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3069 Views 3 Replies Latest reply: Mar 4, 2011 9:10 PM by JamesJohnsonLMT
hellerholz Rookie 1 posts since
Nov 27, 2010
Currently Being Moderated

Mar 3, 2011 5:02 AM

knee pain - need some answers please.....

I have been running and training for a 10k I am doing in June and for a 1/2 marathon in October and I just recently had some knee pain in my left knee. It felt like crunching and ripping sometimes.  At first it just was a bit painful and at times when I ran I would feel some pain. Then it started to hurt to bend my knee to go up and down stairs. It started to hurt worse on Sunday and I have been icing my knee since then.  Yesterday I took a step into my house with my kids and all of a sudden I felt like I couldnt put any weight on my left leg at all because my knee was in so much pain. My knee is swollen a bit and it hurts to bend it. I am getting frustrated just thinking of how this is going to interrupt my training and then I go to the other side of the fence that our bodies are a temple and I need to take care of it. I also do yoga and I was thinking of doing some yoga today, but then a lot of poses you're on your knee, so I'm not sure.  So, my questions are, has anyone else had this happen? If so, what did you do about it? I dont know if I should go see a dr, since I havent had these symptoms for months or anything, but yet I dont want it to get any worse either. What about yoga, do you think it might help? Its vinyasa - so it is a faster yoga class and hot - so any guidance anyone has, I would really appreciate!!





  • Giselle I Rookie 4 posts since
    Mar 3, 2011
    Currently Being Moderated
    1. Mar 3, 2011 6:37 AM (in response to hellerholz)
    Re: knee pain - need some answers please.....



    Im training for a half marathon in May. Its my first one and I started having knee pains as well about 2 weeks ago. Someone suggested I start stretching a whole lot more, before and after my runs and also start taking joint supplements such as Glucosamine. Ive been taking them and bwn the extra time I put into stretching and the supplements, my knee doesnt hurt anymore. I know this isnt something you might to hear but if your knee really hurts, you need to rest and let it get better before you go back to training. I also was following the Hal Higdon's marathon training guide and since it's intense training I had to cut out one day of training to get more rest time in within the week, but I still keep up the guide. Hope your knee feels better and I hope I helped.

  • runrchick79 Amateur 14 posts since
    Feb 19, 2011
    Currently Being Moderated
    2. Mar 4, 2011 2:48 PM (in response to hellerholz)
    Re: knee pain - need some answers please.....

    I was training for a half marathon the past couple of months, my half is tomorrow, which sadly I won't be running....because of knee pain. I had a pocket of fluid just appear on the outside of my right knee and it just felt "stiff". I went to a sports med doctor and he ended up doing an MRI and result was chondromalacia, he said the cartilidge is flaking off the back of my knee. He said it's common in runners, especially those who do long distances. Some research I've done on my own (only on the internet, I am by no means offering any medical advice!) says that a sudden increase of your mileage can cause this to happen. He is suggusting now that I do euflexxa injections on my knee.


    I'm just ready to run again but also in the back of my head know that my knee needs rest if it's hurting or swelling. I understand your frustration and I hope your knee gets better where you won't have to miss your half marathon. I'm missing this one tomorrow plus one at the end of March I had signed up for, so I'm rather frustrated. Good luck to you!

  • JamesJohnsonLMT Legend 1,282 posts since
    Aug 23, 2009
    Currently Being Moderated
    3. Mar 4, 2011 9:10 PM (in response to hellerholz)
    Re: knee pain - need some answers please.....

    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.



    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.



    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.



    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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