There are many possible sources of pain inside the knee, but surprisingly, the most common sources of knee pain are not in the knee itself. Your knee is just part of a sandwich between the muscles of your powerful upper and lower leg, where the problems usually start. There's nothing wrong with icing the knee to control pain and swelling, but there are some other areas that need your attention if you want the pain and swelling to stop getting progressively worse. Yes, there are other interventions for controlling pain and swelling in the knee, but why can other people run twice as many miles without knee pain? What is causing your knee injury in the first place?
Meanwhile, if you are concerned about the effect your knee might have on your training, I can relate to your instincts as a competitive runner myself, but you certainly want to consider making the effect of your training on your knee the greatest priority at this time. Since you have not been dealing with this very long, it is not likely there is any permanent damage to the knee per se, although structural damage is still a possibility.
The Quads
Back to your pain, the quad muscles of your thigh control the way your kneecap rides in the groove of your femur bone. The most superficial of these four muscles, the Rectus Femoris, runs down the center of your thigh, from above the hip joint, to where it anchors on the Tibia bone of your lower leg just below the knee. Study of this muscle and its relationship to knee pain have shown there are portions of the muscle that, when in spasm, can produce a gritty feeling under the kneecap that has nothing to do with the kneecap itself. The upper portion of the muscle, just below the hip, produces this and other pain, in and around the kneecap, while the lower portion above the knee produces pain locally (above the knee)... Strange, but true.
If you familiarize yourself with this muscle, its functions, and symptoms of dysfunction, and learn to self-treat them proactively, you can save yourself a lot of down-time and stay on your training schedule. IF this muscle is to blame for your condition, it is still possible to continue training while you treat it, although you will want to reduce mileage and intensity somewhat while it heals.
Before I get to that, let's briefly look at the 3 other quad muscles (shown in the graphic below), and their effects on knee pain.
Vastus Medialis (inner quad) pulls the kneecap towards the center of the body. When portions of this muscle are in spasm, the knee may tend to give out. The effect will be like the muscle is weak, as if you hadn't trained it hard enough, when in fact you may have over-trained it.
Vastus Lateralis (outer quad) pulls the kneecap away from the body, so you can see why proper balance has to be maintained between these last two muscles. When in spasm, the V. Lateralis can produce pain along the side of the knee, similar to ITB syndrome, because of its location under the ITB. Certain of its fibers can also lock the knee, and it is frequently injured by runners.
The Vastus Intermedius (center quad) has a neutral effect on the kneecap, but all quads when too tight, even if balanced in tension, pull the kneecap hard against the femur, potentially causing premature wear to the softer tissue underneath. The V. Intermedius muscle itself - in spasm - can produce disabling pain in the center of the thigh when standing up, crouching, walking, or climbing stairs. It is more difficult to locate than the other quads, because it is underneath the Rectus Femoris (restored for view in the bottom diagram).
For a runner, the main function of the quads is to absorb the weight of the upper body after the foot strikes the ground, and to extend the leg in preparation for the next foot strike. They are contracted to straighten the knee before the strike (easy), and eccentrically contracted to absorb shock (hard), as the foot rolls through the gait cycle.
Circulation
These alternate loaded and unloaded contractions help to extend endurance by stimulating blood flow during the easy contractions, in between the damaging eccentric contractions while the muscle is being "eccentrically" stretched by the load. You still sustain damage - but less - because of this alternation that lets the muscle "breathe" between loads.
Eventually, as the damage piles up beyond your recovery rate, which happens to many who overwork or overtrain, the circulation enhancement of normal use is not enough. You need one of two things, preferably both: extended recovery, or enhanced circulation. Simple rest is the slowest route to recovery because it does not enhance circulation. Circulation improvement without rest may not heal fast enough to keep up with the damage caused by overuse.
Interventions
A few interventions have proven useful to allow for simultaneous rest, and circulation enhancement, to promote faster recovery. One of the most popular is non-impact exercise, which increases blood flow to the damaged muscles while producing less damage than impact sports like running. Biking, ellipticals, Nordic Track, trampolines, carefully controlled weight-lifting exercises, are earth-bound alternatives to pool running, which is useful in the most severe cases because it negates the effect of gravity on the affected limbs. All of these can promote healing circulation, and produce less damage than running, while helping to preserve your aerobic fitness. Eventually though, you will have to introduce impact to properly model muscle function, or lose the benefits you have trained so hard for.
