Are you doing any PT? Strengthening stuff? Taping?

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mmm-mmm-Momo Charms
Handmade beverage charms, jewelry, and miscellanea
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Damnit! I missed being first! Plenty of experience on the board and in past threads. The search function is wonderful ;-)

Well changing your handle is prob a start. Do more swimming and biking, run as little as you can. You would be surprised how fast you can be on very little run mileage.

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Visit The Chipotle Calorie Calculator

No - I don't think you are screwed. I would get a second opinion from a doctor sympathetic to running. I had runners knee several years ago, and the fix was learning that I needed stability/motion control shoes. I also developed it because my quads were realtively overdeveloped vis a vis my hamstrings.

So, I stopped running long distances (more than 30 minutes), ran in better shoes when i did run, and worked on my hammys.

Perhaps even better than a doctor would be a good, sports minded physical therapist. Its been my experience that a good PT knows as much and sometimes more than doctors about how the muscles/ligaments/bones work in conjunction with each other to produce a result, good or bad. I'll bet a PT could help you strengthen what needs to be strengthened.

Runners knee often occurs as a result of doing too much, too soon. So back off for a bit, make sure you are running in proper shoes, and perhaps strength train. I also found kicking in a pool on my back to be a good exercise when i was suffering from Runner's knee pain.

Daily naproxin + 1 month of no running (still biking and running) + a slow start up seemed to resolve the situation for me. N=1.

My runner's knee was due to weak quads and tight hamstrings pulling my knee funny. I did 3x20 squats (no weight) daily and extra stretching for a couple weeks and it fixed up the problem with me not having to take any time off.

Thanks all. My issue was definitely too much too soon. I basically took three months off from running because of an ankle sprain that wouldn't heal. I was supposed to run Boston so I jumped back into running with too much too soon on hilly, uneven trails and the runner's knee was the result. Boston is out so I'm now willing to do this right and take it slow.

I haven't been doing any PT, strengthening, taping. Rest was my method of attack and I took two weeks off. But 20 minutes on the treadmill on Tuesday convinced me to go see the doc. I'll give a search of the forum a try, but I'd still love to hear success stories. Doc depressed the hell out of me.

You're not screwed. That's a pretty standard response from a Doc, maybe even a bit more pro-running than usual.

I would suggest you're first step is getting a good stride analysis done. You need to identify the cause. The pain is the end result of what is most likely a string of causes, identifying the initial issue is key.

Next you can probably address the cause with strengthening and/or flexibility. Don't necessarily jump onto the motion control shoe route. This is often just putting a band aid on and masking the real issue, which is probably and imbalance of some sort.

Not having seen you run and not knowing much I would suggest low weight high rep strength focused on quadriceps and hips but not ignoring hamstrings. What usually works very well is seated single leg quad extensions (on a machine usually), box step ups done at about 80degree knee angle when standing with one foot on box and one on floor, single leg step downs off a box on same hight box focusing on not twisting your hips and keeping your knee in alignment, drop only till the non working leg touches the floor don't transfer the weight completely.

I would say do 3x20 to start on the quad extensions (each leg), 3x10 on the step ups and step downs do it every other day and build to every day. The weight is very low only body weight on the step ups/downs. It will probably hurt a bit starting off but should improve. Also warm up on the bike or rowing for 20 min.

Also massage addressing quad imbalance and potentially the TFL (tensor facial latae) is a good place to look.

Lastly, I've had great results with Trigger point dry needling. It can be a bit intense but usually corrects my issues. However, massage or needling may fix it for a while but you still need to address the stride or strength issues.

Check out:

http://gaitanalysisonline.com/

Good luck

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Jimmy Archer
Pro Triathlete/Coach/Freelance Writer
http://www.jimmyarcher.com
http://www.dirttri.com

developed runner's knee 3 weeks before a marathon, ran the marathon, took a week off to recover, Runner's Knee was gone. Just my experience.....

I think your doctor's advice is sound, but I also think you could possibly have a better prognosis.

When I first started marathon training a few years ago, my very first injury was runners knee. I even went to the doctor! Here is what fixed me.

