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I've been experiencing soreness in my left knee for the past 7 weeks. I tweeked it on the way to the restroom before a 5K 4/14, but felt nothing running the race (in fact, I won) or the 4 mile run home, but the knee was very sore the rest of the day. For the next couple of weeks my left knee ached when I ran downhill and as I slowed for my cool down and after my run. I've continued to train and race as normal (about 40 miles/week), started wearing a knee strap, and occasionally ice the knee for a few minutes after a run, but my knee still aches upon awakening and after sitting for a while. My friend suggests I do exs to strenghten my quads. Any other suggestions as to a diagnosis or treatment?
Strengthening the quads can help prevent knee problems, but we're getting ahead of the meat of the problem. Many muscles can affect knee pain, but you did not specifically state whether this pain was in the front, side, rear, or inside of the knee. I'll hazard a guess that it is in the front or side, since you were pointed towards the quads and are a performance runner who experiences pain while running downhill, where the breaking action of the quads is more important. Also, being seated stretches the quads, keeping them slightly ischemic, and could explain some stiffness there, as could sleeping with knees bent in the fetal position explain stiffness upon arising.
If the pain is in the back of the knee, the Popliteus muscle, which unlocks the knee, is especially sensitive to descent. Pain inside the knee can still be the superficial Rectus Femoris quad, which spans both hip and knee joint and is aggravated by prolonged sitting. Performance runners can crank this one up as an auxilliary hip flexor, as can walking in heels.
You understand that muscles are not monolithic, despite their naming and grouping, being composed of millions of motor units arranged in fibers, in bundles, in compartments, with a few tiny sore spots needed to result in the suppression of normal contraction, making an over-trained muscle appear to be undertrained. On the other hand, they can stiffen, become inflexible, and constantly contracted or hypertonic. Training them now to strengthen them could be just what you don't need right now. A stretch, by the same token, simply reverses the direction of the strain of contraction, while failing to relax it.
How are the straps and ice working out for you? May be helpful in acute cases, but unhelpful in a chronic case such as this may turn out to be. Ice can impede circulation or the immune activity that heals you, though skillfully used can enhance circulation. It's about timing. Straps can restrict circulation and movement in a way that makes things worse.
What I want to ask the most is why you raced on the problem after it became evident. Think of the recent contender for the triple-crown in the news, "I'll Have Another," who was pulled from making history at Belmont for a problem that may have easily withstood one more race. I've worked out many a tweak with an easy 10-miler, but I learned the hard way not to race on bad legs. A race is supposed to be about all you can do within a given distance, so it follows there is probably nothing worse you could have done to strain this injury further. Thirty lashes for you! But you are already paying a price.
Knees top the list of injuries sending athletes to the doctor. X-rays are taken, joints are evaluated, but I note with some amusement that knee pain very often has nothing to do with the knee itself. In your case, probably with those quads that hold your knee cap in place and focus their formidable pressure there. If your knee cap feels like it is clicking or popping from side-to-side, please say. The tension between the inner and outer quads may be imbalanced. If there is weakness or a feeling of instability, that is also important. The inner quad may have reduced contraction force and needs simple manual therapy. Feelings of junk under the knee cap can be nothing but muscle related. RF again. Location and nature of pain is important to understanding the muscles involved, even when there is no actual injury at the spot where pain appears to be.
Knowing what I do now, I'd say you should examine the entire quadriceps for knots, from the lateral to medial from knee to hip. Foam rolling upwards can help, but serious athletes can develop serious knots that will not respond to general pressure. You may need to apply specific thumb pressure to knots you find in the muscles to slow circulation there, after which there should be increased blood flow as with ice, without the immunosuppressive effect. Following up with a gentle stretch after the muscles have been relaxed this way, should be a major part of every competitive athlete's toolkit.
With a little TLC and less racing on injuries, you should be on the comeback trail, healthcare deductible still intact. For further advice, add more specific detail when possible. Good luck troubleshooting your pain. It comes with being in the winner's circle.
Dear Mr. Johnson,
Thank you for your detailed response.
I raced a 4-miler last night and have 5K races scheduled for the next 2 Sats., but honeslty, I don't feel any pain while running (otherwise, I wouldn't run). And the discomfort I feel in my left knee afterward is more of a soreness/stiffness than pain.
I do think my muscle imbalances are at the heart of my post-run soreness. Ice and the knee strap don't seem to help much, but the quad -strengthening exs seem to do so, though slowly. I just need to be patient and disciplined to do those exs. daily.
I am also having a similar pains. I found Jamesjohnson thought very helpful. I Ran a 5k today with NO pain at all. I feel discomfort and slight pain when walking and wakening up in the morning(normally when I want to run). I was nervous about running today due to i have stopped running do to this discomfort, hoping it would not get worse or just feel better in time.
I have notice with the more I run the more fantom pains I have, Trying to figure out if it will go away or it is a real issue is the biggest problem I have. stopping me from running 35-40 miles a week is killing me! I try to suffer through a 3 mile run buy myself or I hammer through a 10k with a group. Is a lot of this stuff pushing though the pain normal? I Am addicted to running like a drug, I just can't get enough. I drive my family nuts when I don't run that day.
Do you expert runners have to deal with this stuff? Do you mentally get through this or is it a on going battle?
I went to see an injury prevention specialist at the PR running store in Reston last weekend. She said to strengthen my left leg/knee, I should practice balancing on my left leg. And to deal with the stiffness/soreness in the knee, I should massage it with a roller (polar-tigertail, $25) before and after runs. This treatment is definitely working, although I still experience some achiness in my left knee after running turns. I've raced the last 3 Saturdays, setting a PR in one race and winning another. Most important, my left knee, I believe, is on the mend.