Another intervention is kinetic tape, which is known by a few trade names like "Kinesio," "KT," etc. It is a special type of elastic adhesive athletic tape that, when applied properly to the skin over damaged muscle and other fascia, puckers the skin in strategic places to enhance lymphatic flow during normal movements, even during sleep. It delivers some of the benefits of massage 24 hours a day for pennies an inch. Once again I want to emphasize, it has to be applied properly. You can find it at some sports stores, athletic or therapeutic supply outlets, and on-line. It is most effective before an injury gets too far along, or to aid in recovery after other healing strategies.
Another intervention I use is targeted massage therapy. Done properly, both circulation and lymphatic flow can be enhanced in the areas that need to heal, without requiring the muscles or other damaged tissue to survive the wear and tear of use while this is taking place. Of course, massage therapy can be expensive, and has to be done skillfully to avoid making things worse. For this reason I recommend you try mastering some of the techniques yourself, at least so you can use them "on the road" when it can deliver timely relief. If all athletes would conscientiously apply these techniques before exercise instead of just stretching, there would be far less injuries out there to discuss in the Med Tent!
The picture below shows the Rectus Femoris in place over the other quad muscles...
Sorry about the size, I didn't have enough screen space to snap the image in place properly, lol.
Before we begin, a little story from my practice that gets repeated almost every day...
I get a lot of people on exam tables, and check the range of motion (ROM) in their quads. I simply lift the foot up and gently move it until the knee is at a 90 degree angle. In some cases, the complaint is knee pain or a stiff knee, sometimes accompanied by numbness due to trauma. In most cases there is no complaint regarding the knee, but the story is often the same. Knee pain generally results in some resistance as the knee is flexed, even to 90 degrees. Depending on the diagnosis, I will move the foot farther toward the hip to gauge resistance - a surprising number of people cannot comfortably move past 90 without the quads tightening up. Then, I gently reach under the quads above the knee, cradling them in one or both hands, and lightly squeeze the "heads" of the outer quads together in a kneading action. I follow this with some circular friction along the center of the quads, aiming for the R. Femoris and V. Intermedius behind it. The whole process takes about 10-15 seconds. Then, I check the range of motion again. In almost every case, the leg moves at least 10 degrees further without any resistance at all, sometimes flopping forward.
In that 10 seconds I made no change to the "length" of that muscle. I simply changed its tension by touching it. If you've ever been tense, and someone placed a warm, firm hand on your shoulders, and all the tension melted away as your shoulders slumped, you understand the concept. Muscles can become tight simply because the brain chooses to hold them at that tension, and it doesn't always take much to "talk" the muscle out of holding that grudge. That's the simple story... now for what happens in response to the kind of overuse that is typical of distance training.
Self-Treatment
As in the earlier example, patterns repeat. The patterns are so reliable, they have been recorded by doctors in books and charts that allow professionals to attack pain and dysfunction based on symptom and location. While it helps to have experience working for you, there is nothing to prevent anyone - armed with the same information - from accomplishing similar professional results. I work on my own running injuries, so why can't you? In fact, you are in a better position than anyone else, because you know exactly when, how, and where you feel pain, and have the advantage of immediate feedback when it is taken care of. You just need the right information. While I can't summarize the entire human body in a post like this, I can discuss enough of the relevant material here to get the job done. If your quads are too tight, your knee will eventually suffer. If they are relaxed enough, the synovial fluids, lymphatic flow, and circulation can nourish the joint back to health, barring any biochemical or hormonal abnormalities. You've been pretty healthy until recently, so I say it's worth a try to start fixing the problem instead of making it worse.
I know this has been a big read so far, but think of how much time you have invested in your training! One more important fact about muscles before we begin: Overuse almost always results in tightening of portions of a given muscle, call them micro-injuries, which can have the combined effect of causing the whole muscle to splint itself in self-defense, or in some cases to refuse to contract in self-defense. Much of this is handled by the brain, but some of the tightening is an autonomous reflex within the muscle itself. The brain has the power to contract muscle and to prevent signals for contraction, but it cannot "unlock" a muscle that is riddled with autonomous micro-contractions. They can appear to subside with rest, and return immediately when you begin training again, even years later. It is one of those mysteries of physiology I must deal with every day.
If you are not already sitting down, have a seat in a comfortable chair where your knee can bend down to about 90 degrees, but you can also prop your leg up straight. Looking at the drawing above, find the spot on the Rectus Femoris muscle, near the top of its exposed portion, just below where it dives under the Sartorius and TFL muscles on either side. At this spot, the muscle can produce mysterious knee sensations and pains under and above the kneecap. Since all that muscle feels pretty much the same when you feel the area, simply straighten your knee and the belly of the R. Femoris will define itself. You can see how it gets smaller as it approaches the top, so you know where you are on the muscle. Feel free to fish around. Professionals have to do the same thing, just a bit faster. Let the leg back down to soften the muscle before working on it.