1) Take some time off if it hurts just walking around.
2) If you are pain free, run until it starts to hurt. But stop running once the pain starts. This could be 1 minute or 1 hour. Slowly build distance. It will happen.
3) Focus on your running form. This is a topic of hot debate, but if your form is good, your injuries will be minimized.
3b) What improved my running form was to get different shoes, and focus on cadence. I was over striding and really landing on my heels putting a lot of pressure on my knees.
3c) Another thing that caused my runners knee was too much speed, too much volume, way too fast. I was a new runner and thought I'd hammer every run with a heart rate of 180.
4) One leg squats are good for strengthening the knees. I used to do them in the shower. It can help.
5) Once you start to get some mileage, don't go crazy. Ramp up volume very slowly, especially runs with intensity (intervals, reps, tempo runs).

I think that once I really, really started to focus on recovery, it took about 4-6 weeks to be completely healed. Good luck!

When I felt that I was getting runner's knee I went and saw my PT. After doing a strength assessment he said it was probably due to having weak hips which help support the knee. He prescribed core and hip strengthening exercises along with supportive shoes. So far so good.

Are you talking about Patellofemoral (under the knee cap) pain or ITBS (Side of the knee)?

I second finding a new doctor... first one that gives you a more accurate diagnosis than "runner's knee" and secondly, one that accepts that "stopping running" is the last possible solution.

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sometimes you just have to eat the cake

I'm talking patellofemoral.

And thanks to all who've replied.

I'm almost a year out from diagnosis.
First I'll say, my pain was in between the VMO and knee cap area with a pulling sensation, rarely actually behind the knee cap.

Second, I first was diagnosed and took 2 months easy, started back up easy and it returned when I got close to "normal mileage" for me.

I've now been doing PT for 6-7 months. I started with loosening my IT band, stretching my hamstrings and glutes and strengthening my VMO. After that my PT seemed stumped and tried a lot of stuff. I eventually went to a new PT who worked on loosening up the muscles in my hip and back and strengthening my glutes. That has seemed to be more effective and I now have pain free days quite frequently.

I would say talk to a PT/Physio type doctor. Try foam rolling and stretching everything.

Good stuff, thanks. This might be a stupid question, but what's the difference between a step up and a step down? I'm having trouble visualizing this. They seem like they're both part of the same motion--step up, step down, repeat. Am I missing something?

PFPS, not a hard issue to resolve.

1) ensure lateral stuctures of upper leg are not tight (thomas test will identify this quickly, as well as modified Ober's). The ITB attaches to the patella thorugh fascial structure and can pull the patella laterally causing poor tracking and retropatellar pain.

2) Ensure the hip abductor and external rotators of the hip are strong, if they are not they can not control normal tibial during stance phase. (test this single leg squat, watch for medial tracking of the knee)

3) strengthen VMO (not as important as people thought 10 years ago) creates medial moment on patella.


For qucik pain relief see a PT who can perform ITB stripping and patellar taping.

Run volume can be decreased, but often this is not even required. Remeber the pain under your patella is a not the problem, it is the result of a biomechanical issue. Like a tire wearing out from a poor allignment.

Had runners knee in 09. Got it in June, a week after a half IM. I was putting in some big work getting ready for IM Canada that Aug. When it was first sore, I took a day off. Ran 2 days later and felt great for the first 30 mins. Then the last 20 mins home it hurt like hell and I kept running.

Needless to say I should of rested it after the first occurrance of pain. After that second time, I couldn't walk stairs, or even run more then about 1mile without pain. I would rest for a few days an try again. Then rest for a week and try again. Yup just kept making it worse. I did ART, dry needling, acupucture, massage, naproxin, you name it I did it (except REST). I started to stress that I would never run pain free again. A none running doc gave me the same advise as you, I may be dealing with this for ever.

The physio I saw stated that yes the hamstrings and quads were very tight! What eventually cured it was stretching and most importantly REST. I eventually stopped running or even trying about 6 weeks out from IM Canada. Did IM Canada and it hurt but nothing like it did before. After IM I took about 1 and 1/2 mnths off, an got back into it slowly. Never a problem since and average 45-55miles a week (stretching has become a huge part of my routine).

