I have been battling this for a while now and wonder if anyone out there has some good tips for overcoming it. I have recently tried leg extensions with low weight and high reps just focussing on top 30 degrees of motion. Also upgraded running shoes. I have been doing a lot of hills as the only off road area near me is nothing but hills and wonder if hills are a contributing factor. Are there any magic bullets out there? Suppose to do San Francisco Half next weekend but I can’t seem to go more than a few miles right now without that under the kneecap pain. Thanks!
I’m in a similar boat so I’ll give you a free bump for advice.
Search PFS on this forum, just asked this question a month ago and got some great advice. I trained for and just raced the Arizona marathon with PFS. I got lots of massages, did lots of stretching and yoga and made it through. The cause of my PFS was a tight hamstring all season long and then I did an ultra 50K trail race and that was the final nail in the coffin. Everyday after that race, my hammie, glute, and back on my left side was so tight I couldn’t walk or sleep at night. But in training, the first 30-45 minutes was painful but once the hamstring loosened up, the pain was manageable and I was able to do my long run. But now, it’s time to rest and rather than dealing with a chronic injury for all of 2009, I’m going to find out the cause of my tight hamstring.
For the short term you can use RICE and anti-inflammatories.
If the PFS is caused by patella tracking issues then strengthening the muscles around the knee may help in the future. When you perform leg extension, try doing them one leg at a time. This will focus the work on the vastus medialis (tear drop) muscle. Cycling is also good for this.
Note: I’m not an expert/MD. I had a problem with PFS a year or so ago and did some “leg work” on the internet.
chondramalacia almost always results in pain AFTER running. Usually you will hurt at the beginning of the run and the pain gradually subsides until you stop. If this isn’t the case with you, but rather the pain comes on DURING the run then you may want to reconsider your diagnosis. You could have an injury to the cartilege in that area.
I know it’s out of vogue now probably because 2 or 3 people worldwide hurt themselves…but leg extensions like you are doing always cleared me up nearly immediately (I probably had 3-4 bouts of this through my high school running career).
I like that you are working the top 30 degrees of motion and I suggest you add weight. Nothing obscene, but if you can get it 10-15 reps you are doing well. If you can get more before that intense burn sets in then it’s too light.
If doing the leg extensions themselves causes the pain then stop. When you do these leg extensions make sure that your foot is slightly toe out…ie. in the direction that your leg is travelling (I’ll assume straight up/down) you should be able to draw a line in that plane through your big toe down through the center of your heel. That alignment of the foot results in a neutral alignment of the knee and allows the inner head of the quadricep to be worked by the leg extension (which in chondramalacia is the weaker muscle).
BTW, that’s the foot alignment you should have when running too…so if you have never had any gait analysis performed get on the treadmill and have someone use their digital camera to film you for 20 seconds, then watch it in slow motion. In the direction of travel you should be able to draw a straight line from the BIG toe through the center of the heel.
Naproxin Sodium is an important part of the treatment. It’s the best anti-inflammatory available OTC and inflammation causes your pain and is the cause of the further irritation which causes more pain…It’s both the effect and the cause which is why NSAIDS are important for treating overuse injuries.
I’m battling the same - here is what I did/am doing:
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Warm up on indoor bike - then stretch (hamstrings/quads) - then do some squats without weights 3x12 - then sit in a chair and do some leg lifts (2x20 each leg) - then run. Never run 1st thing in the morning and never run when cold/stiff.
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Went back to more anti-pronation shoes with superfeet.
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Switch sides of roads as I run. Don’t run circles around a track/road loops.
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Ice 20 min after the run and 1-2x more later in the day. I just ace wrap a crushed ice bag over my patellar tendon.
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Ibuprofen 600 mg 45 min before run. I’ll try to wean off this in a week if all goes well but I’m trying to run through it which isn’t that smart but hey OCD.
I ran 16 miles today and knee felt o.k.!!! I hope its working and I can beat it without dropping my miles/skipping time…wonder what will hurt next then?
Dave
I have experienced ‘runners knee’ multiple times. My recommendation is to look for the root of the problem rather than treatment only. Consider: 1. Over pronation - doctor prescribed othodic recommended. 2. Flexibility - Many stretches to consider. 3. Bike set up changes - have you moved seat, changed pedals, etc. 4. Worn out shoes - You have new running shoes but I would also look at the cycling shoes.
John
I’ve been in the same boat for almost a full year. Leg extensions and leg curls did nothing to alleviate the issue. I don’t have access to any sport doctors or physiotherapists but from what I know with most injuries they usually have a source which has led to a muscle imbalance. Trick is finding what the imbalance is and then the source. Over the last 2 months it has not been an issue anymore (climbing the stairs without pain has been a good indicator). I suspect mine was from gluteal imbalance and regular lunges and isolated straight leg/hip raises have had me back to running symptom free. Unless you get feedback from a good PT or sports med person you will probably be grasping for whatever works and even then you will be clue-less (like me) but just happy to be running and free of mind.
I have this too and my doc says mine is caused by weak quads. I’ve been doing lunges, leg presses, straight leg lifts, stretching, and lots of training on the bike to try and rehab. Doc said that tracking issues could cause this (in agreement with the other posts).
One thing I didn’t see posted yet that the doc said is that you can’t train through this. You have to stop and let it heal or the pounding on it will just re-inflame the injury. If you run the half nxt week listen carefully to your body, if it tells you to stop do it, a DNF is better than a worse injury.
I’ve been off of running for six weeks and tomorrow is my first run back from this injury, I hope it goes OK!
Good luck, hope you get better.