>Health and Nutrition>Runner's Knee
I have been running for almost ten years now, and logging my miles for almost as long. I ran my last marathon about six years ago and since then have been running consistently. My injury of choice is a strained hamstring. the past two years i have been consistenly running thirty to thirty five miles per week, finally this winter my hamstring issues seemed to be resolving and i decided that i needed to run another marathon. I am currently seven weeks into a twenty week marathon training plan (lydiard)
I have been running in Brooks PureFlow for about the last five years. I love them. they have a 4mm drop, light cushioning, very flexible. When my shoe gets to the end of its life, i get a litte twinge of knee pain and i get a new pair of shoes, i can normally get about four hundred miles out of each pair of shoes. this spring right as i was deciding to start this marathon plan, the knee pain started, got a new pair of pureflows and it didn't go away. i thought maybe with the increase in my mileage i need something with a bit more cushioning, so i did some research and decided to give Topos Athletics Ultrafly a try (5 mm drop but much more cushioning) and the pain went away immediately....for about a month. Its back now and worse than ever.
this past week especially it has been bad, particularly on descents. I looked up in my home remedy book by Metzle and it seems like a pretty common case of runner's knee, pain in the front of the knee under the kneecap, no swelling, starts about an hour into the run as the quads are getting tired. i typically foam roll every day but i have been a bit lazy with it so, since Saturday i have been foam rolling my quads a couple of times a day. I also had the massage therapist that works at my gym work on it on Monday. from what i have read runner's knee is associated with tight quads and with weak quads. I don't think my quads are weak. for one thing i know i was out of balance with all of the hamstring work i have had to do, for the other i work out four times a week with a trainer at a gym doing strength stuff to support my running. over the course of a week i work every muscle group, but definitely focus on squats, lunges, fire hydrants, leg raises, rdls....we do it all.
one thing that i noticed this week was that if i run faster, it doesnt hurt nearly as badly. also if i focus on lifting my knee it also takes the pain away, so maybe i have a form issue?? however, running faster for every run isn't going to help my long term training! its wearing me out. at its best it only hurts occassionally and feels like pressure behind my kneecap, at it's worst it is painful and feels like my knee is about to buckle. it almost never hurts on straight sections, but always hurts on descents and sometimes on uphills. I had to stop and get water this morning and it took a few steps to feel good after i had stopped walking and tried to run again.
i am thinking about taking the weekend off and focusing on foam rolling and stretching, i take rest days on thursday and sunday anyway, so i would skip my tempo run Friday and long run on Saturday. everything feels great, and training is clicking along....sorry i know this is long, but this marathon is important to me (i want to BQ so i can run Boston for my 40th bday)and i don't want to have knee problems throughout the rest of my training! i'm also heading to my LRS today to talk about shoes...
forgot to add that walking and going up/down stairs does not bother me. nothing at the gym bothers me. it's only running
went to my LRS and the guy that i worked with fitted me in the Hoka Cliftons with an added insert, he thought the stability would help to keep my knee going in the right direction. I'm going to skip my next two workouts (tempo run on Friday and long run on Saturday) for a total of four days off and hope that these tweaks make a difference.
Hey, a lot of what I had read indicates that runner's knee is a matter of tightness in the hip and IT band. It may be that all the strength training you're doing, the squats etc, are actually causing tightness in your IT band(s) and this could be what is causing it.
Also, it's possible that shoes with a lot of cushioning actually make knee pain more likely to occur.
I myself have begun to struggle with knee pain for the first time and I have been running for about as long as you have.
Maybe not coincidentally, it is only in one knee and knee that is on the same side where I am particularly tight.
"If you have the fire, run..." -John Climacus
not bad for mile 25
Is it daft to suggest trying some barefoot/minimalist running?
so this is interesting....i just went to the store and got a shoe with more cushioning than i am used to...but maybe i should move the other way and try a shoe with less?? i am wearing the Cliftons around the house this morning and trying to get used to them, there's just so much shoe there. i have a pair of pureflows still in the box, i could try them again, i mean, it is the shoe i have been wearing for years...and the pain even though is subsided for a while when i tried the more cushioned topos has come back worse than ever, so maybe going cushioned is the wrong direction.
