I started running in 2008. I worked my way through C25K, Cool Running's beginner & intermediate 5k running schedules and beginner & intermediate 10k running schedules.
Back in January, I was sick & had a fever. I passed out/fainted and landed on my left knee. I thought I'd just bruised it and didn't give it much thought. After I got better, I resumed running. It would ache when I finished my runs, especially on cold days but I still didn't think much about it. In August, my right knee started bothering me so I stopped running. I've put on 20lbs since I stopped running and I want to get back to it but I'm worried about my knees!
I don't have health insurance, otherwise I'd have seen a doctor a long time ago about this. But the weight gain is really troublesome and I miss running.
The right knee isn't bothering me anymore but the left knee still does on occasion. Most of the day, I don't notice it. But when my knee has been bent for too long (like when I'm riding the bus or sleeping) it starts to ache. It's the soft part below the knee cap is that hurts if I press on it with my fingers or if I'm kneeling on the floor.
My dad thinks I might have arthritis. Bad knees run in the family and my dad had to stop running in his 30s due to arthritis. I'm not sure if I have arthritis...I don't know how to tell if that's what I'm feeling - but I thought arthritis had to do with the joints and this pain seems to be in the soft muscle or tissue below the knee cap - not in the joint. I'm only 31!
Does anyone know what I might be experiencing? Is it unsafe for me to resume running?
Thank you for any help/advice!
Your right knee feels better because you are no longer using it to compensate for the left knee, which has not been properly rehabbed.
Most doctors will tell you the #1 cause of knee pain in this country is overweight. Add pounds, add pain. They are only built to take so much pounding, and running triples the G-forces of standing, which in your case would amount to 60 pounds added to each footstrike, not just 20. A few pounds really matter, and just losing 10 over the last year has made a world of difference for me. Mileage, however, is not the way to lose it in your case.
I believe running is in your future - not arthritis - but you'll have to make some changes. First change is the composition of your food while recovering from your injury: Less carbs, of course, and taper them down toward the end of the day with only lean protein after 6 or 7pm (ex: whey protein). Start your day with only the carbs you intend to burn. Make them more complex as the day wears on until evening when you cut them almost completely. Carbs at night interfere with the production of critical hormones that will help you heal. Proteins will help you synthesize the sleep hormones you need to rest.
You can still run for 20 minutes a day three times a week? Super. That's all you'll need for the next part of the plan. First thing in the morning, even before breakfast, is the time for your 20 minute workout, consisting of a brief 2-3 minute warm-up followed by up to eight 30-second repeats at near maximum intensity (what you think you could do 8 times), separated by 90 second recovery jogs over the same distance back to where you ran from (out & backs). Don't run it for distance, but for time and intensity only. Take a brief 2-3 minute cooldown jog and have your breakfast, though you should consider lowering the breakfast carbs on your workout days. You heard me right - this will make you burn fat like crazy.
Meanwhile, there is your knee to consider. You survived the fall. It's not as bad as it used to be. This is a great time to dig in and make it feel worse! Find that tender spot below the joint you've been nursing and work it hard with your fingers to get the junk out. This may take weeks of application but it will eventually lessen or eliminate the pain. You are going to direct healing inflammation to that spot. Next, let's handle the trick knee.
Weakness and apparent instability of the knee are often due to an imbalance in the pulling force of the component muscles of the Quadriceps. Specifically, it is likely the Vastus Medialis, or inner quad, needs some work - not exercise, but a targeted rub-down. Straighten your leg so the knee locks and observe the heads of your quad muscles as they rise just above the knee. You want to find the fat middle of the one toward the inside, which should be a few inches above the knee cap and over. Note that spot and relax the knee.
Using your thumbs in a circular motion, find sensitive or rubbery spots in that part of the muscle and increase the pressure. When you find the worst knots hold the pressure for a few seconds, release and repeat. Now bend the knee and see the difference. The pain below your knee may still be there, but that is to be expected as your quad anchors at that spot. Relax the quad and you will release the pressure. If stiffness persists, use the above method to check the longitudinal center of the top thigh and the lateral side of the thigh until these muscles relax. They have been splinting your knee for months after the accident, and you must retrain them to relax.
Arthritis is common in cultures where diet is poor, as it often is here in the States. Contrary to popular belief, a moderate amount of running actually improves joint health in most people. Muscle imbalance and tension is common where people spend a lot of time in chairs as we do here, eating, driving or whatever. Stay gently active except for your fat-burning workouts, and eat to live well, rather than simply eating well. Do it right and it will cut your cravings and improve your rest.
Stay on this limited workout/diet and rehab regimen for a few weeks and see how you feel. It may take longer, but you'll lose nothing but pounds in the interim. I'll bet the ranch you'll soon feel like running again, but ease back into it when you do.
I am a physical therapist. Sounds like you have a knee cap issue that was caused by trauma. If I were you I would start by trying some ice, anti-inflammatory medication, and pain free exercises. Some times the longer you've had pain the more your mechanics have been 'thrown off'. To get an overview of treatment options and a link to some exercises you can visit http://www.joint-pain-solutions.com/knee-cap-pain.html
Hope this helps.
~JTrempe PT, ATC
Thanks for the reply!
