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8280 Views 8 Replies Latest reply: Apr 27, 2011 9:23 AM by ORcoastrunner RSS
Finnatic Amateur 11 posts since
Mar 20, 2011
Currently Being Moderated

Mar 20, 2011 9:48 PM

Knee pain- medial aspect of knee

Hi,

This is my first post and tried to do a search for previous threads regarding the same issue that I have.

I am doing a half marathon this Saturday (March 26th) and my training has been good. Last week I ran 13 miles on flat road and I was sore a couple days afterwards. When all the soreness wore away about 2-3 days later I noticed that the inside of my knee (the medial aspect and slightly posterior too) hurts but not terribly.It feels like tendon pain vs. muscle.  By yesterday (5 days after my 13 miler) it felt well enough to do some running (more like jogging).

 

Yesterday I ran 9 miles with lots of hills and it felt quite good until mile 8 it was getting really sore to the point I had to walk.  Last night I noticed that when I sit on the floor and extend my left leg to strech I can hardly bend at the waist to stretch! It feels REALLY REALLY tight. After gently massage and very gentle stretching I can bend over slightly.  I have been applying ice to it. I can stand up straight but it's alittle sore. My hip flexor doesn't hurt, if I lift my knee in standing position the knee is sore.

 

My question is if anyone knows what it is I injured and if I should continue with this half marathon (in 6 days). The coarse is very hilly. I would really hate to quit. I could at least walk it. Would you recommend a knee band/brace for the race? If it is tendon injury, how long do they normally take to heal if it's not a severe injury?

 

I feel like I could jog, even now but I don't know at what point I would start to hurt, if at all.





Completed:

San Luis Obispo Triathlon- July 24, 2005 (2:12)

Oxnard's Santa to the Sea Half Marathon (first running race)-  Dec. 12, 2010 (2:38)

Great Race of Agoura Hills, Pacific Half Marathon-  March 26, 2011 (2:33)

Upcoming:

Ventura City Impact Half Marathon- June 18, 2011

Santa Barbara Semana Nautica 15K- July 4, 2011

  • ~Coach Dave~ Expert 43 posts since
    Feb 17, 2009
    Currently Being Moderated
    1. Mar 21, 2011 7:41 AM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    To answer your question, I would try and make an appt with an orthopedic doc asap to assess the extent/type of injury.  As for your race, I’ve had to defer a HM because of various injuries; while my knees hurt I’m running my race this year come hell or high water!  If your doc tells you that you’ve suffered a more serious injury, you can either run/walk your race and risk further injury or you can defer your race entry until next year…

     

    With regard to a knee brace, my doc told me that depending on your injury type, those braces do little more than hold in some heat and add a little stability.  If you have an injury where bone is rubbing on bone, a neoprene sleeve you buy at CVS won’t do much for you…

     

    I know how it is to train up physically and mentally only to be faced with a difficult decision as race day approaches – run your race injured (and possibly risk further injury) or take a slight blow to your pride and defer your entry.

     

    Good Luck

     

    ~Dave





    2011 Frederick Half 1:53:15

  • JamesJohnsonLMT Legend 1,154 posts since
    Aug 23, 2009
    Currently Being Moderated
    2. Mar 21, 2011 11:37 AM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    There is a chance you can solve this quickly, and I'm going to help   you with that, but I would like you to promise that you will not run   that Half if the problem persists through race day. Like Dave, I've   found that discretion is the better part of valor. I've made judgement   calls at the starting line to run, and paid dearly for them. I've also   made calls at the line, fee paid and goody bag put away, not to run -   even at a full Marathon. This cost me nothing more than I was already   spending, and I enjoyed cheering others to the finish.

     

    To   rub the point in, what pilot takes a plane out with bad flaps and   crippled landing gear? Only in a life or death situation, and your   situation is just not as important as that compared with what you stand   to lose. Speaking of life, if running is one of the things you live  for,  why risk losing what makes life so enjoyable, even for a few  months, if  your life itself is not on the line?

