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Runners Knee, Help!

Hi all,
This will be my first post on the forum and a lengthy one as well I apologize. I’ve been an on and off runner most of my life. Back in 2011 I had a dull ache in both of my knees, went to the orthopedic and he told me I had Chondromalicia (runners knee), he said I will always have this problem and to give up running before it got worse. I finished the season and took a break from running, running was secondary for me… I was a competitive swimmer for 12 years and I didn’t want the running to mess up my swimming. I did a few 5ks occasionally and some light training over the years. Fast forward to 2018, I started running again and became more serious. Starting in May I jumped into marathon training, I completed my first half marathon with ease and for the most part the training was a breeze. I had some slight knee irritation on the 18, 20 mile runs but the next morning they would feel great and give me no trouble. I’ve been following Hal Higdons Novice 1 plan and never missed a training day, even in the rain and brutal 100F and humidity! The week of Christmas I took off for a week when we went on vacation and on the way home I caught the flu. I was in bed sick for another week so that was a total of two weeks off. Once I felt better I decided to do a 20 mile run to make up for lost time, but something felt different. On mile 18 I felt an intense sharp pain in my left knee and I could no longer put any weight on it. I couldn’t walk. The knee was swollen and purple. I had my husband pick me up and I RICEd it for the weekend. Come Monday I still couldn’t walk so I went to the orthopedic. He gave me a cortisone shot which relieved most of the pain and took X rays, and he told me I had patellofemoral pain syndrome. He said rest for the week and then you should be back running and you should be able to race your marathon in three weeks. He told me to cross train if I’d like and that its perfectly fine to walk on it now. Along with that he sent me home with a work sheet full of physical therapy exercises to do each day. He also sold me an $80 bulky knee brace with a hole for the knee cap to go. I rested for the week and weekend, I didn’t cross train but I did walk my dog. I also have been doing the therapy exercises each day, they include leg lifts, clams, side leg lifts, etc. Each day around the 30 minute mark of walking i’d get that intense pain again in my knee on the interior side of my knee cap and had to stop walking. The knee brace seems to be making things worse, it causes more pain and is difficult to bend my leg. It feels like its pulling my knee cap to the wrong side? Midway through the week my toes on the injured leg cramped up for several days straight and turned purple and the leg would start to buckle on walks. Today was the day I was supposed to be back to normal according to the doctor, I went for a quick jog and could only make it .5 miles before intense pain… not surprised considering I still can’t walk on it without pain. I can run up and down stairs effortlessly, no pain at all. But sitting at the dinner table does hurt! My marathon is next Sunday… I prepared so hard for this race I’d hate to give up but at this point all seems lost. More than anything i’m scared I may never be able to run without pain again. Running is my escape, its my sanity, after getting injured I have been so depressed. I don’t have access to a pool anymore or a bike so I don’t really have any cross training options. I don’t know if I should pull out of the race or rest more… at this point I also feel I have lost stamina since I took the week off for christmas, a week off for the flu, and now how many weeks for my knee? It is so disheartening because before all this I could run 20 miles with such ease and I felt so happy… I have come home almost every day crying after the walk because the knee pain is so terrible. I’m wondering at this point too if the doctors diagnosis was wrong, shouldn’t I be able to walk by now without pain?
Thanks if you made it through all this and I appreciate any advice you may give!

  • Heidi

Sorry to hear about your pain, Crazylegs2019. I’ve been in similar situations myself. Sometimes I have been able to run the marathon, and sometimes I had to let it go, along with all the training and expense. It’s a real downer sometimes, but the wisdom of running the event depends on the situation.

In your case, both diagnoses could be correct, in that you may have a knee condition that running can worsen, but you may also be able to compete anyway without doing any damage. It depends on a few factors, and on how you approach this going forward. Having seen a lot of real injuries, and also a lot of pain syndromes, I just want to add that the problem with the knee pain may not be the knee itself. Let’s hope for the best!

A couple things stood out from your lengthy report, that are worth highlighting. You mentioned that after some time off for sickness, you did a 20-miler to get back on track. The other thing is that you can run up steps without the pain.

You’ve probably heard that it’s not a good idea to try to make up for lost training. I’ve tried this too. Sometimes you can pull it off, and some times it will set you back by creating an injury or pain problem. Without writing a book here, I want to differentiate between pain and injury. Doctors are trained to look for signs of real physical injury as the cause of pain. It’s what they get paid for. I trust that the last diagnosis was good, and that the knee itself is intact. It is still possible though, to create a soft tissue problem that doesn’t show up in an exam. The good news is that many soft tissue pain syndromes, if they do not result from actual injury, can be taken care of in a fairly short amount of time.

The bad news is that soft tissue injuries or pain syndromes can alter your bio-mechanics enough to create conditions under which an actual physical injury to your knee can occur. The muscles of your back, hips, legs, and feet must work in concert to minimize stress on the joints. A mere pain syndrome can cause enough imbalance in how the muscles are acting on the joints, that the joints themselves are in jeopardy. This is where you might be, and what you want to avoid in competition or heavy training.

Research has shown that running can actually be beneficial to the knee joints, when not done to excess, or done when the soft tissue (muscles and other fascia) is not functioning properly. One thing to keep in mind is that pain can alter the way muscles work together, so that some are working too hard, and others are working poorly. There are several muscles in the thigh that pull on the kneecap that have to be in balance. Rotation of the hip is also important, in that it changes the angle at which the knee bears weight, and can affect the point in the gait cycle when the muscles and joints load and unload.

In other words, there may have been times in your training when some muscles were pulling too much and others too little, causing possible irritation of the joint, but also pain in the overloaded muscles. The neural pathways that carry this pain can be misinterpreted by the brain as knee pain. This is why the doctor can be absolutely correct about your knees, but you may still hurt when you do certain things.

Another thing I noticed is that you said sitting at the table was painful. This could indicate some problems with hip rotator muscles, which are deep within the gluteal area you are sitting on. Problems here can radiate down the legs and create knee pain by altering the way your legs move when running. Going up steps uses the muscles differently.

You might want to ask if your ortho can recommend a good physical therapist familiar with sports injuries. Many PTs specialize in post-op, but you want one that has worked closely with active athletes. The solution may be as simple as targeted massage, or as time consuming as retraining some under-performing muscles, but it should start with a treadmill exam to see how you are running now. A good PT can spot the problem and design an effective program quickly.

I often suggest a few things to try before scheduling appointments, but you are running out of time to experiment. In this case I recommend booking a session with a good sports PT as soon as possible. It may not be too late!

Good luck with your recovery, and best of health!

Hey Crazylegs2019, I am really sorry to hear about your pain. As a runner, I know how stressful it feels when you have an injury that prevents you from running. For me, running is a major stress reliever and not having it really hurts.

Not sure if you’ve already gotten medical attention, but here’s an idea if you haven’t. When I had knee pain a few years back, I actually worked on strengthening the knee ligaments. For me personally, my ligaments were weak in the knee and when I started doing some light weight lifting (aka squats, deadlifts, single-leg squats, etc.), I started noticing the strength returning in my leg.

This may or may not work for you, it’s just what worked for me. Obviously please still seek professional attention because you may have something different.

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