Runner's knee?

[1Daniel]

So I was determined to win a weekend warrior challenge and look where it got me... 😞 ha

I'm new-ish to running - I said goodbye to my old sloth ways at the start of the year. I have mostly done small runs combined with plenty of walking. I'll do a mile or two twice a day, with long walks on weekends - 10k or so quite often.

I've done a small handful of 5ks (23-28 min) without a problem too, but only 3 in total over the last while.

I did a 5k on Friday (all fine) and on Saturday (yesterday) I asked a friend if she wanted to do a 10k - something I've never done before (as said, I've only done 3 5ks). We went for it and though it was really tough (lots of hills), I managed - 55min. But my left knee in particular just randomly became very, very sore for the last couple of km. I feel it was maybe stupid to jump from short runs/the odd 5k here and there to suddenly a 10k with hills. 😞

Last night, it was extremely sore, particularly when going down the stairs.

Running for me is more just for general fitness, not toward a particular goal or anything, but I'm loathed to not do any exercise for who knows how long...but I know I need to rest it!

Today I went for a 90 minute walk, and though it was tender, it never got to the 'sore' level. I slept with a pillow to raise it, and I've been using the deep freeze spray a few times a day. Have also gotten a glucosamine supplement (not that it'll have any immediate effects but figured it wouldn't harm). Also taking ibuprofen.

It was ok for most of the day today but this evening it is feeling quite sore when walking (which wasn't the case earlier in the day), though it's nearly ibuprofen time again.

My questions are:
1 - is there anything else I should be doing to help recovery?
2 - am I ok to do these walks? During the week the walks won't be long like today's was, but I am not sure if I am helping or hurting by going on the walk.
3 - how long should I wait before I try my 'daily mile' runs again?
4 - any other tips and advice?

I am extremely nervous about any long term damage and about how to get this sorted asap.

Thanks!

[ThatGreen]

While I can't give you a diagnosis because I'm not a doctor and this is the internet, I'd say you're doing ok so far. You're pretty much following the RICE principle, which works for a lot of things like this.

I would be careful with the long walks (and any running) as this might make your knee swell up (which is what you're trying to lessen with the RICE).
Just take it easy until it starts to feel normal (while not on pain killers) and start out with walking and slowly increase your activity towards your original level.

Best tip: See a doctor if you are concerned.

[1Daniel]

Thanks. How can I go about doing the C in RICE, the compression? I'm not doing anything for that at this stage.

[GershonSurge]

@1Daniel,

You made a classic new runner mistake, and now you will have to suffer the consequences. (Don't worry, they likely aren't bad.)

The first rule of running is if it hurts don't do it. If you get hurt, rest until it stops hurting. 

By rest, I mean only short walks to keep the joint from stiffening. By short, I mean a minute or two at a time.

Taking any kind of medicine can make the problem worse by masking the pain so you can run again. The only time I recommend medication is if you can't sleep, and you don't do more than very short walks to keep the joint loose.

Most likely, you tore or stretched a ligament or tendon. These can take months to heal. If you continue to exercise while there is still pain, the tear can get worse and your knee problem can become chronic. It sucks. Try weightlifting during the months off. Just stay away from leg exercises.

When you recover, and you will with rest, I suggest following Jeff Galloway's recommendations in his book:

 The Run-Walk-Run Method Kindle Edition
by Jeff Galloway (Author)

His method is really interval training in a comfortable disguise. When you want to try a 5k or 10k for a personal record, just omit the walk breaks. 

 Added: If it hurts badly, don't be afraid to get an inexpensive cane. It will help if you need to catch yourself when there is a sudden pain in the knee.

[1Daniel]

So you imagine I should stay off running for months? I was dreading it possibly being a week!

[GershonSurge]

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@1Daniel wrote:

So you imagine I should stay off running for months? I was dreading it possibly being a week!

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Last summer I had to take a couple months off. I pulled a muscle in my back and for some reason couldn't walk or run without a cane. So, I decided to paint the house and start jumping rope. Dumb me. I tore an Achilles tendon jumping rope. During that time, I went to Planet Fitness and did resistance training. Once the pain stopped after a couple months, it only took about a week to get back to where I was before the injuries..

[ThatGreen]

The compression is another way to limit swelling (if you even have any), but not necessary if you keep it elevated. I know compression stockings or an elastic bandage is often used for ankle injuries during more active periods of the day because this is most often the lowest point.

I agree with @GershonSurge, who seems to know a thing or two about running in particular, about the importance of rest. Not sure it's gonna take months, but it's hard to know if it's gonna be better in days, weeks or months.

[GershonSurge]

Sorry, I left out a few things.

First and most important: the cause. The most common cause of knee injury is lengthening the stride by stretching the leg forward. This puts the forces on the knee in a way it can't sustain. Your heel shouldn't land farther forward than your nose. Increase speed by increasing the stride rate. As you do this, your stride length will naturally lengthen.

