First, before I get started I am planning to see a doctor, but before I went I was hoping to get some ideas as to what might be causing my knee pain.
Second, I know my legs are hairy but its the off season.
Here is the information. In early December, I started having pain in my left knee in the area shown in the photo. Leading up to this I didn’t do anything out of the ordinary, I didn’t bang, twist or do anything else that could have damaged my knee. Also, I didn’t have a huge increase in mileage around this time. I went from about 22 miles per week to 25, by bumping up my longer run from 5 to 7 miles. The pain started initially as a dull ache, a mile or two into my runs, but as the next couple of weeks went on it became sharper and sharper and started sooner. The pain also stayed for an hour or two after my run was finished, but there was no swelling. Finally, I decided that I would take time off and let the knee rest and see what would happen. After 3 weeks of rest, I just started back this week and after about 1/4 mile the sharp pain was back.
Here is some additional information, it doesn’t bother me when I ride (I didn’t ride while I was resting my knee), but it does bother me when I try to use an elliptical trainer (I tried that before taking the break in December). Going down stairs hurts more than going upstairs and I don’t have any instability, clicking, grinding or locking of my knee.
It seems to be too low for an ITB problem and the symptoms don’t seem to match a meniscus problem, so I don’t know what else it might be. Has anyone else had to deal with something like this before?
I have had ITB problems in that exact location. The difference between my symptoms and your symptoms is that mine only bothered me when I ran and only after I had completed about 4-5 miles. Not sure I helped but I wanted to let you know that it might not be too low for ITB.
That picture looks like the pain is on the inside of the knee. ITB has to be the
outside if I understand it correctly, as the ileo-tibial band runs on from the
illum to the tibia on the outside of the leg.
does the pain feel as if it starts in the area you highlight and shoots upwars over the knee? if so, may be patella tendantis, which i am fighting now as well. search for a thread a posted a few weeks ago, several good ideas came from that. additional stretching and knee bands have helped … further conditioning (quad strengthening) i hope will help too. keep in mind, i am not a doctor and never wanted to be one. i, and most posts that follow, are just guys who like to ride bikes. if the pain persists you should go to a doctor
I had ITB issues, and they manifested themselves in that exact spot in an extremely similar manner. For me the problem was muscle spasms in my upper leg that had to be worked out with lots of self-massage. Once I found the trouble spots and addressed them, I was back and running very quickly with no need to see a doctor.
The pain shoots downward and beneath the kneecap, not upward and over the knee. But thanks for the tip on search out that old thread, I will have to try and find it.
Thanks for the reply, everything that I saw about ITB issues indicated that the pain would have been much higer up on my knee. If it an ITB issue at least there are things that can be done to help work out the pain and get me back on track.
No, that is on the outside of my knee, the camera wass angled to the outside when I took the picture.
I spent like two minutes looking at the picture and then my knee trying to figure it out.
Ok, then I would go with ITB. That is almost exactly where I get it.
Rest. Ice. Ibuprofen.
Google for ITB stretches. PT might help, especially with the ultrasonic stuff they
do.
You’ll have to ease back in. I found trail running helped me prevent it vs the same distance
on flats.
I had a very similar knee pain a few years ago that did the “shoot behind the kneecap” thing. I’d assumed it was ITB and stretched/iced accordingly, but went to a doc when it worsened and it turned out to be a tibial stress fracture. YMMV, and it sounds like you’re going to the doc, but definitely keep an eye on it.
Well … that looks, smells, and sounds pretty much like the iliotibial band insertion (the dreaded ITB).
Definitely not a meniscal issue. Hard to tell exactly without hands on exam, but your description/history is pretty good. I’m assuming you have read up on ITB syndrome (hence the term syndrome). Ice the area, do the stretches, etc. Also, try to asses what biomechanical issue caused the ITB syndrome since yours was not an increase in mileage (22 to 25 certainly doesn’t count).
After a proper warm up, can you touch your toes with a slight 1 to 2 degree bend in your knees?
When you walk, do your toes point outward?
