Likely a load/capacity issue of the injured tissue. The tissues/structures involved currently can handle about 40-60 minutes of load/force/repetition before they get irritated. Your walking gives them a rest, and you're able to pick it up again. Running is very repetitious and fairly high load.

---

CB
Physical Therapist/Endurance Coach
http://www.cadencept.net

Juat got x-rayed today at OrthoAz.
Everything looked good except the saw a small spur on my patella. Recommend gel treatment. I'm not sure this is the issue because when I hit the load, it feels like the inside joint of my knee. Was wondering if the vastus medialis could be weak because it seems a little hot (inflamed) after the run. The pain is not constant, it just happens when I land now and then. I know I didn't give enough info, but I wonder what tissue could be damaged on the inside of the knee. It almost feels like my bones are hitting a tendon or something, but not sure anything is in this area.

Lots of things could be going on, without an in-person evaluation...everyone is just guessing. Its expected for muscles, and tendons to be warm after running. At first blush, patella doesn't match up with medial knee pain---assuming you truly mean the actual inside of the knee. Patella involved pain tends to be on the anterior portion of the knee...usually where it rubs against the femur...can be just lateral or medial of the normal path of the knee cap during flexion.

Without a PT (requires script from the Ortho) to evaluate the injury, you're left with conservative home treatments. My go to for such things is to stop for a few days, and let it heal. Then start back up at a conservative distance that is LESS than the earliest onset. Hold at that limit for a week or two, then gradually begin to extend time/distance again by a few minutes a week.

Hip and ankle stabilizer work is never a bad plan for anyone.

Thanks for the input. Probably need to see a PT. Ortho wants to inject Gel behind the patella next week, but I don't think that's the issue. I'll see if he can refer me to a PT instead.

I went to the Ortho, and he said the fat pad in my knee was irritated. Didn't give much info on what to do for a cure, but I noticed from the MRI, they listed I have Grade 4 Chrondomalacia. I can see this as being the underlying cause of the issue. I can visualize the kneecap irritating the fat pad, or capsule, and after a point (usually around mile 6 1/2 it's had enough. My question is: what can be done about this? I've heard of gel shots-are they any good? What about stem cell-is there any good data with results? Marathons and Ironmans have been my life and I don't want to give up yet. I am 76 years old, so maybe it's time, but that's not the solution I'm looking for. Has anyone run a marathon with grade 4 chondro?

The 5 part Supartz FX gel shots are very good, they might last 6 to 12 months. It takes a person with great skill to do a pain free injection.
But they are extremely pricey.

---

Kevin

I know your MRI said Grade 4 chondromalacia but if that was the primary cause, IMHO, it seems like it would hurt most of the run, and not after 4-6 miles.

Whenever I can run 4+ miles without pain, and then all of a sudden I get knee pain that can be relieved by changing my cadence, or walking, or concentrating on my foot landing, I think about muscle imbalance/fatigue issues. Kind of what PTinAZ is referring to…….he/she knows a lot more about this than the rest of us. With that being said, have you been evaluated by PT to make sure you don’t have muscle imbalance, especially the glutes???

^^ This. Does the OP has this pain when doing other activities - like swimming, cycling or even walking?

I’m two times younger than the OP and started to experience similar symptoms 1.5 years ago. After several ultrasounds and MRIs, I was diagnosed with Hoffa syndrome in my right knee. I tried rest, cortisone injections but it did not help. In fact, I felt even worse after the rest. What helped me was some strength exercises, lots of walking, and reviewing of my existing running shoes. I do not think I could completely get rid of the issue but now I can at least do my activities (I’m focused on Ironmans mostly) without thinking about my knee.

HTH.

---

Слава Україні 🇺🇦✊

Every time I have ever had niggles in my knee, I have traced it back to weak hips. My suggestion is to work on hip strength and stability. Maybe it doesn’t solve your problem, but it certainly won’t hurt.

