18 replies to this topic

[Chelski]

Hi All,

I'm attempting the Sydney marathon (my first) in September and have discovered that I have got Runner's knee. It happened about a month ago on a 28 km training run. It takes about a week to recover and then I can manage another 15km or so run, before it kicks in again. I'm now in a training dilemma as I want to do a couple of 35km runs before the Sept event to get some time on the legs, but not sure what to do. I've started doing weighted squats and a few other quad exercises in the gym to build up the lower quad leg strength, but am worried about not having the 35km runs in the "bank". Would appreciate any advice or thoughts. Many thanks.

[runningphysio]

When you say "runners knee" where abouts are your symptoms and what does it feel like? Does it hang around for long after the run? Can you run through it? Is it there first thing in the morning? Whats worse - up or down stairs?
You need to make sure you don't decondition too much, which IS going to happen if the pattern of training continues along the likes of a week off, 1x15km run, another week off. Miles are accumulative so I'd suggest you straight away reduce the distance and aim to run more than the current frequency. This will at least maintain your running muscle memory ? It is possible that your runners knee is related to fatigue ? If this is the case, by reducing your distance, you may be able to avoid this problem whilst also concurrently undertaking a strengthening program. Areas that i'd suggest you start with are glut/quads/calves - basically the anti-gravity muscles that hold us upright and power us forward when we run. Don't just focus on the quads.

[Canons]

Chelski,

What has caused the 'runners knee'. If it is a tight ITB, then using a roller to release some of the tension on the side of the leg and hip can be helpful. If its to do with your patellar (knee-cap) not tracking correctly over the bone, then my advice would be some sports tape. You want to be pulling the knee cap towards the inside, as this will help the patellar track much better. Wont allow full leg range of motion, but enough for a long run.

[adr1an]

I have this. The taping method Canons is generally referred to as 'McConell' taping. I've been doing this every run. I've also been trying to get strength work done which mostly focuses on barbell squats, as well as single leg squats.

It's not 100% but it's manageable. I've been back at around 60-70k a week for the last few weeks wit it.

You definitely want to try and get training consistently again. Sydney's only 10 weeks away!

Edited by adr1an, 12 July 2012 - 05:08 PM.

[Ikin]

An injured knee is like  baby, you really need to nuture and care for it.  Don't force it to heal too quickly or it will never heal, meaning you may never run injury free again.  I used the taping method and found it very successful, but I also stopped running for 3 months.  And I mean NO RUNNING, I bought a spin bike and took up kickboxing and tried to build muscle and truely when the time came to run again I could hardly notice and running fitness lost.  I also did loads of glute strengthening exercises.

[Andrew2]

As it was explained to me by a physio, the patella tracking issue (if thats what you have), is now thought to actually often be an issue with rotation of the femur.   The  solution is with the deep muscles of the hip and buttock area, not with the knee muscles.  The exercises I was given seem to have helped, and I'd reccommend seeing a physio with sports/running experience as its quite a specific issue.
Of course I might have just toned up whilst luckily staying the right side of the injury threshhold.

[Chelski]

Thanks all for the feedback so far, which is really helpful. Just to answer some of the questions asked so far, the pain is behind the kneecap at the front of the knee and it hurts mainly when I'm going downhill. I'm not sure I can run through it, but persevered in training for about a kilometre or so. Not sure I could last another 13 kms though. The pain stays for a couple of days provided I don't train. I think it's a tracking issue which is why I was leaning towards the strengthening exercises, although it sounds like I need to also focus on the glutes and hips as well. I've never tried taping, but that sounds like a good first step. I'll definitely look at this. The other thought I had was to do some cycling, but to load it up and stay in the saddle. That should increase my leg strength and keep my cardio fitness up there, but I'm not sure that it's the same as churning through 35kms. Thanks again.

[Mile27]

Andrew2, on 12 July 2012 - 09:43 PM, said:

As it was explained to me by a physio, the patella tracking issue (if thats what you have), is now thought to actually often be an issue with rotation of the femur.   The  solution is with the deep muscles of the hip and buttock area, not with the knee muscles.  The exercises I was given seem to have helped, and I'd reccommend seeing a physio with sports/running experience as its quite a specific issue.
Of course I might have just toned up whilst luckily staying the right side of the injury threshhold.

