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My doctor took x-rays and said my extreme knee pain is caused by runner's knee in both of my knees. I've been going to PT without too much success. There is the option of cortisone injections which I haven't done yet. My questions is, does this mean my running life is really over? The doctor said that he recommends I change sports or opt for much lower mileage runs ( I was in training for a 50 mile run). I want to keep running. Has anyone been though this and can offer advice, suggestions? The doc also said that if I continue to run the mileage I usually run I'll ultimately need knee replacement surgery. Thank you.
Ha, ha, I think I'd be looking for a second opinion. Runner's knee is very treatable. You should definitely investigate whether you are in the right shoes. Also strengthening the muscles in your upper leg (quads particularly) can help.
How long have you had this problem? Any previous knee issues? How long have you been going to therapy? Have you tried changing PTs? How long have you been long-distance running?
Your doctor is correct, in the sense that an unresolved patellar tracking dysfunction will cause long-term irreversible damage to the cartilage of you knees. The doc is likely overstating things a little to emphasize that this is not a "run through it" situation. Basically, there is part of the joint surface in the knee called the odd medial facet, and normally that part only makes contact when your knee is extremely bent - something that doesn't happen for a large part of daily activities. Because of the lack of use, the bone of the odd medial facet is softer and weaker than the load-bearing joint surfaces of the patella(kneecap). In runner's knee/patellar tracking dysfunction, the patella is pulled laterally (away from the midline of the body) and this causes the odd medial facet to be in a load-bearing position - which it isn't prepared for. If this is not corrected, you will likely end up with arthritic knees.
If you have been seeing the PT for only 4 or 5 visits, don't get frustrated yet. If you have been going for 4 or 5 months, find a new PT. A different therapist can make a world of difference. Complete resolution requires that you seriously curb going down stairs, sitting with bent knees (ie not 90 degrees in a chair, more like kneeling, that sort of thing) and prolonged load on the joint. Common causes of rehab failures are too much activity in early treatment and insufficient quad strengthening. This is what should be covered at your PT:
strengthen the medial (inside) quad muscle; your patella (kneecap) is tracking laterally(to the outside) because of uneven pull, you need to strengthen the medial muscle to pull it back into it's proper place.
ITB tightness is often a contributing factor, so ITB stretching and soft tissue mobilization is in order.
excessive/abnormal pronation is associated with patellar tracking issues, so assessment and orthotics may be required
tight hamstrings cause various disorders of knee extension, so hamstring stretching may help
When you are able to run again, remember to increase gradually, generally 10% per week in time or distance. Many injuries come from increasing distance too quickly - and the injuries can take weeks to become symptomatic ie. just because Runner A doesn't feel bad after jumping from 10 miles to 15 miles in one week doesn't mean that he actually pulled it off without injuring himself.
Not everyone can run 50 miles even once, and comparatively few humans can run 50 miles repeatedly. I doubt you'll have to give up running entirely, but repeated ultramarathons may be questionable. How about becoming a marathon or half-marathon specialist? I don't think your doctor is trying to scare you out of anything, but rather is just trying to let you know know that, longterm, you cannot put those kinds of miles on your body without wear! As Indiana Jones said "It's not the years, it's the mileage"
It sounds like you have the beginnings of osteoarthritis in your knees. It is more common in runners than you think. In addition to PT, stretching, and using non-impact exercise in your off training days (read elliptical and pool) you may want to look at taking supplements that help reduce joint wear and tear. Look for a good fish oil, vitamin D (especially in winter) and a good natural anti-inflammatory like Joint Kote: http://jointaches.info or zyflamend. Other than that, you may want to evaluate a non-impact sport during your off season to minimize the damage to your joints.
Hi there! As a Physical therapist, my advice is to rest your knee 1- 1 and a 1/2 months to give your knee the time to heal. Then, you can still run but you can only resume running if there's no more pain. You can still continue running but you have to respect pain. Stop before pain sets in. Get a shoes that you feel comfortable with.
I see that this is an old thread, but I still want to chip in. I was a non-runner who tried to run for about a week in July, 2009. At about 200 lbs I was heavy,but remembered my running days in the early 80's with joy. My knees both screamed after about 4 runs and I figured I'd never run again. I wasn't diagnosed or anything. Over the winter I read "Born to Run" and ached to give it one more try when the weather came around. I started in May, 2010 and have since logged just under 600 miles without a day lost to pain. I've only run 2 races, a 10 mile trai race and a 5K. I run barefoot now, or wear Vibram 5 Finger if it's cold. It works brilliantly for me.
Barefoot / Minimalist Runner
...not maintaining this these days..
07/29/2012 Marsh Creek Raptor Run 10 Mile Trail Race
07/15/2012 Quadzilla 15K Trail Run, Trexlertown, PA 1:37 (2011, 1:49)
04/29/2012 Lehigh Valley / St. Luke's HM, 1:43:15 (2011, 1:54:20 )
03/19/2012 Kutztown Fool's Run 10 Miler, 1:18:15 (2011, 1:30:20)
02/26/2012 Ugly Mudder 7.2 Mile Trail Run, Reading, PA 1:20
11/27/2011 Dirty Bird 15K Trail Run, Birdsboro, PA 1:40
10/08/2011 Lehigh Gap Nature Center 10K Trail Run (6.38 miles), 59:20 (10/07/2012)
Started running (again) May 5, 2010