I have pain directly under my knee cap while running when the leg is bent. It is bad at times, but seems to disappear for days or a week at a time before coming back with a vengeance. Is this “runners knee?” What has worked for you to treat it?
My quite painful run/walk last weekend started just to the outside of the patella, later in the run it was under both knee caps. Sunday morning I had to get help out of bed and could not bend my knees and walk close to normal for hours. It was three days after the race in February before I could walk right. Now that the races I have paid for are over I have a doctors appointment tomorrow to get a referral to a specialist. I will find out soon, my ART guy is concerned the patella was not tracking well and damaged the cartlage in there. I ran/rode a total of 1.5/6 miles over 6 weeks trying to let it heal and it did not. My left knee pops and it feels like stuff is getting caught and releasing as I bend and straighten my knee.
Long story short, get it checked out. I hope to get in for the MRI next week. I can let you know what they found if you are interested.
I know why the older age groups are so fast, they have already learned how to fix and move on from the injuries that keep the younger groups from training like they should:)
Sounds like patellar tendonitis. I had same exact pain last year. Left me on the couch for 7 months. I tried everything -RICE, ART, PT, total rest, etc… I think the 10+ weeks of PT and rest were the only things that helped. Just get a real good therapist, otherwise you’ll be wasting your time.
I have my first PT appointment tomorrow for patellar tendinitis/patellofemoral syndrome:
How do I tell if they are a good PT?
What questions should I ask?
What should I expect them to do in the initial visit?
Had it go away once I switched to a new pair of shoes.
I found that doing leg extensions focussing on final 30 degrees of extension helped.
did you change type of shoe or just “new” shoes?
Could just be caused by trigger points in your quads–VMO in particular, weak VMO also.
I had pain under the kneecap after a marathon 2 months ago that was caused by the cant of the roads we ran on. Checked out my VMO and sure enough trigger points, worked on them, pain gone in <2 weeks.
Could also be chondromalacia, could be patellar tendonitis.
I’d try working on your VMO first, because if it’s just that, it will respond rapidly.
I would go to someone who has experience working with athletetes or is an athlete him/herself. They’ll be more accustomed to dealing with people with an athlete’s goals (getting back to the demands of training and racing vs walking around the house pain free).
I would also make sure the PT is only seeing one or two patients at a time tops… I’ve been to therapists with 3 or 4 patients in there at the same time and I basically did all of the exercises on my own with no supervision. Especially when you’re just starting out, it’s important to pay attention to the details and make sure that all of the stretches and strengthening exercises are done with perfect form or else you’re wasting your time. We all know how to do stretch our quads and and do leg press, etc., but you need the PT to show you how to “reactivate” muscles that you’re not using and how to stretch spots that aren’t being stretched.
I would also make sure they have a good amount of experience dealing with the specific injury you have. Just like anything else, the more they deal with and focus on that injury, the more they’ll know about it and the quicker they’ll be able to get you back out there…
I had a flare up of PT on a ride two years ago that was so bad I had to call my wife to pick me up. Only time ever had to do that. Got my medical advice by searching on this forum (horrors). Treated the same as I did in high school when I played soccer – strengthen quads. I simply did two sets of knee extensions on the machine at gym after swimming for a few weeks. In a week it was better. Since then, it occasionally comes back and I just do knee extensions for a few weeks and it goes away.
HH
Warning: pay a doctor or PT. Don’t try this self help first. Do as I say, not as I did. 
funny you should say that…i notice that the PT feels worse when my legs are thrashed from a run. Almost like the more sore my quads are, the more they’re affecting the PT. Make sense??
Well that just sucks because there is no way I am out of commission for 7 months. Hopefully the specialist will find the cause, I am real tired of the trial and error thing. I did that for four months last year with the IT, fount the ART guy, did some specific exercises and was good in two weeks.
what exercises did you do for ITB? I’ve been battling that for months
He worked the IT to get out some knots. The main one was laying on my side and doing side leg lifts 3X20 no weights on ankles for a couple of weeks. Then up to 2 then 4 lbs on the ankle. Exercises included hip abductors and adductors machines at the gym. I believe you can do the same thing with those leg bands also. I also continue to roll on a foam roller. You can find out how tight your it is by laying on a table and dropping the affected leg behind your other leg, if your leg does not drop down at least as far as the bottom leg you may need some help. Of course shoes and bad form could contribute also.
My case was created by weak hip abductors, but I have heard many other reasons for IT flare ups.