My advise is REST, I probably ended up dealing with this issue for 6 mnths, vis 1-2 months if I would of rested. AND stretching!

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Darren

Awesome? Is there any explanation for this?

The step up is probably self explanatory. Get a box, or one of those aerobic class steps. Start with both feet on the ground and step onto the box then back down, always facing toward the box. I like to do alternating R leg lead, L leg lead, so you have to switch at the bottom.

The step down begins on the box/step facing out or away from the step. You will step down just till your toe touches the ground then back up onto the box, so your weight is always supported by the same leg. It's kind of a single leg squat, but different. The key is to try to do it toward a mirror so you can monitor your hips and knee. Be sure to keep your hips level, don't let the hip kick out to one side. Also watch your knee and don't let it bow in or out which will be the tendency to try to balance. This is a slow controlled movement. Thus I like to do 10 on the R leg then 10 on the L. It is tricky so feel free to start on a lower step.

You could do single leg squats using a Smith rack and could even use a Bosu ball or some other stability device since the Smith rack will add some stability. Its a similar movement, but I like the step down better.

The point in the step up, step down, and quad extension are to work on your quad balance and hip stability, which will contribute to your quad balance. The quads fire internally to externally from full flexion to full extension. "Runners Knee" is usually caused by a tracking issue around the patella due to an imbalance. Usually it is seen in the patellar tendon but you should be able to feel if it is on the inside our outside of the patella. That will give a good indication of where the imbalance is and maybe where to focus rehab, but is best to work the full range bilaterally. However, that brings us back to where is the cause? Do you pronate, supinate, have you ever had injuries anywhere along the line, hip, knee, ankle, foot? Are your hamstrings or hip flexors weak? Those are all things to look at and area all translated into your running stride and form. The strengthening could fix it, or it could just put a patch on it. But, it should help.


Jimmy

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Jimmy Archer
Pro Triathlete/Coach/Freelance Writer
http://www.jimmyarcher.com
http://www.dirttri.com

I would also get a new doctor. He obviously knows nothing abou itt. Key is to rest long enough for the inflammation to go down, let the homeostasis of the knee return. I have read some very good articles online on this in the past

I can't explain it nor could I believe it. It was hurting so much it was hard to walk down stairs. There was no way i was going to not do the marathon even if i had to walk it, but that morning i started running and had no pain. Figured I'd run until there was and never felt anything. It hurt like a bitch run up and down hills 4 or 5 weeks out from the race, so during my taper I just stayed flat and took a little more taper than typical. Maybe w/ that and then the week off (or maybe it was 2 weeks) afterwards was enough to cleared it up.

Got it. This makes sense. Thanks so much.

What did you do to strengthen the glutes?

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So I posted back in February about a runner's knee diagnosis. Since then I've been doing VMO strengthening exercises but no luck. I saw a second doc who agreed with the original diagnosis. I've had a couple sessions of PT but so far it hasn't made much difference. I've run maybe three times since February for no more than 15-20 minutes. I ran two miles two days ago and the knee felt okay while running, but since then it has been very achey.

And that's been the real problem. It's really not a sharp pain or anything. And in general it doesn't feel any worse when going up and down stairs. My PT said that the tracking of my knee cap doesn't appear to be off (although I realize the tracking could be off by a mm and not be noticeable, but still be causing the problem). It's just that my knee aches all the time. And it's basically my entire knee. Sometimes the medial part of my knee aches more, sometimes my knee cap, sometimes out near my IT band. Part of me wonders if I should just suck it up and try to run through this and see what happens. When the problem started, it was only when running and it was more painful. Now it's just an uncomfortable, annoying ache.

Anyone have any experience with this? I realize "achey knee" isn't much to go on but I'm grasping at straws here. It's spring/summer and all I want to do is run...

Thanks.
Dan

I had it Dec last year. Backed off a little, used a couple of Nike knee straps. Hit the leg press machine and the hip abductor & hip adductor machines and it was gone with in a month.

Yeah I'm pretty good about working my hips; I've had some IT band issues in the past. No leg presses right now because I'm trying not to do anything that involves bending my knee. I've been doing straight leg raises for my VMO.