You need to nail the tender spots on this muscle before moving on to the others, using the circular friction technique I mentioned earlier. You need to press hard enough to trap the clothing against the skin, moving the layers of skin over the muscle in a gentle circular glide to locate the tender spots. Use one thumb backed up by the other for strength, or the edge of your other hand over the thumb. When you get as far as the skin will comfortably stretch, release and pick a new spot. Keep moving until you have found portions of the muscle that respond to this pressure with a strangely comforting pain, and hold the pressure when you find them, increasing it enough to slow circulation there, then release after a few seconds to let the blood flow in. Somebody else can do this if you like, but keep the dialog going so they don't press too hard. It takes practice, but it's a skill worth developing if you want to run with the big dogs. Elite athletes can often afford to pay somebody to do this, but you can get the job done too, if you stick with it. Now, after scanning the R.Femoris all the way to the knee, let's move on to other important spots.
If you were aggressive enough with the R.Femoris, you may have also taken care of the V. Intermedius underneath. If not, it may be worth another visit. You will need more pressure, doubling up your hands as described above, or using a hard rubber ball or your elbow through some padding. Don't overdo it. The idea is to find painful tissue, not to create it. It is better to err on the side of caution. Know your terrain. Veins are hard, arteries throb, and nerves produce a sharp electrical effect or tingling. Muscles are easy to distinguish by feedback, and most of what you will find.
Locate the Vastus Medialis, just above and to the inside of the knee, on your diagram. If you have trouble finding it on your thigh, straighten the knee again to flex it up. Relax the leg again, and move up the muscle from just above the knee toward where the V.M. dives under the R. Femoris. All spots along this thick muscle can produce pain and weakness in the knee.
I am covering the V. Lateralis last because it is huge, often full of knots, and partly covered by the IT Band, which is a tough piece of tissue that resists being worked through. Some athletes use a foam roller to iron out these knots, but the fact that only part of the muscle is backed by bone, and with the tough ITB over top, some of these knots will "laugh" at your attempts to impress them, hiding safely underneath such non-specific pressure. Once again a rubber ball (try a tennis ball first), fist, or something else fairly hard, but somewhat yielding, can get far enough into this muscle to make a decisive difference (lay on it if you have to). Although the whole V.Lateralis is vulnerable, the portions closest to the knee are most likely to be felt there. Sitting in a chair, you can reach with your fingers under the edge of the muscle, just above the outer hamstring tendon, and pull up into the meat of it, under the ITB. I have found so many problems in that spot when the mileage piles on, all felt at the knee during training.
Before and After
Stretching exercises, even yoga, can enhance flexibiity in uninjured muscle. If the tissue you are stretching is compromised, ask yourself why your muscle is pulling in one direction, while you are pulling in the other. Tension in muscle is the result of contraction. It makes no sense to contract a muscle in both directions at once. You must relax the involuntary contraction first, to avoid risk of tearing and further damaging the muscle cells, and the joints they serve. When muscles seem to need to be stretched, they are trying to tell you something about the state they are in. Learning to "speak muscle" can go a long way toward cooperation with your exercises, including yoga. All athletes can benefit by relaxing their muscles before using them in any way. While skeletal muscle is usually under conscious control, it is important to know that communications sometimes break down, and another route must be taken.
So what brought your knee pain on, in the first place? The training for sure, but how about some other lifestyle factors. Sitting in most chairs can be tough on the quads by keeping them stretched out. You may look lazy propping your feet up, but your quads will thank you. The worst chair may be your car seat, forcing you to keep your leg locked in one position as you hold the gas pedal. Wearing shoes with elevated heels can be death for the quads. Running down hills is notoriously hard on them, and running on uneven (slanted) pavement is hard on the legs and knees in general. Beyond lifestyle, there are congenital skeletal structures that can challenge your muscles to keep everything in alignment as you run, resulting in more pain and longer recovery time than others experience. Some of these injuries can result from the structure of your foot.
I believe that almost anyone can develop into a runner, with the right amount of preparation and patience. One size does not fit all in training plans, so if you can stretch your plan to fit the way your body is responding to it, you should get stronger and more resistant to injury over time, if otherwise healthy. If you push too hard too soon, you will pay the price in pain first, and possibly, permanent damage to your knees later.
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