I’ve been experiencing pain in my left knee, that feels to be located directly under the patella (not ‘below’ the patella, as in the patellar tendon but literally underneath). I thought it was typical runner’s knee inflammation which could be managed. But after several weeks, I am unable to get on top of it. My doctor took an x-ray, which found no problems, and suggests that it could be a mal-aligned kneecap. He suggests I avoid running or lifting for a few months to see if it gets better. I’d need to see a knee specialist for a more in depth examination.
Has anyone had this issue before, and if so, what path did you take to overcome it? Like many in our sport, I’d prefer to manage the issue while still being able to train to some degree (it does not bother me at all when swimming or biking, but the pain comes on after I finish my runs, or sometimes I feel it while running downhill).
For background, I’m 5’10" and 180 lbs. In addition to triathlon I regularly strength train in the gym, and do NOT skip leg day. I do squats, lunges, leg press, dead lifts, etc under the supervision of a personal trainer. So I would be very surprised to find the cause to be a strength issue. One weakness I do have is quadriceps flexibility, however. My doctor was uncertain as to whether that could be contributing. Any advice from those who have had this or similar issues? Thanks!
what you’re describing is classic runner’s knee (patellofemoral syndrome).
I have a mild to moderate case of it on my right knee and I also have very developed quads.
My physical therapist figured out that my main problem was flexibility. I’ve started religiously stretching my quads, hams, and hip flexors for the past several months and have seen improvements in my knee pain. It’s not 100% gone, but a lot better. I use KT tape on my knee for longer runs and for races.
I recommend you see a physical therapist to really pin down what your specific issue is.
Further imaging (x-rays, MRIs) won’t be of much help, IMO. I think you should focus on modifying your training and working with a reputable physical therapist.
Whatever you do don’t let someone talk you into a lateral realignment surgery. This is worthless procedure that has been proven to not be beneficial, but some doctors may still be doing them.
This is most likely something to be addressed by a good physical therapist. Ask around for recommendations in your area for a PT who works with athletes.
What you’ve got is patellofemoral pain syndrome, PFPS. It’s a condition where the patellofemoral joint becomes sensitized to load. The treatment is to increase load capacity of the joint, without causing flareups. It’s not flexibility, its not “vastus medialis”. It’s load capacity, and you need to increase it.
I disagree on the surgery as a blanket statement that it doesn’t work. I had this done to both knees and the pain was eliminated from on knee and greatly reduced in the other.
Very simple - isolate and strengthen the vastus medialis muscle. I 99% guarantee that is the problem. Be careful - most exercises (and therapists) don’t isolate the muscle which strengths the whole complex thereby not helping the imbalance.
A couple of things you can do:
Sit on the floor legs straight out in front of you. Turn you toes/foot outward. Roll up a towel and put it under your knee and compress it by only using the VMCall me Pavlov’s Dog - I do this simple exercise every time my phone rings at the office (which is a lot!). Slide to the edge of your chair. Straighten and relax your leg with your toes falling outward. Do an isometric contraction of ONLY the VM, and then do 10 leg lifts. I end up doing this a 100 times a day and my VO is in good shape keeping runners’ knee in check.
Hope this helps . . . note it takes time to get over the problem, but once you do you can keep it at bay.
I dealt with this for 3 years. 3 PT’s, 1 surgery, 1 TDF dr did my bike fit. 1 PT did a bike fit, 2 local bike fits.
I was still in pain and unable to ride.
What fixed it was using a variation of the Graston Technique and massaging the knots and improving my tissue quality in the quadriceps. I went to Home Depot and bent a 3/8’s inch steel bar and rolled out my quads really good for a few days. I also made a “chisel” out of 2" flat bar steel and use that to pinpoint and work out knots.
Knee healed up and I can do all my old activities. A good massage therapist might be even better.