Inflammation serves a purpose. It helps to immobilize the joint and brings blood to the joint for healing. Pain is your friend as it tells you when you are beginning to over stress the joint.

If you go to a doctor, he or she will probably tell you to rest. If you make a fuss, they might give a cortisone shot or steroid shot to lessen the pain. This will cause you to run before you are ready. At some point, you will do something serious in the doctor's eyes and he/she will send you to an orthopedic surgeon, or they may send you to a foot specialist to get some expensive shoes that don't work.

Addicted runners are great sources of income for doctors as they keep coming back. All it takes to break the cycle is the saying "no pain, more gain." 

[y2kcrash]

The use of the words Runner;s Knee is just too general of term.

Really not a lot of information about the knee pain you are experiencing itself.

Sources and causes of knee pain can numerous (Bio mechanical issues of the foot, hip issues,  IT band issues, muscle imbalances  associated with strength and or flexibility. the terrain you run on itself such as the angle degree of the slope from inside ( usually middle ) to outside of the road or trail you run / walk on, improper running shoe choice ( not all running shoes are made the same)..

A more specific description of the  pain would go a long way. Such as location / type of  pain etc when it comes to suggesting what course of action is best.

As you have done RICE at first is the best course of action no matter the cause.

May want to try using some Voltaren Emulgel Regular or Extra Strength to help relieve the pain and swelling or the short term

A rehab treatment  plan however requires a better understanding of what caused the issue to occur in the first place. 

Search the term "Runners Knee" and you will see the sources of which are numerous.

[GershonSurge]

@y2kcrash, @1Daniel

y2kcrash, 

The root cause of this knee injury was likely trying to impress a woman. 🙂

We are on different ends of the spectrum. 1Daniel is a beginning runner and has many minor injuries in his future. The basic philosophy of taking rest days at the first sign of any minor injury is a sound one. If a person does this, they will never need to learn how to "rehabilitate." I've noticed people who are rehabilitation experts are always rehabilitating from something. Few people seek advice from people who never get injured. In my opinion, people pay too much attention to elite athletes who have to run on the edge of serious injury to win races. Instead, they should focus on the people who run year after year without injuries.

Most people have a good natural form. Bill Bowerman, who coached Steve Prefontaine at Oregon State and made the first Nike shoes said that trying to change a runner's natural form is not a good idea. Jeff Galloway says the same thing except with some mention of common serious errors like over striding. Elite runners are a different case where improving their time by a few seconds in a marathon can result in a win and all the endorsement contracts.

I go through a litany of minor problems every time I take a break for a few months. First it's my left lower back. Then my right heel. After that, it's the top of my right foot. Then my left glute. Then my left hamstring. Finally, it's a muscle between my shoulders. Now, I'm getting a small pain in my right calf muscle similar to cramping. I'm not worried about this one although I won't increase my pace much. Sometimes, I get a few days of shin splints tossed in. If I take time off at the onset, the problem never progresses and doesn't come back until the next time I take a long break.

It helps to keep a running journal so when these minor problems appear, I know how I prevented them from becoming serious the last time. 

[1Daniel]

The pain is mostly a dullness/stiffness, but ever since last night (day 2) it's much more acute when I step, particularly down stairs. This morning (day 3) I am surprised that I feel it (not horribly so, but it's a bit painful when walking), though of course the ibuprofen is not currently hitting me. I feel it mostly under the kneecap.

I will skip walking today, I think, and let it rest, after not really letting it rest yesterday. Maybe go swimming and do exercises at the gym instead.

[Bhuvana]

@1Daniel: Welcome to the run club!  

Even when you train for any kind of distance, you should never increase the distance more than 10% of your current ability. As @GershonSurge says, it's a newbie mistake. There might be some inflammation. Ice it well. (I take naproxen instead of ibuprofen).  If this acute pain continues, do not postpone your trip to doc's office anymore. 

So when you start running again, follow interval running (Run for 10 and walk for 1) and pace yourself. 

Hope your knee gets well soon

[1Daniel]

I went to a physio today. The advice the guy gave was totally different to everything I've read here and elsewhere online. He said no ibuprofen (let the inflammation do its thing, it's natural), no elevation, no ice, and no real rest. Said walking is fine and then start running again by Thursday (but only a tiny bit, then increase). Gave me some stretches to do before each run, though.

[GershonSurge]

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@1Daniel wrote:

I went to a physio today. The advice the guy gave was totally different to everything I've read here and elsewhere online. He said no ibuprofen (let the inflammation do its thing, it's natural), no elevation, no ice, and no real rest. Said walking is fine and then start running again by Thursday (but only a tiny bit, then increase). Gave me some stretches to do before each run, though.

