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1636 Views 5 Replies Latest reply: Jun 13, 2012 8:13 PM by hayes55987 RSS
hayes55987 Amateur 9 posts since
Feb 28, 2012
Currently Being Moderated

Jun 7, 2012 8:30 PM

Pain in the rear lateral of left knee

Been a life long athlete (swimmer for 14+ years) and in the last year have started picking up running. I started out with the basic pains of shin splits, foot numbness, finding the right shoes, etc. Eventually I got on a system and about 4 months ago started ramping up my mileage. 9 weeks ago, I did two long runs in a row (I typically space them out much more) of 7 and 9 miles back to back days. On the last 2,3 miles of my 9 miler I started descending my miles and in about the last half mile when really booking it, I started getting a severe pain in the rear of my left knee.

It forced me to hobble back home and was very painful.

I thought it was just a small tweak and did the usual of icing and resting a few days then tried a run again. Made it about a mile and a half and had to hobble home again.

I kept trying to run on it for about another week until I realized it was serious and have been resting/doing "trial" runs to see if it is healed.

 

Current day (9 weeks) after and it is a little better but still gives me pain and I cannot seem to narrow it down. I have posted a thread which describes my pain but they don't have any real solutions on how they were fixed.

http://www.coolrunning.com/forums/Forum11/HTML/009238.shtml

 

In going to my GP, I have had xrays done and nothing revealed. Reluctent to go to an ortho because I am hoping it will heal itself.

Symptoms I have are:

When in a butterfly stretch, my knee hurts the more it is pressed down

When running, it almost "starts" in the front of the knee but will eventually move to the back. Almost as if it is a slow cramp

Haven't gone over 2 miles in total

Hamstrings seem to be a little affected and "tighter" in my left leg when walking if that indicates anything

 

 

Anyone else have any updated information on this? Kind of wondering if stretching is helping/hurting it, keep icing even though I can't detect any swelling, etc

 

Thanks!

  • JamesJohnsonLMT Legend 1,155 posts since
    Aug 23, 2009
    Currently Being Moderated
    1. Jun 9, 2012 10:37 AM (in response to hayes55987)
    Re: Pain in the rear lateral of left knee

    Don't stretch this, please. It can and probably will, make things worse. The hamstrings are probably just a symptom, a guarding reflex to protect the knee, but can be the actual cause of the exact pain you feel. More on that later. Realize at this point that tests so far indicate what I would have told you, that a pain in the knee very often has little to do with the knee itself, so will show nothing on scans.

     

    One typical differential diagnosis that comes up when searching for "pain behind knee" is a Baker's Cyst, but I would nor expect something like that in a tenderfoot runner with a year under his/her belt. Often undiscussed are the many muscles acting on the knee that produce pain symptoms in that location, but first, I want to ask you why you did back-to-back long runs at the same time you were adding speed to your routine. The question is rhetorical; I already know why. I did it myself in the first year of running, and had the pains to show for it. The rule of thumb here is, you can gradually increase your time, mileage, or intensity, but not more than one of these factors at a time. Your training will always be ahead of your body's ability to adapt to the new stress, and this is one reason why we train at all. Just add patience and strategy to the mix. Don't pile it on all at once, or overuse injury is the result. Chalk it up to experience.

     

    Back to those muscles, they have a lot to do with stability when running. Though you have been using them in the pool for years, they are being used in a different way now, and will need time to adjust to the new work load and firing order. It's a neuromuscular re-education process that underscores the fact that fitness at one sport does not necessarily translate directly to another, without approaching the new sport as a complete newbie. However, you have still worked the muscle in both sports, and have to account for that when calculating your training load. I know the impatience. It's pretty hard to resist the adrenaline rush of more miles and more speed, but lesson learned and we'll move on.

