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2494 Views 5 Replies Latest reply: Mar 16, 2010 5:16 PM by Damien Howell
bootsy Amateur 23 posts since
Jul 10, 2007
Currently Being Moderated

Mar 15, 2010 7:51 PM

Anyone else hobbled by kneecap pain?

I have been running seriously for about seven years, I am 41 years old, and I average about 40 miles a week.  I have been thru Plantar Faciitis, ITBS, AT, and scores of pulls and sprains over those years.  Each of these injuries was overcome with patience and each had a root cause-poor form, over-training, bad shoes, etc.  For the past year or so I have been dealing with pain in my kneecaps, it started in my left knee and now it is showing up in the right.


Symptoms: crunchy sounds when bending, squatting; clicking and popping sometimes painful sometimes not

                  Sharp pain when knee is under load at an angle of 30-40 degrees, lunges are really bad front and back

                  during flareups, it is very painful to kneel on the affected knee.

                  Oftentimes, the pain goes away while running, then is bad after or the next day


I am going to a Orthopaedist next week, not sure what to expect.  I would really appreciate some feedback from people who have endured this and come out the other side, or those who are struggling now just like me.  My favorite marathon is in May, and right now I don't think that it is going to work out.



  • aj01 Pro 143 posts since
    Jul 8, 2008
    Currently Being Moderated
    1. Mar 15, 2010 11:09 PM (in response to bootsy)
    Re: Anyone else hobbled by kneecap pain?

    Even before running, my knees did some creeking and cracking but nothing major and no pain.  Just recently I've had a few minor flare ups but they seem to go away with a little extra rest.  I would try some strengthening excercises that don't aggravate your knee.  You may have some muscle imbalances that are causing your knee cap not to track properly.  Just like you got through your previous injuries with patience and finding the root cause, you'll get through this one and hopefully in time for your marathon.  Mine isn't serious right now but I've got a 1/2 in a month so I'm trying to be cautious.

  • JamesJohnsonLMT Legend 1,288 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Mar 15, 2010 11:33 PM (in response to bootsy)
    Re: Anyone else hobbled by kneecap pain?

    This is one injury I have not had to struggle with or endure, but I  know a tight quad when I see one.


    If you could see all  the trigger points in your thighs right now, they'd look like swiss  cheese. Of course 40 miles at 41 is no picnic with quads that tight.  It's time to relax them. The quads connect directly to the kneecap,  which cannot track properly when quad tension is not balanced. Tension  is rarely due to all muscle fibers pulling at once, but to small,  sensitive areas of micotrauma called trigger points which in turn cause  the rest of the muscle to protectively splint.


    Even though you can't see the problem spots, you can  find them individually if you try. Scan the (relaxed) leg with your overlapping  thumbs using moderate pressure. Start at the middle of the quad between  the knee and hip bone. Then, move up to the area just toward the center  of the thigh from the hip socket. These are two places where Rectus  Femoris typically develops trigger points that manifest as knee cap pain.


    Next,  move to the fleshy part of Vastus Medialis just above and to the inside  of the knee. Staying on that muscle, move about halfway up the thigh,  still to the inside of the Femur bone.

    Lastly, the huge outer  quad muscle Vastus Lateralis is the trigger point capital of the world.  You can work up the center of this muscle sandwiched between the Femur  and the ITB that partially covers it. Finish near the knee itself, just  above on the outer mound of the quad, and slightly  under the outer aspect of the knee joint where ITBS is usually felt, by  reaching under the ITB itself while seated. These areas all contribute  to and translate into knee pain when tight.


    Many people  are tempted to stretch tight muscles in order to lengthen them. If  muscles were made of taffy, this would make sense; why not just tone or  stretch this pliable mass to the desired length and tension? Muscles are  made of living, reactive tissue that is more likely to tighten the more  you challenge its apparent autonomy. There is another approach that is  more effective, and takes into account the special relationship between  the automatic portion of your brain and the muscles it directly controls  (the conscious mind only controls them indirectly).


    To simplify this process, instead of trying to force  the muscles to lengthen or contract, open a dialog with the pain itself.  After finding sensitive spots in the muscle (trigger points), press  them with your fingers to intensify the pain. This simple act will draw  the brain's attention to the dysfunctional portions of your muscle, and  force the brain to recalibrate them. It's as simple as that, but you can  expect to have to repeat this process several times over weeks to  reverse long-standing neuromuscular patterns of behavior.


    While  all athletes should master this form of damage control, more general  maintenance such as foam rolling can keep the muscles flushed out,  similar to a very basic sports massage. In your case, while it is  possible to relax those quads to normal function, an aggressive training  schedule and the aging process will both require this more proactive and  specific approach to muscle health.


    Here's an interactive visualization tool:

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    3. Mar 16, 2010 5:12 AM (in response to bootsy)
    Re: Anyone else hobbled by kneecap pain?

    Bootsy take a look at these short articles Knee Pain: Treatment Based on Individual Evidence, and Knee Pain: What makes it worse what takes it away?.  The articles may provide some guidence in terms of what questions to ask your Doctor or Physical Therapist.

    Damien Howell PT, MS, OCS  -

  • Damien Howell Legend 312 posts since
    Feb 27, 2008
    Currently Being Moderated
    5. Mar 16, 2010 5:16 PM (in response to bootsy)
    Re: Anyone else hobbled by kneecap pain?

    Bootsy an MRI can do a good job of clarifying which tissue has been injured.  When dealing with repetitive use injuries it is nice to know the tissue source of the injury, but we need to know is how that particular tissue has be subjected to abnormal and/or excessive amounts of physical stress leading to the injury.  Take a look at Diagnosis of Repetitive Use Injury.

    Damien Howell PT, MS, OCS  -

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