For what it's worth, my knee problems (early in my running career) disappeared when I went minimalist. YMMV, of course.
It's easy to slip from proper running form when we slow down, which is common whenever we're running a lot with more fatigue than usual, like training for longer stuff, or generally increasing volume, so forth.
I find the thing I have to avoid most of all is dragging my leg/foot back from ahead of me, rather than properly getting it down below me so I can roll through it and push off. Anytime I find that happening, it puts strain on my knee area and past experience shows that it just leads to all sorts of bad stuff. So I stay mindful of my form, no matter how slow I'm moving, making sure I get that knee up just a little so that I'm guiding it through the transition from ahead to behind and not 'pulling' it through.
Jim, i noticed this when i tried running earlier this week, on Monday when i was running easy I noticed that when I picked up my pace it felt a lot better, Tuesday i was running a fartlek run and didn't notice much discomfort at all, then Wednesday was another long slow easy run and it hurt the whole time, especially down hill. I remember ages ago when I was running at home on my treadmill that someone here on this forum had advised me to think about raising my knee extra high since i was experiencing some discomfort and it immediately took it away....so while i was running Wednesday morning i thought of that the whole time, picking up my knee (i thought of running with high knees but it wasn't that high) and it did help, although my pace also naturally increased a bit while i was running and thinking about that.
i think it could definitely just be a form issue, so i think i'm going to try my pureflows back on Monday and see how it feels if i think about my knee coming up the whole run and not just when it hurts...
things did go well today, got 2.6 miles in, felt fine, was hyper focused on form (and wearing my old pureflows) and climbing a hill and all of a sudden sharp knifelike pain through my knee cap. i ended up going to an orthopedic urgent care center this morning because all of the ortho/sports medicine clinics were scheduling two weeks out...they say patella tendonitis (basically runners knee), no running for two weeks, alieve every day, brace for the next week at least and see them in a week to check in.
im going to scrap my fall marathon, maybe if things go well i can retry for the st judes or something in december....
Tendonitis is a gradual condition that starts with soreness and gets worse. It probably went to another level but rarely does it put you to a complete halt. This indicates injury or more damage. I agree no running but you need active recovery. I am anti ice but won't start this conversation Move. If no pain to walk do this. Can you do calf raises, toe taps, bend knee while standing or sitting?? Elliptical, bike, row.....If you can do any of these things without causing more irritation, then do this as much as possible. Movement encourages healing, stillness does not.
THE RECOVERY MAN. Run Injury Free. www.smartapproachtraining.com
i went to my gym yesterday and did twenty minutes on a stationary bike, reverse lunges and fire hydrants and some other stuff, normal workout for me except for the bike. the nurse practitioner i saw told me i could do anything that doesn't cause pain. i just got home from a forty five minute walk around my neighborhood with my dogs and i made an apt with a local sports medicine and performance clinic instead of going back to the ortho that i saw yesterday....i felt like she mostly sees sedentary patients and i want to go to someone who is used to seeing athletes...
It's always a YMMV sort of thing, but I ran into very similar issues between finishing a 25k and starting training for my first marathon (I had a week or two of recovery running before starting my months of marathon training and that's when the knee business set in). I tried everything...change in shoes, weeks off, stretching, cross-training to work my quad support muscles (cycling)...nothing worked. As a last ditch I threw in a pair of Superfeet insoles and it was like magic. I continued to wear Superfeet for a couple of years. Gradually working from mildly posted, lower rise shoes -- eventually ditched the insoles -- to a lower rise neutral shoe. That's where I've been ever since. I haven't had knee issues, since. I don't entirely know what caused my issues. Maybe overuse. Maybe too much shoe/stability.
No published goals...not going to jinx things • $500
Getting the wind knocked out of you is the only way to
remind your lungs how much they like the taste of air.
~ Sarah Kay
This is all encouraging and certainly sounds like an overuse syndrome. The fact you did what you did and came out of it ok (right??) makes me feel you just need a little time to bounce back. Look for steady improvement which would be a positive.
yeah, i just got home from another long walk with the dogs and today i felt so good i wanted to start jogging, but i didn't. the nurse practitioner told me one more week off, so i'll hold off but next Monday i'll probably try a slow easy jog again