I was training for the NY Marathon last year and I had to pull out due to a severe pain in the back of my knee. This was my first marathon and I haven't run any long distances for the last 10 years. I was at the point where I could run 8 miles regularly and then something just seemed to happen one day at the gym. While running on the treadmill I started getting this sharp pain in the back of my knee (right leg) at the one and a half mile point. I just ran through the pain for another 3 miles assuming it was some random pain that would go away, but the pain got a lot worse. I could hardly walk for the next several days. A week later I tried running and I could not run over the one and a half mile point. The pain always came back right at the one and a half mile point.
I stopped running for the next 6 months. I tried running after the long break and the pain was still there, so I stopped running again. I just went running yesterday and the pain is still there. It's been almost a year now. The pain in my knee won't let me run over one and a half miles. However, I can climb a stairmaster or do the elliptical for hours with no pain. I've been mountain climbing and no pain. So, it seems exclusive to running, whether I'm on the treadmill, on concrete, or in the park on a dirt trail.
The pain is in my right leg, behind the knee, just inside the lateral collateral ligament on the right side of the knee. It doesn't feel like the ligament though. It feels like its behind the ligament on the right side of the back of the knee, towards the bottom of the back of the knee, just above where the calf starts.
Does anyone have any idea what this could be? It's very weird that I can't feel any pain unless I'm running, and only until the one and a half mile point.
One thing to know about pain is that is not always exactly self-diagnostic, that is there are causes of pain that feel like where they are, and many that feel like where they aren't. The easy thing is to tell you what pathologies potentially inhabit the area where you feel pain, but the realistic thing is to address the whole picture.
You did not run for years and decided to train for a marathoncold-turkey. I'm not making fun, because I did the same thing a while back. Marathons are inspiring and we all need a little inspiration from time to time. Your goal is likely within reach despite this temporary setback.
Marathons test your endurance. Endurance is a product somewhat of genetics, but most certainly of training and fitness. If you are fit you can train well, but you can train yourself out of fitness as easily as into it. Right now you probably do not have some of the overuse pathologies that plague seasoned runners and are often blamed for the pain you have. Chances are good you have overworked a muscle or group of muscles in your quest for marathon glory. Not to worry, we have all done this to various extent, and your prognosis is probably very good.
One of the most frequent contributors to back-of-knee pain is a muscle that is not actually at the back of the knee, but is involved more in running and other activities than it might be in stair stepping or non-impact activities because of its structure and when it is called into play. I am referring to the upper calf muscle known as the Gastrocnemius. While only its two heads cross the knee on either lateral side to their mooring point on the femoral condyles, a frequent and mysterious side effect of its overuse is a pain felt between those two heads where the muscle does not exist, as if the brain were averaging its location. you can rub all day where you feel the pain and not affect the cause.
There are also a couple of deeper muscles involved in unlocking the knee to begin flexion, so it is helpful to isolate all these players before settling on a culprit. The Gastroc is engaged as a plantarflexor when your knee is straight and you stand on your toes, but because of its design across the knee and ankle (via the achilles tendon), it also acts as a non-loaded knee flexor when your foot kicks back and heel upward during running. Other movements may not load the muscle at all, hence your exercises that involve the knee with impunity.
Probe this upper rear calf muscle with your fingers to see if you can replicate your symptoms. It is frequently overworked to dysfunction in new or returning runners. After that, you can check the deeper Popliteus muscle in the crease of your knee, but take care to avoid sensitive nerves and blood vessels in that area that will also resister pain if irritated. This muscle helps to unlock the knee by rotating the joint when it is straight. It starts on the rear medial tibia and ends on the lateral femur above. There is another tiny vestigial muscle that runs from the back of the knee all the way down to the heel via a long skinny tendon. Though it does little in its title job as a plantarflexor, its small size helps it escape attention during diagnosis). All of the hamstrings can also produce back-of-knee pain, and sitting on them all day for years makes this even more likely.
An extract from the following copyrighted article on muscular pain sources (note bottom right, "Ts" representing dysfunctional area and red shading the associated pain pattern):
The copyrighted article referenced (please note textual error in discussion of Popliteus, which actually connects upper medial lower leg to lower lateral thigh, hence its action):http://www.gadibody.com/treatments/knee-pain.php
Disclaimer: I own these charts, use them in my practice, and paid a lot of money for them before digital versions were available on the web. That may get me out of copyright infringement, but any professional use beyond advertising should involve purchase. They are based on many years of expensive medical research, available from many channels, and should be taken seriously.
Message was edited by: JamesJohnsonLMT
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