That doctor doesnt know what he is talking about. Runners knee is definitely cureable. Quad strengthing drills, an anti-inflamatory, and rest will be your best bet, if you want it to go away permanently.

Runners knee is basically tendonitis of the patella tendon, and although the doctor was incorrect about the remedy, he was correct about that it will not cause you any structural damage, but it will continue to progress till its too painful to run.

Taking time off is difficult, but in your situation its a must, that is, if you want to run pain free.

I went to the doc with the same complaint. However, I went to a D.O., not an M.D. . In my experience, a D.O. looks beyond the primary affliction and finds a connection that may be causing the issue, i.e. a very tight Illiotibial Band and super tight hips. I picked up a foam roller (which was beyond painful on my IT band at first) and rolled it out 2-4 minutes daily. I also statically and actively stretched my hips- Knee feels 10X better, not perfect, yet certainly not the pain I was feeling previously. Best wishes!

Yeah I've pretty much been doing everything you mentioned and no luck. That's what is so frustrating. No real running for almost 4 months. Quad strengthening drills. Stretching. I did 10 days of aleve 400 mg (i think) in the morning, 400 mg in the evening. That was a few months ago though and now I take it only when my knee is particularly achey. I actually just bought some aleve today so I can try another 10 days of it.

Patella Tendonitis is termed 'Jumpers Knee', which is different to runners knee. It requires eccentric knee exercises to remodel the tendon

Runner’s knee – Patellofemoral pain - inflammation and softening of the cartilage under the kneecap, resulting in pain. This requires rest to reduce the inflammation and allow the damaged tissue to heal. Very common and much easier to heal than Jumpers Knee

Rest from anything that irritates it (ie running), ice and anti-inflam. And it really should be healed in less than 3 months. At least that was my experience

Have you had X-rays or MRI done?

My runner's knee turned out to be:
-- Chronic partial tear of MCL
-- ITBS
-- Patellalfemoral Syndrome
-- Early onset of Osteo-Arthritis

Long and short, almost most of my cartilege is worn, and lots of strengthening, stretching, icing and other maintenance needed on a regular basis.

I had an x-ray that was clean. No MRI.

as a doc i can tell you that most docs are useless to you unless you have a serious injury.
and most people don't.
runner's knee is a garbage can diagnosis that has no evidence to back it up.

on big question is how long have you been running and at what volume. most pain in the ass injuries like yours occur in the first few years. it is rare, in my experience, that the body cannot adapt to what you are asking of it. you just need to learn what is serious pain from what is the pain/joy of running.

if you can run and the pain is not getting worse, keep running. the day after is always your test. and if the pain is not getting worse then you are not hurting anything.
strengthening exercises rarely work.
use ice.
try glucosamine supplements.
use traumeel.
use kt tape.
get away from support shoes and orthotics is you can.
try the most cushioned and neutral shoe you can for a while.
use two or three different shoes and rotate.

try some accupuncture.

my two cents

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jjk
http://enduranceanimal.blogspot.com/

Thanks for the thoughts. I've been running for about 7-8 years. Picked it up after rowing for two years in college. I ran a marathon last fall; 2:48 on a very hilly course. Mileage was 60-70 mpw. The knee problems began after a couple months layoff back in the fall after the marathon after I sprained my ankle. Ankle was finally good to run on in the last week of December when I ran 13 out of 14 days trying to run myself back in to shape so I could train for Boston. Was running hilly trails with uneven footing and I just did too much too soon I think. But now I can't get my knee right. And right now it's not pain. It's discomfort that I know is not right. I tend to run through lots of nagging injuries. Every now and then I get something that I think I shouldn't run through. This seems to be one of those things.

As for doctors being useless unless it's a serious injury, I tend to agree. As one who has had PF, ITBS, and now my knee, I find myself going to the doc hoping I've torn something.

Sorry to hear about your frustrating experience with this.
Lets assume that the diagnosis is correct (not a hard diagnosis to make).
Unless I've missed something your focus had been on the knee and since you are not improving I would broaden your view.
There is very good evidence in the sports medicine literature that lower extremity injuries are related to core/gluteal weakness. One thing I do in my practice is video people running and the core weakness is usually apparent as a subtle dropping of the hip on the opposite side of the weight bearing foot. When this is happening it affects everything below the hip and starts to affect the knee.
By incorporating core and gluteal strengthening exercises into your program you can improve PFS.
One other suggestion. Go to the American Medical Society for Sports Medicine, amssm.org and find a local primary care sports doctor to take a look at you.
Best of luck.

