Are you doing any PT? Strengthening stuff? Taping?

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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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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