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@1Daniel

There are some injuries that can easily turn into operations. The knees, back, neck and anything to do with the feet are in this category. Any pulled or suspected pulled tendon in any area of the body or injury to cartilage in the joints are also in this category. Many times, the operations don't work and create other problems. This is why I'm so conservative. When I balance a chronic injury that can affect my running for decades vs. losing a few weeks of training, decades win every time.

Let's look at the advice I gave:

Inflammation serves a purpose. It helps to immobilize the joint and brings blood to the joint for healing. Pain is your friend as it tells you when you are beginning to over stress the joint.

Taking any kind of medicine can make the problem worse by masking the pain so you can run again.

The only time I recommend medication is if you can't sleep,
and you don't do more than very short walks to keep the joint loose

The reason I say it's OK to take medication if you need it to sleep is because it will wear off before you attempt to use the knee again. Sleep is a part of healing, too.

I'm agnostic about ice and compression. It works sometimes and doesn't work other times.

Telling you it's OK to walk more than short distances and to start running on Thursday when you are having difficulty going down stairs is nuts in my opinion. What's the harm in waiting until the pain is gone? A week or two of lost training. What's are the most probable harms in starting to run on Thursday while you are still in pain?

1. You could re-injure the knee, only worse this time.

2. The imbalance caused by altering your gait to avoid pain may cause another injury. Most likely to the back on the opposite side.

3. You could trip and put a large amount of force on the bad knee and injure it worse.

Most recent research says only sprinters should do specialized stretching. For everyone else, it can cause more harm than good. I have no opinion on stretching being good or bad.

Good luck to you. Most likely, things will work out.

[1Daniel]

Wise words. I will see how it feels over the next few days and definitely not push too hard.

In good news, I've been off ibuprofen all day today and have pretty much had no pain, even on the stairs (though I've been going down them very gently). It's still a bit tender - so I am aware of there being something not quite right there - but walking about the house etc has caused no problems at all today.

[GershonSurge]

@1Daniel.

That is good news. I wouldn't worry too much about stairs. They are designed to hurt knees. Try going up more slowly and think of straightening your knees like a scissors joint. Press gently on your kneecap a few times to get a sense for the different muscles used. 

[MagsOnTheBeach]

So that is why my knees hurt going down stairs but not up!

I overdid it.  I am limiting myself to 2 miles at a time and took 2 days off running (kept walking).  It seems to feel a little better.  I have noticed NOT moving makes it feel badly too.

[Corney]

1Daniel:  Runner's Knee also known as Patellar/Femoral syndrome occurs when the Patella is moving outside the Patellar Groove formed by the Femoral Condyles.  The majority of the time it deviates laterally due to the Q angle, the angle formed between the long axis of the Femur and the long axis of the Tibia.  The normal Q angle in men is about 6 degrees but is wider in females due to their wider pelvis.  One of the causes of runner's knee is hyper-pronation.  Hyper-pronation causes the tibia to external rotate relative to the Femur causing the patella to deviate laterally.  Your complaint of increased pain going down stairs compared to going up stairs is a RED flag signalling  early to mid stage arthritic changes on the under side of the patella, which will eventually be transferred to the Femur and Tibia.  Check your shoes, place them on a table side by side and if the backs of your shoes are falling toward each other the problem is over pronation.  Solution: get new shoes with a straight last and a firm heel counter for rear foot stability.  You should probably consider some over the counter orthotics which should help minimize the over pronation.  Stretch your Achilles Tendon, and also check your leg length, if one leg is longer than the other that foot will over pronate to compensate for the length difference.  Rule # 1, NEVER TRAIN THROUGH PAIN!  I'm not an advocate of NASIDS, nonsteroidal antiinflammatory drugs.  They relieve pain by decreasing inflammation, but inflammation is the first stage of healing, so in effect NASIDS slow down healing.  In summary:  Check your shoes, get new ones if they are old and the backs are breaking down.  Stretch your Achilles Tendon.  Consider orthotics.  Check your leg length and add a lift to the shoe of the shorter leg. Listen to your body, if running or long walks increase your pain, stop!  If your pain continues when you go down stairs consult an Orthopedic surgeon before it gets worse.  Just to let you know, I'm a retired Physical Therapist with 38 years experience, a retired AVID runner for over 25 years that stopped running when my Plantar Fasciitis problem traveled up to my knee.  Good luck, have a nice day!

[Corney]

GershonSurge:  Sorry George, but stairs are not designed to hurt knees.  Having pain when going down stairs is a RED FLAG signalling early signs of arthritic changes on the under surface of the patella, if ignored will eventually be transferred to the Femur and Tibia.

[Corney]

1Daniel:  A post Script to my previous post.  I will advise you to NEVER allow anyone one to inject your knee or any other joint in your body with Cortisone or any other substance, they may give you short term relief but in the long run they do more harm than good.  Surgeon's just want to heal with steel, be it surgery or injections.