Runners Knee is often due to poor control of the rotation of the femur.

When looking at the knee we need to think about what the major influences on the knee joint are. Despite what many think it is definitely not the quads.

If we are talking about the tracking of the knee then the first thing to look at is the bones involved- the tibia(shin)  and femur( thigh)

If these bones move too much ( or too little ) or even more inportantly move in different amounts or timings then you have problems.

So if the demure moves to much and the tibia doesn't you have problems , likewise if the tibia moves to much and the femur doesn't.

Looking at how well you can control internal rotation and Adduction of the hip and pronation of the foot are the keys to resolving a knee tracking problem.

Exercises that work the muscles that control  internal rotation and Adduction of the thigh ( deep muscles of the hips and glutes) and also looking at the foot and seeing if there is anything amiss there will fix your problem.

This means seeing someone who can assess the problem. You can do all the glute exercises in the world but if the problem stems from the foot then you will still have knee pain.

Taping the knee is a good short term solution but obviously won't fix the problem.

Avoid hills as much as possible.

Running much shorter distances more often may be a better approach than running once a week.

Your running fitness will gradually decline running once a week. If you only had 4 weeks to go it wouldn't matte but you have over 2 months.

[runningphysio]

Chelski, on 12 July 2012 - 10:10 PM, said:

Thanks all for the feedback so far, which is really helpful. Just to answer some of the questions asked so far, the pain is behind the kneecap at the front of the knee and it hurts mainly when I'm going downhill. I'm not sure I can run through it, but persevered in training for about a kilometre or so. Not sure I could last another 13 kms though. The pain stays for a couple of days provided I don't train. I think it's a tracking issue which is why I was leaning towards the strengthening exercises, although it sounds like I need to also focus on the glutes and hips as well. I've never tried taping, but that sounds like a good first step. I'll definitely look at this. The other thought I had was to do some cycling, but to load it up and stay in the saddle. That should increase my leg strength and keep my cardio fitness up there, but I'm not sure that it's the same as churning through 35kms. Thanks again.

Righto - so it sounds like you are suffering from patellofemoral pain. As others have suggested, this is a malalignment of the patella as it moves over the femur. When you run downhill or up stairs you significantly load up the patellofemoral joint, hence it is at its worst during these activities. As an immediate treatment protocol i'd suggest getting the ITB and glut med released. Quite often a huge amount of the problem is due to active trigger points within glut med - particular so as glut med is an internal rotator, hence tightness will see a malalignment at the patella. Also it would be wise to get on to some NSAIDs providing you stomach is all good, as well as icing the knee a few times a day. You should also use the Jenny McConnell Taping technique discussed above - probably best to get someone else to do this for you, preferably a professional. If you see a physio they are likely to start you on closed chain combined glut med and quad (VMO) activation exercises. Try riding but often riding will not improve it because the locked in deep flexion of the knee actually loads up the patellofemoral joint a great deal, hence may irritate the problem more so. Hence, it is important to get it right quick. As for cross training - trial the bike, but also consider the cross trainer, swimming and pool running. Pool running is great for maintaining muscle memory and is a great way to do speed work when injured. I've treated this problem very aggressively with some patients by seeing them 3 times per week for 1-2 weeks. Treatment would consist of release of ITB, glut, Quads, and dry kneedling of the ITB and glut. This doesn't address the why the problem occured, but the most important thing is to first reduce the symptoms, and get you back running. It is unlikely it will return again before your race, provided you are also concurrently doing exercises. Once symptom free, then is the ideal to start to investigate why the problem occurred in the first place - i.e. an injury prevention screening. Just a few thoughts for you!

[cjr]

As someone who suffered to distraction from this for years, was always looking for a quick fix, and gave up running a few times as a result, all I can say is to echo what others have said - the only long term solution is to treat the cause not the symptoms. Treating the symtpms may get you to the start line of your next race but will eventually do your head (and your knee) in...