I may be wrong, but I'm thinking the kneecap, without much cartilage, starts irritating the surrounding tissue (fat pad, capsule, etc) and after 5-8 miles the tissue swells a bit and has had enough. I'm thinking it may be caused by the lack of space between the kneecap and the femur, tibia due to the cartilage not being there. I thought the gel fills the space the cartilage used to take up. I could be all wrong, and probably am, but that's what my logic is saying because the Dr did not address this issue at all. So, I'm trying to solve it, and wondering who else has been in this situation.

Bad thing about loss of cartilage is you lose the cushion for the bone and can develop bone to bone contact. This is part of the pain complex. The bursa (fluid sac) of the knee is always there, and can become inflamed (bursitis) but it’s not really filling in spaces to make the loss of cartilage any easier. The tissue likely does swell some but it’s a damaged area (the chondromalacia) there from the start of your run and all the way through so I would likely hurt most of the run. Many people have to give up running because of it. Your situation sounds more like muscle fatigue instead. Hips/glutes likely need strengthening. I’d go see a good PT who works with runners. Many docs, even ortho, just don’t think much about “runner’s knee” when a patient presents, so once they rule out (or rule in) structural disease, that’s where their focus turns. Runner’s knee is actually a lot more common than a lot of people realize.

This is what I was thinking as well. For knee pain on the inner side of the knee, I'd be looking at stretching and massage for the hip flexors, specifically the sartorius muscle.

I'm with the others, see a doc, therapist, etc. The downside is how do you find one that is decent?

Just throwing in my $0.02, I got terrible knee pain, seemingly out of the blue. Not terribly different than what you described. I went to the best sports based PT I could find and they worked with me but said I would ultimately need knee surgery and stop running.

The PT seemed to know what they were doing, but something didn't seem right with their diagnosis. I worked on foam rolling the IT band (using the RollRecovery device) and the problem went away. I'm not saying that is your problem, but what I am saying is:

• Find the best doc, but be skeptical. Ask how they know their diagnosis is right.
• The problem might not be where the pain is located. Just like plantars is often alleviated with calf stretches.

Thank you. I'm high on PT's as they look for the root cause rather than putting a band aid on the symptom. Good luck resolving your knee issue.

Thanks, I've done this and still no improvement. I cut back for 6 weeks. Nos, the pain may flare up after 8 miles or after 4 miles depending on the day.

Would give PT a shot 2-3x per week for 8 weeks and see how you feel. The fact you have gone this long without serious issue means you have been doing something right. I've know people that had gel shots (1 shot every week for a 3 week period) and had success. I did PT for a patellar issue for 8 weeks and it worked.

I have a mid 60s year old friend that was really tough on his knees (tennis, biking, basketball). UCSF head of sports medicine (stanford trained) said he had torn it up so badly over the decades that he couldn't do anything but give him an artificial knee.

So, my buddy took a chance and did the stem cell thing in his knees. Lipogem in oakland. Insurance didn't cover. I think it was about $5K.

2 years later and he says the knee feels as good as new. He's still active in tennis, biking and running.

Anyone have any additional insights on stem cells to fix knees? I've been thinking about it myself.

Good info. Thanks.

Thanks for this response. I looked up Hoffa's disease, and it really sounds similar to my problem. Interestingly enough, some of the data indicates the kneecap can be mechanically positioned via tape and/or a strap in order to avoid irritation of the fat pad. I'm sure stretching and strengthening helps also. I probably need a little help or trial and error in getting this resolved but I now feel better thinking I can eventually resolve this. I'm also always interested in Ironmans and marathons. Not meaning to be a back door bragger, but I've completed 25 ironmans and want to do more. Not ready to quit yet, and that's why I'm so actively pursuing a solution.

Forgot to mention, kinesio tape helps me as well, especially, when I’m feeling the irritation more than usually. So for me, it is rather a plan B for now.

---

Слава Україні 🇺🇦✊