Hopefully Marcus' good progress is catching! I'm back from my appt. with my PA...with good news and bad news... Good news: nothing wrong with my knee Bad news: nothing wrong with my knee I'm not really all that surprised, actually. The PA manipulated my knee, sort of twisted my leg both directions with knee bent, applied pressure, bent and straightened my knee, and really couldn't find anything structurally amiss or any signs of knee weakness or instability. He's in agreement that what I'm dealing with is almost certainly an overuse thing in the form of "runner's knee" or perhaps some sort of bursitis or tendonitis (which he admitted can take months to heal, especially if one is still continuing with the activity that caused the issue). I asked if ITBS could be an issue, but he didn't think my symptoms fell quite in line with that. The fact that I am able to do shorter runs without any problem and am pain free at least half of the time and really only have pain after 6 miles or so on longer runs had him believing that I'm irritating and re-irritating something, not that I have any meniscus issues...an injury like that would have me in pretty much constant pain and would prohibit running entirely. He doesn't think running with the pain is doing any sort of damage, other than making me really hate my knee and dislike running for a few hours each week. He's recommending that I scale back on the miles I had been doing (which I'm already doing), continue with the quad work, bike if it's not causing pain, and consider having my gait/shoes reassessed, though he thinks it's not likely a shoe issue, since I've been in essentially the same shoe for 9 months and only had issues for the past 2.5. He also said that he would refer me to a PT if I wanted, but that there's not likely much a PT would have me doing that I'm not already doing. He'd also schedule an MRI, but that he really doesn't believe it's going to show anything amiss, which has been my suspicion. So...I guess it's mostly a good prognosis. I'll continue to train to the best of my ability and if it gets to the point where things are not getting any better even with more conservative training and cross-training, then I will probably suck it up and take as much as a month off...and forget the marathon for now. He didn't recommend that I stop running entirely or forget the marathon goal, so that's promising.

I know you've been doing a lot of quad work, which is cool. However, a lot of runners are notorious for having big quads and weak hamstrings. Is it possible that you're in this boat? If so, a lot of quad work and no hammie stuff would only further a muscle imbalance. Something to think about and ask your PT.

Hmmm...it's possible, but I think runners almost always have quads that are relatively weak--compared to their hams (I know Trent has discussed this, too). Not that their quads are weak compared to the average population, but quads should be significantly stronger than hams, and if there is even minor imbalance (especially if the hams and calves are too tight) it can cause the kneecap to be pulled out of track--hence the popping and clicking when the knee is straightened (which I have always had, at least since puberty). Compared to my quads my hamstrings feel really solid--though that could just be where my fat likes to deposit on my legs.

I've never actually had any hamstring issues, *knocks on wood* but I have had some very tight calves over the years. I've always stretched the backs of my legs very thorougly, but sometimes I think I'd benefit from stretching several times/day. I also think I will benefit from doing the lower mileage Higdon plan. It requires 1 day of cross-training/week in exchange for some miles. I think getting on the bike and working muscles opposite what I work with running AND still getting the cardio benefit can only be a good thing.

PT's know the body sometimes better than docs. If your insurance will cover you go go go. my friend who had pain that would only occur 5 miles + in to her long run was able to work with her PT so she would go out for her run and run to his office and get there about 6 miles in to her run and he would interrupt what he was doing to evaluate WHICH tendon was pissed and watch how her gait was when she was fatigued.

Oh, now that is way cool! I'm not sure if we even have an PTs within running distance, unfortunately. Pretty sure we don't have any sports PTs. I'm going to play it by ear for the next week or two. The last 2 weeks I have had reduced mileage. Hopefully after this week I will have a better idea if knocking my mileage back is helping--that should tell me if the problem is simply more miles than my body is ready to handle consistently at this stage in the game. I'm also thinking about going and having my gait looked at--haven't done that in a year. There is a good running store 40 minutes away (as opposed to the other really good one an hour+ away...gas...ow). My biggest hurdle is finding a shoe to actually fit my foot. Narrow heels and wide forefoot REALLY limit my selection. I also can't seem to tolerate anything without a really flexible forefoot without feeling it in my arches and shins, which eliminates most moderate stability shoes (LOVED that new Saucony Progrid Guide, but the high, curved heel tabs didn't like my achilles).

Ahhh...gotcha. I'm really hoping that this knee garbage is just my body's way of saying "too much, too soon." Now I definitely know why so many say not to even think about a marathon until one has been running for several years (I had logged just over 2 before starting training). I have to say that in hindsight I'm agreeing. But I have never been injury prone, so the timing of this is just so frustrating.