[NatalieC]

Hi,
I also get a pain in my knee when I run. However it doesnt sound like the pain being described on here. It occurs on my right side. It feels like a shooting pain on the left hand side of the knee. I dont know the names of the bones in the knee, but the pain occurs between bones (one of them being the main knee and the other being the bone to the left of the knee). I know this probably makes no sense but does anyone have any idea what this might be?

The pain goes away, it really is whilst I run/walk. I want to do the C2S Perth marathon in a few weeks. I am running intervals, a few shorter runs during the week and a longer run on the weekend. Will I be okay for the marathon? (1st marathon)

Thanks guys

[Morley]

Chelsik - I have had knee pain occassiosnally. It is worst when running/walking down hill. The cause has always been tight ITB and glutes. Solution for me is massaging with a foam roller for ITB and stretching the gluts. Some strengthening of quads also works. Hope it helps. Cheers.

[Chelski]

Thanks again to all for the comments. I'm so glad I found this site as the support network is great. I really appreciate it.

[Quinkin]

Yes, McConnell taping really helped me. It took the pain right out of my knee, and it made my weak inner quad or VMO fire more strongly and therefore the quad and glute exercises where more effective. I also practiced activating my VMO, when I first started this was almost impossible for me. Without the tape my VLAT was the only muscle activating. I think I took the prize for the weakest VMO the physio had ever seen

It took me three years to rebuild my knee. Is started this physio regime in November 2006, I went for my first run in June 2008, I taped to run until about October 2009. I've now run up to 30km, fisnihed over 20 half marathons and this September I will run a marathon. I also needed a wheel alignment of sorts custom made orthotics to prevent pronation and the right shoes. I found rolling pin massage of the ITB and some self massage of knee tendons and lateral reticulatum to help.

Edited by Quinkin, 20 July 2012 - 08:24 PM.

[sportsphysio]

The diagnosis is really just putting a name to your pain. The real solution isn't associated with the diagnosis but with the underlying cause. Until you figure that out, it's just trial and error. Internet forums can be great but it can't substitute for an in-person assessment. Once you've got an opinion on the diagnosis and (more importantly) the cause, these forums are a great place to seek advice. Until then, they can inadvertently add to the problem and the frustration.

Chelski, on 12 July 2012 - 02:12 PM, said:

It takes about a week to recover and then I can manage another 15km or so run, before it kicks in again. I'm now in a training dilemma as I want to do a couple of 35km runs before the Sept event to get some time on the legs, but not sure what to do.

And to answer your original question, it comes down to risk vs reward. Not doing the longer runs won't ruin your race although it is likely to have a small affect on your performance. On the flip side, stirring up your knee pain can ruin your race. You need to weigh up the small potential gains with the huge potential losses and make a decision.

[Quinkin]

To follow on from what Sport physio says. The first step of getting to a sports physician who knew knees, and then getting a referral to a physio expert in patella femoral pain and taping techniques was the best investment I ever made. The battle is to get the diagnosis and to find a treatment regime that will provide the answers for you.

For me McConnell taping, quad and glute strengthening was the answer, and set me on my way to recovery. It broke the cycle of ineffective physio I'd been having for several years. The answer might well vary for each sufferer of knee pain.

[Mile27]

sportsphysio, on 20 July 2012 - 10:17 PM, said:

The diagnosis is really just putting a name to your pain. The real solution isn't associated with the diagnosis but with the underlying cause. Until you figure that out, it's just trial and error. Internet forums can be great but it can't substitute for an in-person assessment. Once you've got an opinion on the diagnosis and (more importantly) the cause, these forums are a great place to seek advice. Until then, they can inadvertently add to the problem and the frustration..

Well said.

To all those suffering an injury , finding a diagnosis of the injury is far less useful than finding the cause of the injury.

I read so often that a tight muscle is the cause of an injury - a tight ITB causes knee pain , tight calves cause shin pain etc etc. Based on this the sufferer spends ages stretching and foam rollering and sometimes that relieves the symptoms. UTMB very rarely will it address the cause.