You may need to possibly strengthen the Quadricep muscle called the Vastus Medialis, perform self myofascial release with a foam roller on the gluteal/itb/hamstring complex.
How many miles do you have on your running shoes and do you rotate through the shoes?
Do you have flat feet? No, I don’t have flat feet.
After a proper warm up, can you touch your toes with a slight 1 to 2 degree bend in your knees? With or without a warmup this is no problem.
When you walk, do your toes point outward? Toes point straight ahead to slightly inward.
You may need to possibly strengthen the Quadricep muscle called the Vastus Medialis, perform self myofascial release with a foam roller on the gluteal/itb/hamstring complex. I will be starting with the foam roller as soon as I can get one.
How many miles do you have on your running shoes and do you rotate through the shoes? I replaced my shoes 1 month prior to the problem starting, so I had 75 - 80 miles on the shoes. Replaced shoes model for model - Mizuno Wave Rider 10’s
Hope the answers help.
i agree with the ITB diagnosis. i have battled it in the past and my 3 suggestions are to have your running shoes checked, strengthen your glutes/quads/hammys, and get some ART treatment.
Agreed - try some ART. and/or look into buying/borrowing someone’s foam roller or trigger point kit to see if that helps. the combo of those 2 things has always worked for me.
Often athletes can bike pain free and still have acute symptoms when running. This is probably due to friction or impingement at certain angles of the knee. However, this does not mean that your cycling position or cycling equipment is not responsible (in part or fully) for the injury/aggravation. Consider your bike set-up, cleats and any rotational components in the equation. As well, if you continue to run, change up pace; it may help mitigate symptoms. My personal experience and those of my patients has been relief through ART. Pay attention to tissue in the mid thigh as well as the hip and TFL. You want to lengthen and increase elasticity of the entire structure(s). I have not found stretching to be helpful for acute cases. Rather, specific contact, be it roller or hands, is superior. Include vastus lateralis as the ITB and vastus should glide over one another and may be partially adhered. Gluteus weakness strongly correlates to ITB pain so lateral raises may help aleviate symptoms and act as prevention (key). Along the lines of prevention, have a look at yourself on a treadmill in front of a mirror. Weakness in the glootz allow genu valgas (drifting knee across midline) and this is a strong predictor of ITB.
Its ITB. I had similar pain for years, and much like Kevin said, I finally got rid of the pain by strengthening my hip abductors (gluteus medius). It was amazing after years of not being able to run over about 8 miles, i spent 6 weeks going hip strengthening and the pain completely resolved. You can use a “machine” to work the abductors but i think its best to stand and use pulleys attatched to a cuff around your ankle. This also helps your balance and core.
It’s most likely ITB as there aren’t too many other structures where your pointing. I’ve said it once and will say it again. The Actual ITband is damn near impossible to stretch. You can stretch the glute med. muscle which the ITB runs off of, but’s probably more a matter of weakness, rather than tightness. Start doing hip abduction strengthening immediately. Sidelying hip abduction 2x20 2xday. No weights required. It will work. Most of us men have very weak gluteus medius muscles so they are not doing what they are supposed to be doing. You need to train the muscle to fire when running, and the best way to do it is just start strengthening exercises. Back off running outside. If you know it’s going to start hurting at exactly 10-12 minutes running and then when it usually starts to come on. Do 2x20 sidelying hip abduction exercises, get on the treadmill and run. At the very first sign of any discomfort shut it down. Get back on the floor and do some more hip abd. Do this program 3x a week. If you able to run longer periods before pain starts after a week or 2 then you know you are the right track. On off days from running keep doing the exercises and whatever else you normally do swim, bike etc… assuming they are non aggravating. I guarantee you this program will work.
Today I got a hold of a foam roller and put it to use for a 10 15 minutes. Based on how painful it was as I rolled up and down my ITB, I would have to believe that this is a good place to start. I also started on the lateral raises and was shocked just how hard the second set of 20 turned out to be. I never expected that to be a difficult exercise.
I’ll try some easy running in a couple of days and see how it all goes.