     

    The outer hamstring Biceps Femoris is the major knee flexor and hip extender, and will be pressed into service more as you add speed. Check out the BFs on a sprinter for details. The main symptom of BF tightness is dull aching pain in the lateral rear knee. Some have success foam-rolling out knots in this muscle to alleviate this pain, but I must caution you to do it properly and not excessively. this is not like icing, which numbs pain and little else when there is no swelling. This, like other self-massage techniques, can promote healing rather than simply cover up pain like ice and meds. Just make sure to limit the time spent on the technique to a few applications of limited duration each day, and let your body do the rest of the healing in your off-time. Some activity to encourage circulation without excessive loading of the muscle (such as the load during a stretch is often overdone) can help speed healing. Foam rolling or massage on extremities should be done in the direction of the valves in your veins and lymphatic vessels, which is toward the heart. This not only makes physiological sense, it will help prevent potential damage to these valves, such as varicosities.

     

    Your other hamstrings can contribute to this pain, so the therapy chosen should fan out across the entire rear thigh. Meanwhile, there are a few more muscles to consider. The large calf muscles Soleus and Gastoc can contribute to rear-knee pain, and would be taxed by speed and mileage as well. Apply some therapy there. Two small muscles found in the actual rear-knee compartment should not be overlooked - the knee-unlocker Popliteus and plantarflexor Plantaris, which though tiny and so vestigial as to be sometimes mistaken for a nerve in cadavers, still feels pain like everything else. How many hairs do I have to pull to produce pain? Plantaris is more substantial than a hair. These back-of-knee muscles are in a sensitive area, and should be approached carefully near unprotected arteries and nerves (arteries throb, nerves register numbness and "electrical" pain).

     

    Use the following tool as an aid to locating muscles and what they do...

    http://www.getbodysmart.com/ap/muscularsystem/legmuscles/plantaris/tutorial.html

     

    Please understand that though self-applied therapies seem simple in nature, they address the elaborate complexity of muscle structure and function. It only takes a handfull of spasms in microscopic motor untis to produce a boatload of pain and bring an entire muscle to its, um, knees, and it helps to think of it as pulling that tiny hair again. You may have to hunt for the spots to fix, or enlist professional help, but these tiny mini-spasms are the only damage you need to limit your mileage and increase your pain. Handling them properly will turn things the other way around.

  • daffodil255 Rookie 1 posts since
    Jun 10, 2012
    Currently Being Moderated
    3. Jun 10, 2012 7:25 PM (in response to hayes55987)
    Re: Pain in the rear lateral of left knee

    Thank you so much for the post.

     

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  • JamesJohnsonLMT Legend 1,155 posts since
    Aug 23, 2009
    Currently Being Moderated
    4. Jun 12, 2012 6:17 AM (in response to hayes55987)
    Re: Pain in the rear lateral of left knee

    I'm glad you are committing to a plan. I'm sure you've seen solid athletic careers respond well to planning, and some fall apart when people get carried away. The fear that comes from unfamiliar pains helps develop a healthy respect for the working body, and I suppose that's the job pain is supposed to do.

     

    I like your plan, but you will probably have to modify it a few times before it works well for you. I have found that people who over-train tend to overdo self-rehab as well. Not saying you are in that category, but it's really up to you. Below, I'm posting a video on self-massage techniques more specific than a roller, which though a bit goofy for my taste, shows a few creative techniques that are likely to be more productive when it comes to nailing the knots in your muscles. Rollers and sticks are very broad-brush approaches that are better for maintenance than for rehab, in my opinion. Treating dysfunctional tissue is one thing, but treating normal tissue that does not need treatment can actually irritate it and make things worse. Learn to scan with your fingers for the spots that need attention so you can focus your efforts there.

    Above all, I would suggest that you avoid the rear of knee area until you develop a high level of skill in reading the tissue underneath. Do not run sticks or rollers behind the knee. There are arteries and nerves with little protection, and you don't want to mess anything up there. Fingers only, with light pressure, knee flexed to relax the tissue. If in doubt, google up Gray's anatomy of the back of the knee to view the structures there. It's your body, and you are entitled to know it well. Good luck with your rehab!

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