Very very rarely is a tight muscle the CAUSE OF AN INJURY.

Ask yourself why is that muscle tight in the first place. What caused that muscle to work harder and tighten up. If you want to understand why you get injured have a read of http://www.mile27.co...nning-injuries/

Back to the OP , if you can't manage a long run without knee pain I wouldn't run a marathon unless you are prepared to have months of afterwards not running. It may not be that bad but if you run a marathon starting with an injury , it is going to need time of afterwards to recover.

Also remember the longer you run with pain the more a pain cycle becomes entrenched in your brain , making it harder to overcome the injury.

I agree with sports physio , reduce you runs so your knee can handle it. The risk in running longer and stirring up the know probably isn't worth the reward.

[ITri]

HI Chelski, I am very interested in your story... it sounds a little like mine. I note this is an older post, but I think your Mathathon hasn't happened yet? Is it next fortnight? What's the story now are you up for it still...

Here's a little background on my situation - I hope this might help you.
I'm a triathlete and in January this year as I was preparing for a half-ironman I started getting terrible left knee pain and plagued me right throughout the training to the race in May, spoilt my race completely, and I am still suffering here in September. The week before my knee problem started I had acute tendonitis in my glute medius but didn't alter training. The following week on a very solid 14k run my hips started to ache but I pushed on and then my left knee gave out and I crumpled (cried), and limped the final 2k home. Back to physio.... patellofemoral syndrome... off to podiatrist. I pronoate (worse in right foot) so I already had orthotics but he showed me the McConnell taping and set me down that path. The problems abated initially with the taping but it wasn't a practical solution for triathlon (wet tape=drops off) so I tried knee braces, then rock tape with mixed results. I gave up on the physio/podiatrist and opted for remedial massage. I lived with icepacks strapped to both hips and around my knees plus doses of Voltaren/Nurofen. I suprised myself my completing an Olympic Distance tri (1.5k swim, 40k cycle, 10 run) with no pain only 2 weeks out from the Half Ironman so that gave me hope but in all training runs I was only pain free to about 9k. Over 3 months I had gone from pain onset at 14k to pain onset at 9k (sometimes 7k) so had to go in under-cooked for the run and had not done any runs over 14k at all. I did the race (1.9k swim, 90k cycle, 21k run) but the run was pathetically slow. I just wanted to see it through and then focus of rehabilitation. I took 2 weeks solid rest after that race and then did a 14k fun run and really hurt myself. The pain started at 2k. I had to stop running and find a new physio - debating the initially diagnosis of patellorfemoral syndrome. He agreed and we've now gone down the path of looking at it as nerual entrapment in my superior tib/fib joint, with some hip/ITB complications and a tight L4. *I've also put a lot of time into the gym - with weights/strength training on glutes/hips/hip stability. I've had a few awesome runs around 5-7k distances when I've religiously stretched the hamstring nerve (in the back of my knee) but if i don't do it 4 times a day, 7 days a week, it is bound to show up in my next run. After more setbacks and going back to pains on 2-4k runs, I've decided I can't live like this. On 1st October I am due to start my training for another half ironman and I'm in trouble with no running base (but my cycling is as strong as ever thanks to the stronger glutes!) I went to yet another physio (the Eagles team physio actually), and I had an MRI last weekend - getting results tomorrow. In the meantime, my other physio has given me strength work to focus on single-leg hip strength (hip hikes).
Sorry for the long story - but I guess I am showing you that its not always a clear cut case of patellofemoral and there is no point in pushing through pain and causing long term damage to your running. I am really disappointed and frustrated but I will fix it - I will find a way. I hope you do too. Please let me know how you're going? You're description is the closest I've ever come to finding someone with similar symptoms so I'm keen to know if you solve it and how? Meanwhile, let me know if you're interested to hear the results of my MRI I get tomorrow and what this Eagles doctor has to tell me!!!

[Bellthorpe]

Try running on the other side (camber) of the road. It worked for me the one and only time I suffered from 'runner's knee' some 40 years ago.