In the first five months of the year, I ran two marathons (and all the training related thereto), rode two full centuries, and two metric centuries. During the course of all that, I developed a nagging pain behind my right knee. I took a week off but nothing helped. Whether stupid or not, I continued with the events I had planned a trained through the pain. It wasn’t unbearable…just a nagging pain.
After the last century in late May, I finally broke down and saw an orthopedic. An MRI ruled out a meniscus tear but showed evidence of “signals.” (I have no idea what that means and the doc didn’t explain it.) All the tendons and ligaments seemed to be in perfect condition. Finally, the doc diagnosed me with hamsting tendonitis and told me to rest until the discomfort went away. (From my conversation with the doc and his facial expressions, I got the distinct impression that he doesn’t know what is wrong with me and just said hamstring tendonitis as his best guess. I don’t think he was confident in his diagnosis.)
After six weeks of rest (no running or cycling), I still feel a “catch” behind my knee quite often. I don’t need pain relief and I can function but I can tell that the knee isn’t right. The rest doesn’t seem to be changing anything. With tri season in full swing, the Tour on TV, and all my friends riding in the beautiful sunshine while I am relegated to the pool, I couldn’t take it anymore and decided to hop on the bike today. I did an easy 15 miles just to test the hammy. It responded with the same pain that I had many months ago. From what I can tell, six weeks of rest did nothing. I am frustrated an have no confidence in my diagnosis, unfortunately. If my hamstring was inflamed, I would have thought that six weeks of rest would have been sufficient.
If it matters, I am a healthy, thin, muscular 35 y.o. male with a long history of endurance events and no history of any health problems.
Questions:
Does anyone have some differential diagnoses and suggestions for treatment?
Where can I learn about “signals” in the meniscus from an MRI?
Ok, so if i read correctly the pain is behind the knee? How does this effect the miniscus if the miniscus is in front just under your knee cap? Hamstring tendonitis?? never ever heard of that and in fact didnt know it was possible lol…I’d say get a second opinion because clearly the Dr. that checked you out didnt have a clue what was wrong with you…I’ll do a little research and see what i can find but it may take a day or two since i have a paper to write by thurs first…
Im not a doc, and I dont play one on tv or st. I had a similar pain as you, nagging, but managable. It turned out to be my popliteal (sp?) I did some focused stretching and it cleared up, maybe look into that, like you said, you got the impression the doc didnt know anything. FWIW, I dealt with this for several months before I got it figured out, I thought I had a tear or some other knee injury.
I would try a second opinion, sometimes pain behind the knee can be a small tear of the posterior horn of your meniscus. The “catching” may be the tear catching in your knee joint.
Like others have said. I am not a Dr. But I did stay in a holiday inn express this past weekend.
It could be any of the three conditions mentioned but it’s impossible for anybody to do an internet diagnosis based on the described symptoms without a physical examination of the knee.
The other thought is that an orthopedic surgeon may not always be the best person to see for this kind of problem, because they’re surgeons, and this seems like a non surgical procedure. You might want to try a good chiro or PT with a background/interest in sports injuries.
I have had what I feel is miraculous results with a chiro tained in Graston technique. I would see someone skilled in it, as they do much more “hands on” than most orthos, and can usually feel problems. Mine has a mechanical engineering degree, and ART training, and is a virtual gold mine to me. His knowledge of anatomy, and the actual sources of the trouble is phenominal, and I would not hesitate in recommending his treatments…he has worked on Olympic Gold medalists, and has kept me going when I thought the season, and a comeback, was over…
Ditto on the ART/graston stuff. Orthos are great for people who need xrays of broken bones. In my very injury-plagued athletic career, my opinion is that they aren’t great with soft tissue issues.
“ortho’s are great for people who need x-rays”
That is one of the most rediculous statements. As an orthopedist, i reconstruct ACL’s (soft tissue), i repair or remove torn meniscus (soft tissue) I repair patella or quad tendons that are torn (soft tissue), i repair torn rotator cuff’s (soft tissue) and on and on…in fact as a sports medicine specialist i dont deal all that much with bone.
As for the original question, pain behind the knee usually is tendonitis, either hamsting or popliteus, although i agree without an exam its tough to say. Meniscus (which are NOT behind the patella, as someone above stated) usually cause pain on the sides of the knee, either medial or lateral. And “increased signal” in the meniscus in a 35 year old i basically a normal finding that occurs as we age. its unlikely that has anything to do with your symptoms.
First…lay of the marathons if you can and stick to 13miles or less. Just a thought.
Second,
Does it hurt when you bike? Upstroke or downstroke?
When you run does the pain go away after a mile or two?
I have a medial meniscus tear. I got it 3 yrs. ago. The doctor told me that arthroscopic might or might not help it. He said, after you tear it…my knee would never feel the same again with surgery or without it. Finally, he said run on it and if it gets out of control we’ll operate. My knee catches and pops all the time. I can pop it whenever I want. I don’t think that is good for me…but it is a habit.
Three years later…I am still running with no pain. However, I know my knee is messed up. The price I pay. Look at it this way…I am 28 and by the time I am 45 they will be doing artificial cartilage implants with perfection. They are already doing trials of it right now. Hang in there. Ice it. Take short strides/high cadence and the pain should go away in a couple of months. If your hamstring is inflamed you’ll know it. In that case, get a gatorade propel bottle with water, freeze it, and roll your hamstring on it. That will work the inflammation out.
Does it hurt when you bike? Upstroke or downstroke?
When you run does the pain go away after a mile or two?
Answers:
Yes, both up and down.
Now that you mention it, I do recall that it went away after several miles but tended to come back later on super long runs.
The meniscus tear was ruled out by the MRI so I think I’m safe on that.
I appreciate everyone’s suggestions. I think I am going to follow this advice and see a sports med PT I know who is also a triathlete and marathoner. In the meantime, I’m going to ice it every night and hope for the best.
I will agree with IRONBLO. It sounds like the popliteus muscle is part of your problem. They can give symptoms like that. I know from own experience and from beeing a Naprapat (a lot like chiropractor). I would recomend you to get someone or yourself do a propper massage on the popliteus muscle and some stretching like previous mentioned.
Another thing that could indicate the popliteus muscle is if you get pain behind the kne from having it bent 90 degrees when you are sitting.
But like others have said it is hard to say without a examination myself.