     

    Now   for your knee, it is obvious from the description of your attempted   stretch and leg lift, that muscles on both sides of your knee are way   too tight from all that training. The conventional wisdom is that a   tight muscle needs to be stretched, but that's only half right. Your  quads, hamstrings, qlutes,  at the very least, need to be  relaxed to the point they can move  through their normal range of  motion. A stretch alone may irritate  tissue that is already  compromised.

     

    I was bothered by a tight  hamstring on the way  to my last Marathon a few months ago. The muscle  was not torn, just  pulling with a painful, persistent twinge in the  weeks leading up to my  race, no doubt due to the accumulated wear and  tear of speedwork I had  done during the summer months. This went on all  the way to race day.

     

    On  the long drive to the hotel the  day before, my hamstrings could not  relax on the car seat, and I had to  shift and squirm a lot to help the  circulation. Then, I applied to  myself what I do for a living for  others. I cupped my hand under the  sore hamstring and felt for  differences in muscle tension and pain,  finding a number of spots that  needed work, but one area in particular.  I let gravity sink the  hamstring onto my fingertips until the pain  intensified, just before it  began to wane. I allowed this pressure for a  few seconds, before  repeating this action in several sets over a few  hours, getting a little  more relief each time as my body adapted to the  pressure by increasing  circulation in the muscle. The sensation was  warmth accompanied by a  pleasant numbness as the natural pain-killing  endorphins kicked in.

     

    To  make a long story a bit shorter,  the hamstring that bothered me for  months did not bother me in my  Marathon the next day. Sure, it came back  briefly in my recovery, weeks  later, but I knew how to nail it. Until I  up my training level again,  I've since banished it to memory.

     

    Your  case differs from  mine in that it is likely your quads are involved to a  high degree,  especially after fighting the tight hamstrings and glutes  that did not  let you bend over. Imaging the pressure on your knee,  caught between  the two most powerful muscle groups in your body!  By  examining the  anatomy, you can see how the quads attach directly to the  patellar  tendon that attaches to your tibia below the kneecap.

     

    The   balance in the pulling force on the left and right of this tendon   affect the pulling force on either side of this joint. An amateur will   tell you to balance the strong and weak muscles to correct this, but   after all that training, no one should tell you that any of these   muscles are weak. The fact that they are not functioning has nothing to   do with relative strength or weakness, but your body's wisdom not to   employ some of them at 100%, tight as they are. The tightness is not the   healthy contraction of an overstrengthened muscle, but a splinting of   the muscle in self-defense. A student of muscle physiology can tell you   that a dysfunctional muscle can manifest as tighter or looser than it   potentially is within minutes, even seconds of proper treatment.

     

    An   Osteopath might explain this to you in terms of a principle known as   "strain and counterstrain," which explains how damaged muscles support   one another via dysfunction, and how that function can be easily   restored. When a given muscle is strained, the opposing muscles on the   other side of the joint can contribute as much or more to the problem   when they impede the free movement of that joint by stiffening. So while   you may well have pushed your hip flexors past their limits, the   hamstrings and glutes as extensors of the hip may have gone unnoticed.   Both sides are now fighting each other in an attempt to immobilize your   joint, and your persistent training is pressuring your knee joint just   as surely as if you had brought it to a grindstone. No problem - the   pain usually occurs before permanent damage, if you listen for it and do   not try to train and race through the pain.

     

    While   cartilage can be restored in a healthy joint, portions of the meniscus   and either end of the joint are not vascularized and are not rebuilt   naturally. Surgery can repair tears, but when this tough tissue is worn   away, the surgeon usually is forced to remove what is left. I'm sure   you'll agree it is better to correct the pressure on this joint now,   rather than face that scenario later.

     

    Back to your  knee,  there are other tendons leading to the area on the underside from  your  hamstrings, and the medial and lateral aspects of the quads as they   morph into tendon at the sides and beneath the kneecap (patella). Pain   here does not happen by chance, but is directly traced to the powerful   muscles pulling on them, and increases when these muscles do not   release. Attempting to strengthen or stretch these muscles before they   are released can intensify this pressure.