I will have to think back... I am almost 100% positive my x-ray was fine as well. I think it showed some of the early onset of osteo-arthritis, but the "you should find low-impact exercise" conversation did not come until after the MRI

9 years later. doubt you are still on the forum. but what ended up happening with your knee problem? I ask bc I am currently dealing with and very frustrated.

Yikes, I'm not sure why the doctor went with such a bleak diagnosis. I've had runner's knee before and it's really just a rest and strengthen situation. I will tell you, that guy that said get a run analysis done was right though. Chances your probably not landing perfectly right, that was certainly my case. I was way overstriding and putting way too much force into my knees, a few adjustments and I'm fine. I only required a few weeks of rest. Definitely don't feel as though this is a death sentence, it's really more of a chance to evaluate your running and then getting back better than ever.

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Team Zoot 2023

Get some rest, evaluate your form, fix what's wrong, and you'll come back better. Runner's knee is pretty common, definitely not a death sentence.

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Team Zoot 2023

wow. didn't expect a reply. Thanks! I have been in PT for 5 weeks (going on 6). No running except short intervals on an antigravity treadmill at 70% (walk/run intervals) this past week. PT plans on putting me on regular treadmill next week to analyze gait/running form. Just a little frustrated bc while there is no acute pain, I still get the occasional (and quite random) bouts of achiness. But I'm hopeful that I will get better soon. Question: how did you get back to running ... a walk/run build up ... or just running with a slow build up? Did you ever experience pain when you returned to running? Thanks.

Well first time I got it 3 weeks prior to the LA marathon and then went a ran the LA marathon, so that was measurably stupid. The second time was in prep for IM texas this year. I find when I try to slow down for really slow runs is when I start to heel strike and that definitely triggers it. I know some people say that at speeds slower than 7:00/mile that heel striking is more efficient, but it definitely triggers runner's knee for me. The first time after the LA marathon I had to take 3 months off. After each 3 weeks I would attempt to run and when I felt the pain, I would stop and walk home. 3 months was brutal, I hadn't had that long off running ever. This year I took 2 weeks off with absolutely no running, still swam and biked. I filmed myself running to look at my gait and I was heel striking and over striding despite aiming for 8:00/miles. Just the slightest focus on posture and foot placement can be the world of difference. I'm back to running after that incident just 1.5 months ago, just did 9 miles the other day and felt great. I think the big thing for me is to do some self checks while out running. If my calves are not engaging and firing, I know I'm not striking correctly. It's such a small change I've made, but it's been the difference between unbearable knee pain and being able to run pain free.

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Team Zoot 2023

Been there. I know your pain. I started by taking time off in lengthening increments (a few weeks, then a few months) and it didn't go away -- came back before long as soon as I started running again. I tried doing PT, but sort of half-assed it, because it was "easy" and "boring" and the PTs didn't really inspire me. Had two surgeries (plica removal, and petellar tendon debridement) and PRP injections. Didn't help. Maybe even made things worse. Still never got up to running more than ~10-15 mpw and the pain would come back. So I threw in the towel, found some new hobbies (racing cars and sailboats), and took nearly a decade away from endurance sports.

Woke up one day and decided I was going to do another Ironman. I found an incredible PT. Worked my ASS OFF (literally) strengthening glutes and hammys, doing core work, and just strengthening muscle imbalances that came with starting long distance running too young (started marathon running at 13).

Finished that Ironman last year and a great season back in the sport. Haven't had any pain since. But I stay on top of the "prehab" doing it at least 2x/week, usually 3x. On track for 70.3 PRs this summer and getting my marathon time down to <3hrs.

