I just came back from Crete, where I took a week's vacation from everything - including running. Normally, I run every day, rain or shine. The mileage depends, but I try to get at least one 8 mile or more mile run in every week. The normal days vary between 2 and 6. Because I was feeling seriously under-worked-out, I stupidly overdid it this morning and did an 8 miler in very hilly terrain. Hills aren't new to me - I'm surrounded by them, so that's where I run daily - but I'm guessing it wasn't a good idea to jump straight back into them after my week off. Anyway, my knee started bothering me a little around mile five, and now I'm walking with a limp and stairs are impossible. My knee is a little swollen, but normal colored. It is very stiff and I cannot bend it more than a little without experiencing pretty serious pain. I have been icing it in intervals all day. I have never had any knee problems (I've been a runner and soccer player for a good part of my life) but I do have very flat feet and have experienced problems with both hips. I don't know if all this will help, but I'm trying to give as much info as possible so that maybe one of you reading this will be able to help me out! Any advice/ideas are very much appreciated.
Thanks so much!
This problem could have more to do with spending hours cramped up in a jet than with the 8-miler, but swelling is usually not a good sign. You probably weren't sedentary in Crete, and probably should not be now. I'd stay mildly active, using ice to keep the swelling down during the acute stage of this apparent injury, but gradually weaning yourself off the ice as swelling subsides. Only immobilize yourself if the problem keeps getting worse. In that case, You might need to get the knee examined for a possible tear or inflammatory condition.
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While we are on the subject of inflammation, I was listening today to ------------ Paul Ewald's explanation of a new "germ theory" of chronic disease, which argues that certain microbes, and the body's defensive reaction to them, are at the heart of many chronic diseases that involve inflammation, diseases and conditions widely assumed to have no connection to microbes at all. Extrapolating from this theory, it is possible that you were introduced to a strange microbe of some kind while vacationing abroad, and your body is in a heightened state of sensitivity at this time. Just a thought, but mysterious pains cannot always be explained by conventional wisdom. The myriad effects of microbes on our physiology is food for thought.
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While pondering that, some of the usual stuff, such as the effect of low arches on knee and hip pain, is still in the running for setting you up prior to this setback. No matter which straw winds up breaking the camel's back, the other straws are more important. Another possibility is that running every day delayed some of your recovery, which is now taking place after a week of rest, and which sometimes hurts as your body makes some badly needed changes. Body construction is sometimes as much of a pain as highway construction is.
Down time is a great opportunity to look under the hood for things that need fixing. This is the time to check for physical attributes in your hip or foot structure that may have an impact on the long-term health of your knees. While a gait analysis would deliver useful information, it would be inaccurate now due to the effects of your injury. Much of what needs to be known already is, anyway. History of exercise, hip pain, flat feet, etc. make a real diagnosis and prognosis easier.
Sometimes muscle strains are responsible for knee pain, even when another concurrent pathology is causing the swelling. Bearing weight involves muscle as well as bone, tendon, ligament and cartilage. Muscles can be quite sensitive, and generate pain throughout an affected joint. You rear Gastroc calf muscles, for example, wrap around the sides of your knee and become increasingly active when climbing. They are stretched in the rear foot when descending. If they were strained, both actions could hurt.
Stiff quads are behind many knee pains, especially when one side is tighter than the other. It often happens that the outer (lateral) quads tighten up, while the inner medial quads lose contraction force. This causes the kneecap to pull laterally, which may cause pain in the knee. Swelling under the kneecap then has the effect of loosening the inner quad even more, and the cycle repeats. Massage to the outer quad sometimes helps to alleviate this imbalance, but the entire healing process takes time to complete. Have patience for this.
I'm hoping that a gentle return to mild activity will help iron out the kinks in your knee. By all means take advantage of your time off the trail to allow someone to have a look at it. Rest alone may not help, but sometimes does. No matter what, you are right about making sure to transition slowly back into activity when things appear to be on the mend.
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