     

    If your  lateral  or medial quad were out of tune with respect to the other, your   symptoms might involve kneecap pain ala chondromalacia, or a snapping or   catching of the knee as the kneecap is pulled to one side of the   femoral groove. Absent these symptoms, your center quads Vastus   Intermedius and the hip flexor quad Rectus Femoris over the top can   produce knee pain and dysfunction. Proper treatment of these muscles   should involve placing the leg in a position where the muscles are at   minimum tension for several seconds, before firmly manipulating and   releasing the softened muscle. As discussed earlier, the hamstrings and   glutes need to be treated this way as well. There may also be issues   with your calf, and a number of hip flexors, rotators, & adductors,   of which there are many.

     

    As you improve, some assessment  of your stride  efficiency needs to be done to determine if there is a  structural or  executional flaw that is isolating and overworking one or  more of these  muscles, resulting in excess motion, dysfunction, and  pain. I'm more  inclined to think at this point, that you have just been  pushing too  hard to have much left for your race.

     

    This could have been said in fewer words, but I thought it better to  lead you through the clinical thought process I would use, rather than  simply tell you what to do or where to go. Best of luck in your  decision. Regardless, I am confident you will live to fight another day!

    (from Gray's with thanks...)
    http://upload.wikimedia.org/wikipedia/commons/thumb/b/b2/Gray430.png/100px-Gray430.png

  • ~Coach Dave~ Expert 43 posts since
    Feb 17, 2009
    Currently Being Moderated
    4. Mar 29, 2011 11:31 AM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    So did you end up running your half?  I ended up going to a knee doc and they found a cyst in the back of both knees (one was hardly worth draining and the other, as spotted on an MRI days earlier, had disappated).

     

    Anyway, I've been doing a ton of stretching (hams and IT band).  I came across an article in this months copy of Competitor and it featured a crossfit trainer named Kelly Starrett.  He has a ton of very informative videos on Youtube - lots of stretching, technique (e.g., squats).  I highly suggest his videos.

     

    Hope your knee pain has subsided...

     

    Dave





    2011 Frederick Half 1:53:15

  • JamesJohnsonLMT Legend 1,154 posts since
    Aug 23, 2009
    Currently Being Moderated
    5. Mar 29, 2011 6:25 PM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    Now that you mentioned the Sartorius, it is a segmented muscle that    creates pain local to its path when in spasm. Try working on the  portion   of that muscle exactly where you feel the pain along the  inside knee,   tracing back a bit over the top of the quads along the  muscle's path,   with the leg straight and relaxed to soften the muscle.  Sartorius pain   can be quite intense, usually brought on by sudden  twisting motions of   the hip, like dodging some debris on a trail run. I  cranked mine a few   years back up on a backwoods boardwalk run with  lots of elevated twists   and turns, and could hardly get out of my car  later. This muscle is   impractical to stretch, as it is normally lax,  and is most important  when sitting on the floor  with legs crossed  ("indian style").

     

    By  the way, I used to have chronic  medial meniscal  pain which disappeared  after a few years in the  evolution of my  footwear. There are many  possible causes, including  short-leg syndrome,  but the important thing  now is to nail the muscles  to reduce any  possible damage, then move on  to addressing the  possible causes. (Image from medicalook.com)...

    http://www.medicalook.com/systems_images/Muscles_of_thigh_and_the_hip.jpg

    You  may also find that warming the muscle before working on it can help it  to relax and release its pressure. Many people make the mistake of  combining ice with stretching, which is potentially dangerous from a  physiological point of view. Ice dulls the pain that you feel, but  forces the muscle to become active in order to prevent hypothermia  (muscle contraction is the body's main heat-producing mechanism). A  contracted muscle should not be stretched, since it is being pulled in  both directions at once and more prone to injury - injury you may not  feel at first when it is under the influence of ice. If you are going to  stretch any of the muscles we have covered, do it after they are  warmed, relaxed, and not in spasm.