So don't despair. Find the PT, not just any PT. Find one who is a genius, who has worked with pro athletes. Get strong like a bull. And don't let some non-sympathetic doctor tell you that you can't do what you love. It's OK to take some time off and REALLY get strong. So strong you jeans don't fit your big strong ass anymore. So strong your wife is like, "wow honey, you used to have no ass and chicken legs, and your ass looks amazing". Like, that strong. Swim a lot, and even if you don't, the fitness will come back much faster than you think. I took 10 years off any meaningful exercise and am hoping to clock in a <3hr marathon after just 18 months of running.

ortho doc here (and triathlete)...and at one point I did have a bit of "runner's knee" which was really a catch all term for a sore knee in a runner without another obvious structural cause, like a ligament injury, meniscus tear, etc.

it will likely take a few weeks if not 4-6 of being consistent with the strength/PT program to settle things down. myofascial release treatments or ASTYM with your PT might be of some help. taking a myofascial release tool to my ITB and really focusing on stretching it out before and after running helped mine to go away....along with making sure I was doing some strengthening a couple times per week. it doesn't have to be anything major, can easily crank through it in 20-30 mins. pay particular attention to the hip abductors and glutes, as well as your quads and hamstrings. strengthening the VMO preferentially is basically physiologically impossible, as it has the same attachment at both ends as all the other quad muscles! check out myrtl hip strengthening....there are reasonable videos on youtube

as for running through it, it's certainly possible if you can tolerate it, but generally if you need to premed with an NSAID (ibuprofen, aleve, etc) it can cause more problems than it fixes, so I would avoid that. focus more on softer surfaces when you do run....a dirt road is better than a concrete sidewalk.....a good treadmill is pretty good as well. hope that helps!

Thanks for your reply. Going on week 7 of PT. Have been building up my run time gradually on an anti gravity treadmill w walk/run intervals. Up to 4 minutes running (3 intervals) without pain while running. What is nagging me is the achy knee I feel afterwards. Sometimes 12 hrs, sometimes 24 or 48 hrs afterwards. No one specific spot, just an achiness on the inner side, sometimes top, sometimes just general achiness Is this normal? Should I continue to progress w my walk/run intervals despite this achiness that I can’t seem to kick? My PT seems to think it’s ok but would like opinions of people who have been through this injury. Thanks!!

Thanks for your response. The thing is, I feel like I have been giving my all you PT. 3 office visits a week. 4 days of dedicated exercises at home. Getting Graston, art and deep tissue massage done on the quads, calf and hamstring and hip and glutes. I can run painless when I’m doing walk/run intervals. PT has progressed me up to 3 minute walk/4 minute run (x3). What concerns me is the achiness I fee after those sessions. Sometimes 12-48 hrs after. No pain, just a general feel
Of achiness. Both doc (had MRI done) and PT say to progress as long as it doesn’t hurt to run. Just wanted opinion of someone who has been through this as to how their recovery went. Thanks!

I think it would be more concerning if it was always aching in the same spot, rather than seemingly all over the knee in the aftermath of running. I think it's probably ok to continue to progress your intervals as long as your pain isn't becoming more frequent or more consistent in one spot. has your PT (or yourself) been doing any myofascial release along with your treatments?

Thanks for your reply. That’s what my PT thinks as well. And he has not done any myofascial but I am seeing a separate PT who works the leg muscles and hip with Graston and myofascial release.

Yep, I’m still around. This post from the past is timely for me, unfortunately, because I just started having some knee issues again this week.

I did eventually get back to consistent running. I did PT for awhile if I remember correctly, but for me the main thing was just a lot of time off from running. And in 2013 I bought my first pair of Hokas and my knees have been more or less okay since then. I was able to train to run a sub 60 10 miler a couple years ago. And last year I ran my first 50K. I’m hoping to run a 40 mile trail race in Colorado in August.

So there definitely is hope. It might just take longer than you’d like.

Hey thanks for the response. Did you wait till there was no achiness at all to start up running again or did you slowly build and find the achiness went away?

Sorry to hear your knee issues may be back. Good luck!

If I remember correctly I think I waited until the achiness was gone, maybe not entirely but for the most part.

I picked up this little tool a while back when I was having my knee issue (and has since used it on similar things as well as some plantar fasciitis with my wife). seemed to work well for me, and it comes with a handbook and website links for specific areas to work, etc. maybe it would be of some benefit? https://www.amazon.com/...dp_s_web_10540308011