I know I definitely need to change my diet. Due to a variety of less-than-ideal circumstances, I eat out a lot and I know I need to start making wiser choices. I'm open to eating less sugar, fewer carbs and increasing fruits & vegetables.
Just so I'm clear on the 20-minute workout you describe, are you talking about 30-second sprints? Also, about breakfast - I'm trying to do away with boxed cereals. As often as I have time, I like to make oatmeal but are there carbs in oatmeal. I'm also thinking yogurt & fruit would be good for breakfast. Other ideas? I often need something that takes little or no prep time because of my crazy work schedule.
I will work on the massage techniques you've described.
I went into a running shoe store the other day to see about getting outfitted for new shoes to provide better support. The fellow who helped me recommended I do some shallow, one-legged squats to help strengthen my Quadriceps. I've tried doing them a few times but they sure hurt the knee!
Thank you for your help!
Thanks for replying to me. How often during the day should I ice/take anti-inflamatory medication?
But it's not my knee cap that's hurting...it's the soft part below the knee cap...it's not even underneath the cap...just directly below. Sometimes I have to work on my hands & knees and the past few month a tend to shift my weight onto the knee cap or to the side because when I'm on my knees, that soft part is where the pain is.
Carbs are OK at certain times, but it's the timing that is most important. I used to think right after a workout was the best time, as some sports supplement manufacturers suggest, but it depends on your goal. Carbs have value during active competition, when muscle glycogen runs low and blood sugar levels need to be restored as soon as possible, say, during a marathon. The problem for you with carbs after your workout is two-fold: your body will not need to burn off stored fat, and the production of growth hormone will be curtailed as carbs are being metabolized.
From your original post it appears you want to burn fat and heal an old injury, so carbs would interfere with both after a workout. Quickly absorbed proteins, on the other hand, would insure the body does not need to cannibalize muscle in order to find an energy source in lieu of carbs. The closer to your workout, the more important these things are. The rest of the day and on non-workout days, low-glycemic (slower absorbed) carbs like whole oatmeal are a good way to restock your main energy source, that is until the last meal of the day, which should once again lean towards proteins and away from carbs and fats. The reasons are similar, because fats and carbs will interfere with your sleep and hormone production, while proteins will enhance this process, particularly for the sleep hormone melatonin.
You are wise to take care when selecting grain products. The endosperm of a plant is meant to provide the raw material for seed germination, and it is a very concentrated energy source that has an explosive effect on blood sugar levels when ground into flour and ingested in the form of breads, cakes, and processed cereals. Whole grains have to be broken down to release their carbs, therefor are lower-glycemic and less likely to trigger fat storage. They also take more energy to digest. It is easy to get too much of a good thing with grains, though, so restrict their use after lunch. Ditto for white potato products and white rice, while brown rice and sweet potatoes (ironically) are lower-glycemic.. if you've got to eat starches at all. Watch yourself closely, and you will see how many simple-carb choices we are faced with each day that are entirely unnecessary. Dressings, sauces, buns, pastas... the people who eat them usually grow fat. Eventually, when your metabolism has been restored, you will be able to eat some of these things without gaining weight, as I and many runners can now, but the change does not happen overnight.
It will, however, happen much faster if you follow the workout I suggested. The beauty of the short, intense workouts is that you will get the maximum 24-hr fat-burning benefit with minimum wear & tear, and maximum healing potential for your knee. While I wouldn't call these measured workouts sprints, they may seem that way at first. The idea is to finish the eighth repeat feeling like you could do one more just as fast. In other words, try to stay under control.
Regarding exercises for the quads, in many cases dysfunctional, unbalanced quads are behind knee pain, as I suspect may be true in your case after the accident trauma (see diagram from Gray's). A muscle is not a monolithic structure, and can be relaxed in some spots while being hypertonic (tight) in others. Your goal should be to find the tight spots and iron them out, without messing with the rest of the muscle. When you have restored the muscle to its normal, relaxed state, your knee pain should diminish and strengthening exercises will be productive. The exercises can make the muscle worse otherwise, which is why people often have to stop exercising to heal. You can't go wrong by relaxing the tight muscle first, before you begin retraining.
The above rendering shows the area, just below the knee, where the muscles of the quad and Sartorius muscle insert and intersect. Of the five individual muscles at this junction (Vastus Intermedius not shown because it is under Rectus Femoris, the one most likely to produce pain under the knee is V. Medialis, on the right. The spot where the name tag is drawn should be your most productive spot to rub. You may want to check and see how this area feels when you attempt to sit "indian style," activating the Sartorius (far right), just to see if it is involved.
On running shoes, make sure any support shoe does not restrict your natural movement, or you may find as others on this forum have, that more things start to hurt that didn't hurt before you switched shoes. If you must err, err on the side of too little support rather than too much. A recommendation for control shoes is not a ringing endorsement of your running style, so there may be some biomechanical issues to address. Some stores offer running analysis, and I think you should find out what your style of running is, so you can make the necessary changes before something else begins to hurt. Changes may include a customized orthotic for your shoes, which when properly designed, can be more important than the shoe itself. This is more productive than trying to force yourself to run a particular way, because your running style tends to reflect the structure of your foot (which you can work with), as well as the knee and hip, which you can't do much about (you can do some things, but that's another story).