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.
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.
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:
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 - www.damienhowellpt.com
Thanks for the information Damien, I guess it just comes down to seeing the Ortho and going from there. He has scheduled an X-Ray, but I don't think this has anything to do with my bones, I guess that is just SOP. Have you any knowledge of Plica or Plica Syndrome? When my leg is straight and I move the kneecap around in the joint, I can feel it catching on something, like a bump or a piece of something. It makes a clicking sound too, but I can feel something in there, like a little piece of God knows what it could be. I just want to know what is going on in there. Is the only way to know for sure to get scoped? Will an MRI or CT scan be able to see in detail? What are the costs of these procedures?
Sorry about all the questions, it just seems that there is almost too much information out there and everyone has there own take on what to do and how to do it.
Again, thanks for the links, they were very helpful.
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 - www.damienhowellpt.com
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