He worked the IT to get out some knots. The main one was laying on my side and doing side leg lifts 3X20 no weights on ankles for a couple of weeks. Then up to 2 then 4 lbs on the ankle. Exercises included hip abductors and adductors machines at the gym. I believe you can do the same thing with those leg bands also. I also continue to roll on a foam roller. You can find out how tight your it is by laying on a table and dropping the affected leg behind your other leg, if your leg does not drop down at least as far as the bottom leg you may need some help. Of course shoes and bad form could contribute also.
My case was created by weak hip abductors, but I have heard many other reasons for IT flare ups.
How frequently did you do the leg lifts you mentioned? Did you have to refrain from doing all other exercises, or were the “leg lifts” in addition to your normal routine? I’ve been dealing with IT issues for appx 10 months … i’m desperate!!!
Thanks!
Quad/VMO strengthening is absolutely the best way to fix this…ie: leg extensions but do light weights, keep it PAIN FREE with the level of resistance (weight that you use), 15-20 reps, single leg and don’t go full range. Start at 30-45 degrees and extend the leg to straight (0 degrees). Leg extension machines usually start at 90 degrees and you can adjust them to start at 45 degrees…ask a trainer in the gym if you do not know how to do this. Strength of the quads keeps the kneecap tracking correctly (so it doesn’t irritate the underside of the knee cap) and has really been the only thing found in the current literature to do this…don’t get lost in all the stretches, ART folks advice, massage therapists advice, PT’s advice etc.
Yes.
Sounds like you have a “cluster” like I experience.
It’s easy to have both PFS and ITBS on the same leg. Faulty glute/hip/quad mechanics, leading to kneecap tracking issues compounded by pain on lateral side from a tight TFL.
I HIGHLY suggest you get the book The Trigger Point Therapy Workbook by Clair Davies, and start hunting down and fixing your trigger points (work with your massage therapist on this). I am also a big fan of the tpmassageball, although there are other, cheaper balls you can use (NOT tennis ball, though–not hard enough!).
Regardless of the presences of actual tendinitis, once there is pain, there ARE trigger points being created, and part of the curative process HAS to be to deal with those, because even if you are able to “fix” the acute problem, triggers will stay without treatment.
I check my trouble areas for trigger points daily as part of my stretching routine, and work on things that need it. If you stay on top of them, they don’t develop into larger problems, such as knee pain, ITBS, etc.
ITBS is ultimately caused by tightness/trigger points in the TFL. Pain under the kneecap can be caused by trigger points in the VMO muscle. If you have repeated bouts of PFS, you may need to work on strengthening your VMO and adductors as well, as someone else already described. Leg extensions aren’t the best way, IMHO, though, because they are an open-chain exercise, and the knee can actually hurt while doing them. I do 3 exercises to keep my VMO strong and kneecap tracking properly: Wall squats with a stability ball and squeezing a smaller (8" cheesy “play” ball) between my knees. The squeezing helps to activate the VMO. I do 2 sets of 15 reps twice a week. Dirty 30’s. A squat-type activity. PM me with email address if you want the instructions. They are good for anyone who has unstable knees. Leg lifts. Lay on floor, one leg out straight; other knee bent. Turn foot of straight leg slightly out. Contract the quad (focus on VMO) and raise leg about 10-12" off floor. I do 2 sets of 15 reps each leg twice a week.
For ITBS, you need to work out the triggers in your TFL, possibly stretch the TFL, and probably strengthen the TFL. TFL is an abductor; note that there is no movement triathletes do that involves much abduction. So a good exercise is to use the low cables in the gym, standing perpendicular to the machine, and in a controlled fashion, kick the outer leg away from you and then bring it back in. OR you can use one of those abduction machines. 10 to 1 you will feel how weak your TFL really is, and when a muscle is weak, it develops trigger points.
If you have ITBS, you may also have a jacked up quadratus lumborum.
Buy that book! You won’t be sorry.
definitely makes sense… the problem probably isn’t weak quads, but weakness in other stabilizing muscles around the knees and hips. Your quads are strong enough to handle a long hard run, but these minor stabilizing muscles aren’t. So you need to work on reactivating them in the gym so they’re strong enough to hold up on the long/hard run.
what worked for me was getting into treatment with a skilled physical therapist who had ART expertise.
I had self diagnosed runners knee. I did wall sits with a stability ball and it worked like a charm. Try to do 5 sets of 60 seconds holding a 90 degee angle between the shins and thigh. Work up to 90 seconds. If you still have problems I would be surprised.
From what I understand running works the hamstring much more than the quads. This can produce a severe muscle imbalance over time. This imbalance causes the knee cap not to track correctly cuaseing pain. I do wall sits religiously now to keep my quads strong and haven’t had any knee problems since.