Pain in the back of my knee

Triathlon Forum
1

My knee hurts. Not a ton, but enough that I thought I’d fill your Boxing Day up with a plea for some advice.

I ran Cal International Marathon pretty hard on 12/3 (4th Clydesdale - go me!). I was horribly sore afterwards, but with no noticeable localized pain. I started running again after about 10 days, all easy efforts. After a week or so, I noticed a tightness on the inside of my left knee towards the back. The pain seems to be outside the joint itself. As I’ve continued to run some, and done a little biking, it’s got worse. It seems localized to to the tendon running from the back of my knee down my calf (at least, there’s something tight and ridged under the skin there, and it hurts when I push on it. I’m to the point where I can’t really run comfortably, which is going to put a big-ass crimp in my plans. I’m also walking oddly, which makes my wife giggle, and not in a cute way.

So, tell me I’m an idiot for asking here, or tell me to go see a analyst/therapist, or tell me that you’ve had this, it’s nothing, and I should just take an Advil and go out to play.

Oh, and Happy Holidays!

2

Congratulations on your race! It’s quite normal to be pretty beat up after a hard marathon effort.

You probably just developed some trigger points in either your gastrocnemius or soleus muscles training for or during the marathon. Trigger points in them refers pain to right behind the knee, and both muscles attach to the Achilles tendon (that big ropy thing down the center of your lower back leg).

If you are finding tender spots on the calf muscles, that’s the trigger points–exert pressure with your thumbs for 15-20 seconds, release and then massage around the area. It will do you good to do this several times a day if you can, and check the other leg, too, because even though it’s not sending any pain, chances are there are some knots over there, too. I bet if you check your quads that they, too are loaded up with trigger points, which will also cause knee mechanical issues and potentially pain.

Back of the knee pain can also be referred from popliteal or plantaris muscles, but you should work on the gastroc and soleus first to see if that’s all it is.

If you have a massage therapist, some deep tissue/trigger point work from him or her would also be great.

Work on the trigger points BEFORE you stretch the muscles. Stretching without addressing the trigger points can be a futile exercise, since the localized tight spots will not yield until they’ve been softened up a bit.

If you don’t notice relief in 3-4 days, then you might want to go see a physical therapist.

I’ve been having calf issues the last few weeks, too, as I ramp up for the Goofy Challenge/Disney marathon in < 2 weeks. A combination of big run mileage plus too much time running on a treadmill (I tend to run more flat-footed on it which seems to be bad for my calves). I was worried about one of my calves, too, but now that I’m tapering and resting and I’ve been working on myself and getting massages, the calves are coming around, but I fully expect they will be a mess after running 39.3 miles in 2 days. That’s just normal wear and tear post-marathon.

3

Hey not to hijack this thread but you sound like you know what you’re talking about re: trigger point and myofascial release. I found a nasty trigger point/knot in my right glute after having pain in the right side of my SI joint. Do you know where trigger points in your glutes typically refer pain to? I’ve been rolling on a Nalgene bottle to work the knot out but I’m not sure yet if it’s helping as the pain in the joint comes back after swimming with lots of kick sets.

4

I am self-taught in terms of trigger point therapy, having had my share of ills. I learned from reading and using as reference 2 books:

The Trigger Point Therapy Workbook by Clair Davies
Trigger Point Therapy for Myofascial Pain by Finando and Finando

Best $40 I have ever spent! I also have various “tools” like tpmassageball and their rollers, foam roller (on its way as we speak), Theracane and The Stick. All are helpful in self-treatment. As is a good sports massage therapist who is versed in trigger point work, which is close to ART, which I love getting, but it’s been just as effective for me to work on myself during stretching sessions, and an ART therapist recently confirmed that what I’m doing is just as good.

Trigger points in glute muscles refer on down back of the leg, depending on which muscle they originate in. Sciatica can be caused by trigger points in piriformis, but in my experience, by the time the piriformis gets jacked up there are other muscles involved, like QL, glute medius, iliopsoas.

Pain around SI joint is commonly referred from trigger points in iliopsoas and piriformis muscles. It’s fatigued iliopsoas muscles that tend to cause low back pain in runners and cyclists, which is why they are the very first muscles that I stretch after a long run or ride.

When you’ve identified a trigger point, yes, you work on that area, but you need to find the originating and participatory muscles. There’s usually more than 1 muscle involved in any myofascial problem. Anyone who tells me about low back/piriformis/hamstring usually finds they have iliopsoas involvement. ITBS starts with a tight ass (!). Knee pain is problems in the quads, and unattended gastroc/soleus issues can develop into Achilles tendonitis. Soleus trigger points can refer pain UP the leg as well.

I have found that doing supplemental strenghtening exercises for the iliopsoas, abductors and adductors seems to help, too.

