Not sure if this is the same thing as Patellofemoral Pain Syndrome (runner's knee). I was diagnosed with that last year in my left knee only. It was painful most of the time - for days after a long run. It hurt especially when I was going down stairs or pressing the clutch pedal while driving. It also hurt when I pressed on my patella. At the time I was training for a marathon.

The PT had me stop running and get back into it very slowly. First I did several weeks of exercises and stretching focuse on my quads primarily.

Training for Moo I have had no problems. I stretch more and, obviously, have been cross training a lot.

Maybe this helps?

As with any persistant injury I always recommend RICE and seeing a Dr or PT.

This article may help a bit as well - the crab walk may be a race saver :)

http://www.slowtwitch.com/...chcorn/strength.html

maylene wise, cscs

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maylene jackson, cscs
http://www.kidsintraining.org

Yep thats exactly what happens to my knee. Stairs are not fun. Im just going to try to stretch more and hold off on running in the next two weeks leading up to the race. Did you ever try any sort of brace?

look for trigger points (knots) in your quad muscles and work them out if you find any. also, you may want to do some strength work for your vastus med. eccentric leg curls can help. additionally, you may have tight hip flexors/psoas and quads that need stretching. odds are your ailment may be caused by one or more of these.

sorry, I meant eccentric leg extensions not curls.

If I were you, and i haven't even done a two hour run for the same IM, I'd quit running and let your knee heal. You have enough built up at this point to run/walk the event. If you don't and you keep it from healing, you may kiss more than the event away. Really analyze your stretching as tight quads and hamstrings can pull the knee cap to one side. With less than 3 weeks, the very small loss from not running will pale in comparison to a full blown knee injury. I would RICE all week and stretch all the time. Mid next week you may want to try a 2 mile run and wait a few days and add a mile or so. At the first sign of discomfort quit. Most taper plans have 45 min runs as the max right now anyway.

The bad news is that this put an end to my marathon training. The good news is that it sounds like you are in better shape than I was.

I second the idea of seeing a good Orthopedist/Sports Med Dr. and PT. They gave me very specific stretches and strengthening exercises.

I did not use a brace. The PT did offer to teach me a specific type of taping that can help if you continue to train. IMO, that kind of stuff is just a mask to the symptoms - you need to work on the cause.

You will find a ton of stuff on the web if you google "Patellofemoral" or "Runner's Knee."

I am not a doc, but have had this problem on and off for 15 - 20 years:

Here's what works for me. If it is truely a tracking problem, then leg extenstions, with light weights and focusing on the final 20 degrees to horizontal could be the solution. Don't work hard through the full 90 degrees - this could make the situation WORSE!! Do both single leg and double leg. Best done with a leg extention weight machine.

When my knee acts up, a couple of intense sessions of leg extentions causes the problem and pain to completely go away.

Best wishes

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Steve Fleck @stevefleck | Blog

Really, I mean no offense at all, BUT:

My PT specifically said not to use leg extension machines for this problem.

And they did have me use ankle weights (the kind in which you can adjust the weight) for leg lifts on the floor (not knee extensions), but I started with NO WEIGHT and only after a week of daily rountines did I even put the minimum weight in them. I then gradually increased. The recovery program was all about gradual strengthening and improvement.

Thanks for the reply. I think thats exactly what I'm going to do. I figure by running all I can do is hurt it more. Hopefully by strectching it and the time off by race day It will feel okay.

My problem was/is caused when tightness or strength in the lateral muscles of my left leg pulling my patella laterally. It only needs to be pulled a mm or less and then I get pain, due to improper tracking. The solution for me, is to quickly strengthen the vastus medialis( the medial head of the quadricep) muscle with isolated leg extentiones and stretch the lateral muscle group( ITB etc . .) This provides almost immediate relief for me. It's astounding, really. I come home one day from a run hobbling along with a very sore knee. 2 days later, after intense leg extentions and ITB stretching, the pain is completely gone.

You physio may feel that something else is causeing your problem.

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Steve Fleck @stevefleck | Blog

My PT specifically said not to use leg extension machines for this problem.

that point is addressed in the article posted above as well. Has to do with the sheer force directly on the patella caused by this open chain exercise.

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maylene jackson, cscs
http://www.kidsintraining.org

Maylene, what do recommend for prevention, after all the pain has subsided? Right now I can do easy weights on a leg extension machine no problem. Is this a bad idea?

I was also a little confused by the crab walk - once you have the tubing in place, are you actually walking forward, one foot at a time?



Thanks

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I believe I listed all the exercises I recommend for stability in the following article "More strength". http://www.slowtwitch.com/...hcorn/strength2.html

I do not recommend the open chain exercises such as the leg curl and extension. If a muscle is weak it will strengthen just as well in an open chain exercise while working in the same manner and with, the other soft tissues it should. Always make sure you keep good form, feet and body in correct position.

The crabwalk is a lateral move, like a crab. Keep your body still and move only the leg, to the side and plant then follow with the other. Do not rock back and forth like a sumo wrestler.

All the exercises and their progressions are shown on the DVD, if this not clear enough.

