, by a physical therapist or someone else qualified to do so. There can be anatomical explanations for why your foot and hip might be used in a way that requires more stabilization of your knee.

     

    Even when the ITB is the thing people focus on, what is important to know is that the ITB runs along the same path as the underlying lateral quad (V. Lateralis), that is one of the muscles most frequently irritated by endurance running. It can and does build multiple knots of tightened tissue that register pain in the same spot as ITBS, also exerting lateral pressure on the kneecap and increasing the risk of damage to the cartilage underneath. Stretching it, or trying to strengthen it via focused exercises, can backfire and make the fibers tighten more.

     

    Another important point is that the ITB, even when it is involved, is kept taught by the Gluteal and TFL muscles. When these muscles do not release and recover after exercise, there is unrelenting tension on the attachments of this Band. Focus on the Band itself should be redirected to the hip muscles supplying the tension in the first place. The Band is secondary.

     

    While some athletes have learned to foam-roll this ITB/VL/hip area to reduce tensions and increase healing circulation there, they often do it wrong. Foam-rolling or massaging the crap out of a muscle can make it tighter and more sensitive, too. Also, foam rolling or massaging from the hip down produces pressure against the valves of the veins and lymphatic vessels, which are pointed in the opposite direction: toward the heart. Many athletes blindly risk damage to these tissues, such as varicose veins, by happily rolling downward on the limbs.

     

    The first order of business is to identify excess motion, regardless of locus of pain, then pinpoint the anatomical or procedural reasons behind it. While some athletes adapt to excess motion, even thriving on it, most do not. I suspect you are numbered among the gentler folk, and need to minimize the extent of excess motion. Everything from the structure of your foot, to the action of your hip and back, are important in supplying the underpinning forces and restrictions that guide your stride. Train yourself to look beyond the end result to the origin of your unique motion. It can involve everything from relative bone length, to tightness of ligaments and muscular tension.

  • AliciaGriffin Rookie 2 posts since
    Sep 10, 2012
    Currently Being Moderated
    2. Sep 16, 2012 7:21 AM (in response to JamesJohnsonLMT)
    Re: Knee injury or Patellar tendinitis?

    Our knee possesses a few big component bone fragments named femur, thetibia, and the patella or knee cap. The most important suspensory ligaments arequite susceptible to shock. The muscle ligament or cells called Quadriceps andPatellar are the big muscle cells that join together the knee joint. In orderto protect the knee joint and knee pain inside of knee, nature has provided cartilages andBursae sacs that takein the abrupt strikes from inner or outer causes.

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