You start with basic trigger point work, and then as you get good at it, you learn to stretch the muscle as you are attacking the trigger points, which is just shy of ART. For some muscles you can do it to yourself (see the tpmassageball site–it shows some examples); for really bad or hard-to-reach, you might need assistance.

Iliopsoas is tough to work on by yourself, but the first of the 2 books shows how, and a good sports massage therapist will be able to position you to dig in on it. If it’s bad, then massage work is a good idea. Once you get it loosened up, though, with regular stretching it should be fine.

Regarding kick sets–if you are using a regular old hard kickboard, it tends to put your back in a hyperflexed position, which strains your back muscles in the area of the SI joint, so it’s not surprising that giant kick sets aggravate things. You might want to switch to a kickboard that keeps your back in a less hyperflexed position, or ditch the kickboard for awhile and just kick on your side or on your back.

5

Hey Fefe-

Yes I have psoaz issues----it’s a target area for stretching. I have had the ART guys do some manual strethcing for it and I also have a stretch/dig thing that I do to stretch it. I’m not exactly sure what is causing the SI joint pain but I do know that working on the trigger point in my glute has helped. I think I’m going to check out those books. The kick sets— I do all my kicking on my back in streamline position. I think part of the problem is that my core has got weak from not focusing on it and when I kick it torques my hips/ lower back a bit—I need to work on the core. What are the ways you know of to strengthen the psoaz muscles?—any different than typical core and ab work? I also need to go see and ART or massage thereapist and get my psoaz, glutes and hams seriously stripped out.

6

If you can’t run comfortably - don’t run.

If you are walking with a limp - stop all exercise that may make it worse. Likely need to stop biking and running.

You aren’t an idiot for asking to get some ideas but you may be an idiot if you listen to our advice on an internet forum…:slight_smile:

Your description needs to be expanded. Tendon on the medial (inside of knee) or lateral side (outside of knee)? Are you talking about the tendons that run from the thigh - cross the knee and insert at the back of the leg (top of the calf?). Actual calf muscles (gastroc/soleus) run deeper…

Back of knee pain can be lots of stuff - mensical tear, Baker’s cyst, DVT, tendonitis…but sounds most likely like a tendonitis from overuse…

See someone with expertise in running/cycling related injuries - get an exam - then get some real advice. Likely just need rest and time (which nobody wants to hear…). Tendonitis is micro-tears (or at least thats what a lot of people are saying now…) so many people question the benefit of NSAIDS…

Good luck - I’m recovering from plantar fasciiitis and it sucks to be injured…

Dave

7

Thanks for this. I think your advice was spot-on. I dug around with my thumbs pretty deep in my soleus muscle, on the medial side, and found a sensitive spot. It’s elongated somewhat along the muscle, but I managed to get it to release a bit, and iced it too. It feels better today, and I’ll give it some more work later.

Thanks!

Congratulations on your race! It’s quite normal to be pretty beat up after a hard marathon effort.

You probably just developed some trigger points in either your gastrocnemius or soleus muscles training for or during the marathon. Trigger points in them refers pain to right behind the knee, and both muscles attach to the Achilles tendon (that big ropy thing down the center of your lower back leg).

If you are finding tender spots on the calf muscles, that’s the trigger points–exert pressure with your thumbs for 15-20 seconds, release and then massage around the area. It will do you good to do this several times a day if you can, and check the other leg, too, because even though it’s not sending any pain, chances are there are some knots over there, too. I bet if you check your quads that they, too are loaded up with trigger points, which will also cause knee mechanical issues and potentially pain.

Back of the knee pain can also be referred from popliteal or plantaris muscles, but you should work on the gastroc and soleus first to see if that’s all it is.

If you have a massage therapist, some deep tissue/trigger point work from him or her would also be great.

Work on the trigger points BEFORE you stretch the muscles. Stretching without addressing the trigger points can be a futile exercise, since the localized tight spots will not yield until they’ve been softened up a bit.

If you don’t notice relief in 3-4 days, then you might want to go see a physical therapist.

I’ve been having calf issues the last few weeks, too, as I ramp up for the Goofy Challenge/Disney marathon in < 2 weeks. A combination of big run mileage plus too much time running on a treadmill (I tend to run more flat-footed on it which seems to be bad for my calves). I was worried about one of my calves, too, but now that I’m tapering and resting and I’ve been working on myself and getting massages, the calves are coming around, but I fully expect they will be a mess after running 39.3 miles in 2 days. That’s just normal wear and tear post-marathon.

8

More follow-up:
I went out and bought myself ‘The Stick’, and then whaled on my legs every few hours for 3 days. Things are pretty loose now, and I can run seemingly normally again. This must be the best 30 bucks I’ve spent in recent memory. My left soleus, in particular, no longer feels like a rock.