  • ~Coach Dave~ Expert 43 posts since
    Feb 17, 2009
    Currently Being Moderated
    7. Apr 4, 2011 5:14 AM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    You have to use your light therapy 2-3/day @ 30mins?!?!  And I thought 15 minutes of stretching twice a day was a pain

     

    Glad you ran your race - hopefully you didn't do any lasting or hard-to-heal damage.

     

    I have a half I'm running on May 7th so I'm trying to ramp up my mileage while carefully managing my very tight hams and sore knees (I believe a result of my tight hams).  Congratulations on not only finishing your race but shaving 5 off your PR.  I'm shooting for an even two hours for my half.  On good days that seems very likely; bad days, I wonder if I'll have to walk more than half a mile...

     

    You bring up a good question about stretching too hard.  James Johnson weighed in on a post I had regarding PF.  Turns out that I was actually OVER stretching and actually causing more pain!  He was the first to bring up the issue of how stretching too much could, for some people, be harmful (e.g., stretching an already overstretched or pulled muscle isn't helpful).  The two foot docs I had seen never once suggested that I may be stretching too much or even the idea of stretching pulled muscles is bad.  I actually stopped all stretching completely for a while and all my various pains subsided - that turned out to be a very temporary fix.  Now back to stretching for 10-15 minutes AFTER my run.  I do a 5 minute warm-up walk prior to my run (of any distance) and I may add a stretch or two in before but I don't overdue it.

     

    For me, running proves to be a major stress reliever - it's a real shame that it causes me so much pain!!





    2011 Frederick Half 1:53:15

  • ORcoastrunner Pro 83 posts since
    Apr 9, 2011
    Currently Being Moderated
    8. Apr 27, 2011 9:23 AM (in response to Finnatic)
    Re: Knee pain- medial aspect of knee

    I am reviving this thread because your pain sounds similar to mine.  I am pretty sure that I have a pes anserine bursitis--although I am aware of the old saw that the person who diagnoses himself has a fool for a patient!  I am a total newbie runner, running for the first time at 43, and just finished the C25K program April 10th.  My first 5K is coming up on April 30th, and I don't want to injure myself--but more importantly, I don't want this to smolder and keep me from progressing toward 10K.

     

    I am tender to press right over the pes anserine bursa, but not farther up the tendons.  My flexibility is good--I can put my nose to my knee while doing a hamstring stretch, and my affected (right) side is actually a little more flexible than the unaffected side.  My strength is not so good.  The discomfort started after I did my first 4 mile run--ever.  It is actually pretty mild, but kind of nagging.  I have two sets of stairs at home, and I can feel it when I go up the stairs.  My running course is hilly.  There really isn't a nice, flat place to run very close to home unless I hit the track or the treadmill (boring).  I did a short run on the treadmill last night, and the warm up walk was actually more uncomfortable than the run--and my knee felt better after the run, but is tender again this morning.  Going uphill also seems to exacerbate it.

     

    I already suspect there is something to correct in my gait, but I'm not sure how to go about it.  I'm currently running in Nike Free 5.0s, which my feet love.  I am planning to go to the Eugene Running Compay for a second pair of shoes, and they do video analysis of gait (not sure how effective this truly is, but it is worth a try), so I'll probably look for some advice there.  I also realize that I have been running my circuit in the same direction, so perhaps reversing the circle would be good for me.  I am on a mixture of roadway and sidewalk, with the sidewalks having frequent dips for driveways, all of which cant my right foot medially (overpronating it, I think).  When I ran on my treadmill last night, I tried to shorten my stride a bit, and it seemed to help, but as I said, it feels better when I'm running anyway.

     

    In the meantime, I am icing at least daily, this week taking it really easy.  The discomfort is currently mild enough that I know I can run my race, but I think I need to correct something before I increase my mileage.  If I'm going to run outside, I'm going to have to tackle hills.

     

    Any advice for a newbie like me?





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