Zooms...not to freak you out or anything, but clinically my knee was entirely stable. On MRI only some bone marrow edema showed up (which can be symptomatic or non-symptomatic). Like you I was told too much running....inflammation, rest, ice, PT, strengthen, etc. At the end of the day none of that crap solved the problem. The diagnosis of pateller-femoral pain syndrome (runner's knee) was incomplete. While I am sure I had that to an extent, it was not all that was wrong on my right side. If it had been, 90 days of little to no running would have fixed it. Clearly it did not. I knew something was structurally wrong, even though the MRI said otherwise. Being a doctor treating you or I is difficult. They have to ask how well do we know our knees? Are we being typical neurotic runners that just need to scale it back a bit or is there something really wrong? In my case I had to wait 90 days and 3 doctors before someone finally believed the MRI likely missed something. The moral of the story is that you need to take charge of getting this fixed. If you trust and agree with the diagnosis, do the treatment and move on. But if you honestly think something might have been missed, take charge. It's your right as a patient.

Zooms, you said that this sucker usually kicks in after about 6 miles or so. So you may want to try doing a double here and there to still get you miles on (run two five milers instead of a ten on a longer day).

It's so hard to describe pain because it's entirely subjective. We are probably a little different Z. Not to be dissing or anything, I have had to endure small aches and pains over years of athletics whether it be running, cycling, swimming, football, etc.

Yeah, but have you dialated from 4cm to 10 in 40 minutes with pitocin and no epidural... I know I have a fairly high tolerance for pain from all of my reproductive abnormalities, too. This can be a blessing and a curse.

But we learn over time what's normal run of the mill pain and what is beyond that. Well, most of us learn that. We all know the stories of people that push too far past that and suffer career ending injuries. I have always listened to my body because on a very few occassions where I thought I should ignore it, I was quickly reminded who was in charge. That being said, prior to my injury I really didn't have any signs of something serious coming at me. I was recovering from runs normally and not running on anything I saw as problematic. One week I ran 75 miles with a 22 mile run that Sunday and on Monday morning I couldn't run 10ft. The pain was diffuse about both knees, right greater than left and hurt worse going down stairs, thus the runner's knee diagnosis. Sharp pain to me is a stuck kidney stone. My knee pain was pretty much dull with quick periods of short lived sharpness. Even at its worse the pain was not that bad. It never kept we awake at night nor made me want to cut my lef off. I just couldn't run normally without pain and that was the problem. My stride was being altered because I was babying the knee.

Could you not run at all? That is what I can't figure out...if I did all my runs <5-6 miles i would likely never know i have any issues. it's the strangest thing. i have very few issues just walking around, either...stairs don't seem to bother me much, or walking down hills--though running down them is not comfortable. jeff, i have thought about doing a few doubles, too--just to see how i fare with that. the only tricky part is the timing. i try to do my running earlier in the day as much as possible (the last 2 weeks of summer are gonna be tough--no childcare for dane, so all of my runs will have to be done with him along on his bike, evenings, or when i can find a friend to entertain him for a few hours), so that did has the evenings to get on his bike. sometimes i wish we had a dreadmill. miles="" i="" would="" likely="" never="" know="" i="" have="" any="" issues.="" it's="" the="" strangest="" thing.="" i="" have="" very="" few="" issues="" just="" walking="" around,="" either...stairs="" don't="" seem="" to="" bother="" me="" much,="" or="" walking="" down="" hills--though="" running="" down="" them="" is="" not="" comfortable.="" jeff,="" i="" have="" thought="" about="" doing="" a="" few="" doubles,="" too--just="" to="" see="" how="" i="" fare="" with="" that.="" the="" only="" tricky="" part="" is="" the="" timing.="" i="" try="" to="" do="" my="" running="" earlier="" in="" the="" day="" as="" much="" as="" possible="" (the="" last="" 2="" weeks="" of="" summer="" are="" gonna="" be="" tough--no="" childcare="" for="" dane,="" so="" all="" of="" my="" runs="" will="" have="" to="" be="" done="" with="" him="" along="" on="" his="" bike,="" evenings,="" or="" when="" i="" can="" find="" a="" friend="" to="" entertain="" him="" for="" a="" few="" hours),="" so="" that="" did="" has="" the="" evenings="" to="" get="" on="" his="" bike.="" sometimes="" i="" wish="" we="" had="" a="" dreadmill.=""></5-6 miles i would likely never know i have any issues. it's the strangest thing. i have very few issues just walking around, either...stairs don't seem to bother me much, or walking down hills--though running down them is not comfortable. jeff, i have thought about doing a few doubles, too--just to see how i fare with that. the only tricky part is the timing. i try to do my running earlier in the day as much as possible (the last 2 weeks of summer are gonna be tough--no childcare for dane, so all of my runs will have to be done with him along on his bike, evenings, or when i can find a friend to entertain him for a few hours), so that did has the evenings to get on his bike. sometimes i wish we had a dreadmill. >