Sigh, when will I learn. When the coaches speak, trainee's need to listen!!!

Saturday morning I ran an easy 5k. I now know there really is no such thing as an easy 5k! At least not when you are running close to 19 miles the next day.

I had a really rough time on the course yesterday, ran the first 9ish miles, walked 2, ran another 1.5, and walked the rest. When we got back to Beaches, I felt like I had gravel imbedded behind my knees. Pretty much every muscle/tendon/bone from the waist down hurt at some point along the way, but the tender area behind the knees is what has remained. I don't usually resort to medication, but have taken advil both last night and this morning. I took an ice bath when I got home, iced again last night, and will ice again when I get home tonight. Is there anything else I should be doing? I'm wondering if a massage would be in order, or if this could just make things worse.

What is your training goal full/half etc.? - Portland Marathon, I'll be walking part of it.

Are you a walker, runner or mix? Runner, but thinking mix might be smarter.

How long have you been training as a walker/runner? Distance walking since 2006, began running around Oct 2007.

What is your current injury? Pain behind the knees that has me walking very gently. If I move wrong it is quite severe

How long it’s been a problem? Since yesterday's 30k

What makes it worse? Moving, LOL!

What is your height, weight, shoe size? 5'5". 130, 7-1/2 to 8. Currently wearing an 8 for the summer.

Have you had any treatment? If yes, what was done? Ice and Advil only.

Disregard above!
I woke up this morning with no pain behind the knees...the ice did what it's supposed to do.

Ice is the 8th wonder of the world!! Glad to hear such a simple modality helped you so quickly!!

Dr Greg

Wait! Don't stop this thread yet! On the 30K I got to about 9 miles and started feeling pain in my knee. As long as I kept my stride short (I have been training slower for the past 3 weeks due to VO2 results) it was ok and I did make it the whole way. If I picked up the pace I got sharp pain under my knee. It was really sore and stiff that day, lots of ice and sleep made me think it was gone. A tiny twinge on my short runs on Wed and Thurs. The problem is, on Saturday's run it started hurting (I could feel it wanting to start hurting I should say) around mile 5 so I cut my run down to 8 miles. It was getting worse as I kept going. It feels totally fine today but I haven't run.

My question: How long do I need to stay off it to let it totally heal and won't that interfere with my overall training? I'm quite worried about any long run now.

General hx: This is my 2nd distance running year with no problems (other than an IT band problem after stupidly running a 10k the week after the marathon!). The IT band sidelined me for 2 months hence my fear over this. And this isn't IT band pain, that much I can tell.

Thanks in advance,
Lori

Lori,
How are things going this week? Which knee is bothering you, and is that the same leg you had IT band issues on? Is the pain behind the knee or under the kneecap? What is you height, weight, age, and running pace?

If I were to guess, I would say that you are probably experiencing a calf strain. Frequently pain behind the knee is from gastrocs that are to tight or over-active. Shortening the stride puts less stress on the joint and the muscles (especially if your knees hyper-extend). Make sure you are diligently stretching your calves and deep compartments of your lower extremities.

To answer your question: 4-6 weeks is the normal amount of time required to heal a mild strain (without re-aggravation) and yes, taking that much time off would not work with the training schedule. A good sports medicine doc, chiropractor, or PT should be able to reduce the healing time in half while still allowing you to train.

I will look for your response.

Happy trails,
Dr Jake

Hi Dr. Jake,

Ran 3.2 miles today without any problems though could feel a little tenderness at the end. Keeping in mind it didn't hurt on Saturday until about mile 4 or 5 either. The pain is behind my kneecap. At its worst it felt like a knife jabbed underneath when I landed on it and it would feel totally fine when I walked, during the run that is. The remainder of the day it was just plain sore and stiff all the time with any pressure on it. The following day it felt fine but I took Tuesday off from running as well to be on the safe side. Wed and Thurs runs a bit tender but not bad. And then more difficulties on Saturday with the longer distance.

It is the same knee (left) as my IT band problem. One difference is this doesn't particularly hurt going down stairs, a bit more going up, unlike the IT. It's also under the kneecap unlike the IT was to the side. One other tidbit; With the IT I went to the doc (Dr. Greenleaf at Oregon Sports Medicine) and ended up with orthotics for my pronation. These seemed to have done well though he didn't think that was the problem with my IT necessarily. That had just been due to stupidity (my words, not his but pretty close).

As for the other technical info: I'm 45 (JUST turned!), 5'8", 135 lbs. I used to run a 10-10:20 pace but have slowed it down to 11-11:30 trying to keep my heart rate lower due to feedback from my VO2 about a month ago. During my weekly runs I was actually running at a 12-13 pace for 3 weeks prior to the 30k as I was supposed to be building up my fat burning abilities. My hunch is that is what led to then over working it on the long run at a 11 minute pace.

I feel like I can handle the short runs but am worried about going 13 this weekend and then obviously about 21 shortly after that.

Suggestions?

Lori

Lori,
Pain under the kneecap is definitely more difficult to diagnose over the Internet. Likely culprits are tendinitis or capsulitis due to the quad being extra tight. Frequently runners use too much quad and not enough gluteal muscles when running, leading to problems like tendinitis and IT band syndrome. I would also want to check for a leg length inequality since both injuries have occurred on the same side.

Worst case scenario would be chondromalacia patella, which is a softening of the cartilage behind the knee cap that starts to erode with repetitive stress. If this is the case it would definitely hinder your ability to run the PDX marathon.

It is important to have this looked at before you run anymore of the long distances. If you can't make it into the clinic this week, then stop by the tent on Sat so I can check out your knee, hips, leg length, and bio-mechanics.

In the mean time, stretch your quads (45 second holds 2-3x/day) and ice down the tender areas (20 min with a towel barrier/ one hour break and repeat 2-3x). You can keep running the shorter runs as long as it doesn't flare you up too bad.

Happy trails,
Dr Jake

Hi Dr. Jake,

I ran last night doing speedwork with Eric and after 4 miles total there was no pain at all. Eric also said that the bike riding I was doing last week, since I don't normally do that, could have added to the problem. I have had all the mechanics checked out previously by Dr. B at Clear Water due to my funky looking stride, and Dr. Greenleaf at Oregon Sports with my IT. Both said while it was "interesting" it shouldn't create problems on its own. Since I can't make it in anywhere this week and while it's doing ok so far I'll see how it goes on Saturday and will stop in if there's a problem. In the meantime I'll do the stretches you mentioned.

Thanks much!
Lori