Let me know if u need anything else.

maylene wise, cscs

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maylene jackson, cscs
http://www.kidsintraining.org

Thanks! - I forgot about that second page.

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I'm working through a similar problem with my left knee now, seems to be improving w/ rest + ice (and tons of ibuprofen). I'm curious if any of you fellow sufferers also had pain while riding? Cycling actually seems to bother my knee more than running, although either can cause pain if I keep at it long enough. I've raised my saddle a total of about 1.5 cm in response, hasn't been long enough to know if this is helping. In addition to getting a professional asessment, anyone have cycling specific patellar tracking/knee experiences to share?

Ken

I posted this on another thread earlier regarding the same problem while cycling:

Since it mainly happens on the bike did you check your bike fit?

Sometimes the hips can ache since most cyclists tend to bring their knees in close, which makes the soft tissues (ie. IT band) work in a more elongated position than the run. Sometimes stretching and/or strengthening the areas can help.

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maylene jackson, cscs
http://www.kidsintraining.org

The only time it happened on the bike is when I rode the IMmoo loop 3 times. It might not have been the same pain but my kneecap did hurt along with the rest of my leg. I just figured it was from riding 120 miles. The pain was gone by the time I drove home about 90 minutes so I wasnt alarmed from it. Hopefully staying off it and doing a lot of stretching and those exercises maylane mentioned helps.

Hmmm. I missed the earlier thread- I'll look for it though. I was fit to my bike a year ago and haven't changed much of anything in my position (until now) for several months. I haven't had problems of any sort until a 1/2 IM 3.5 weeks ago. During the bike I noticed a dull knee pain that I hadn't felt before. In the excitement of the race I didn't pay it much attention until afterwards, when I noticed it was fairly sore, and slightly swollen.

For the week after the race, I was a wreck in general, but the knee was the biggest problem. 10 minutes of cycling or running would bring the pain back, which would then last for days. I'm now up to 30 minutes of running and 45 minutes of cycling pain free, but beyond that, the pain returns, and I stop- mostly to prevent further damage, the sensation is more sharply irritating than actually painful.

I've been fortunate to avoid injuries during my athletic career (such as it is) and this has been a intensely frustrating experience- I'm in the best shape of my life, but can't run or ride for any duration! But, I haven't been doing much of anything beyond rudimentary stretching (1-2 minutes at most) after working out, and no strength work. Bad, I know. But my tri season is more or less over- one sprint race in 3 weeks (I hope!) and I'm planning to turn over a new leaf in the off season.

I see I'm rambling on quite a bit- anyway, I don't think it's the bike fit per se, since I put in many miles in preparation without any trouble. The one thing I did notice during the race is that I had trouble keeping my cadence up, and frequently found myself pushing a larger gear that I normally would- couldn't tell you why. I've now sentenced myself to the small chain ring for the foreseeable future. Thanks for your advice and previous articles- I'm going to take the strength/stretching to heart- honest!

Ken

Yes, have had a similar problem that flaired up in my left knee (directly above the patella) during my taper for the full Vineman. Was the shearing moment during the pedal stroke that caused the discomfort. Never a sharp pain, just very annoying and power-robbing.

Always much better on the run, particularly using a short stride, higher cadence.

For those of you getting ready for IM moo, perhaps this will help. During race week, was very concerned about my knee. Wasn't sure what would happen. Had stretched and iced all week. Did the swim as I trained and then got on the bike! With the first pedal stroke of the left knee, felt that discomfort. Knew it was going to be a long day. Had to just ride an easy spin for 112 miles. Was discouraging to just have to sit there as everyone rode past and I couldn't respond. I had trained to ride 5:50:00 and came in in 6:15:00. Because of compensation, both knees were hurting after the ride. Was grateful to start running. The shearing discomfort went away and it just basically became the normal pain of running and finishing an IM marathon. Had trained to go 4:15:00 but was happy to do a 4:34:00.

So. Don't lose faith. Just keep the pain under a certain "threshold" on the bike. On the run, short and quick will see you through.

I difinitely need to spend more time stretching. I'm not getting any younger.

Thanks for the advice- just got back from a "mini-brick" 45 min SCR ride followed by 25 min run, which is about all I can handle right now. After a couple minutes of running I was starting to get a few "twinges" in my knee, remembered your suggestion, chopped the stride length down- the discomfort immediately disappeared! I'm on the road to "real" workouts- thanks!

ken

The more I read details about your PTD... It seems you may have both a bike fitting issues and running form issues. Neither of these are likely to significantly improve without complete recovery first... I would highly recommend seeing an Ortho for diagnosis and completing a proper PT program. After therapy and recovery... then re-evalute your bike position and running form. Trying to adapt changes to your running form and bike position while inflamation and pain exists will most likely have only short term positive results.

If I was in your position... I'd spend the coming winter months doing therapy and recovery (i.e., no training). The most serious and long term injuries (if not permanent) to the knee are as a result of patella damage. I would avoid causing more problems to this particular kind of injury. Good Luck...

FWIW Joe Moya

Bear,

How's the knee? How's Moo looking?