Member Case Study: Right Knee Pain Post Ironman

author : AMSSM
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I just completed my first Ironman season and I was free of injuries. I am now just messing around when I run at a fast pace (for me), I get a shooting pain in my right knee.

Member Question from sbr.geek

This may sound like a silly question, and I truly apologize if it is. I just completed my first Ironman season and I was free of injuries (and have been for the five years that I have been involved in triathlon). I am now just messing around and doing light workouts and, all of a sudden, when I run at a fast pace (for me), I get a shooting pain in my right knee.

 

The pain begins on the inner side of the knee cap and shoots down through the center of my shin. The odd part of this is, when I slow down to a jog or walk, there is absolutely no pain at all. I am a firm believer in Chi running and it doesn't seem to be helping the pain. Any ideas? Right now, I am treating it as an overuse injury and only running until it hurts. Thanks so much! Kim
 

Answer from the AMSSM

 

Dear Kim,

Congratulations on your first Ironman!!! It is a long year or more of training and dedication. You were fortunate to have survived all the training without injury. I have finished three Ironman Wisconsin races from 2006-2008, and have had my share of overuse injuries during those three years.


The injury you are experiencing sounds like a common overuse injury called patellofemoral pain syndrome (PFPS). Other possibilities include patellar tendonitis, capsular or medial plica inflammation, stress fracture, or bone bruise. PFPS is the most common cause of overuse anterior knee pain in runners. It is achy or sharp and shooting, and is increased with running, stairs, or prolonged sitting with the knees bent (known as “theater sign”). It will usually improve when the offending activity is removed, but as with any overuse injury, the longer it goes on the more likely it will start to cause pain well after the activity is stopped.


Patellar tendonitis is also called “jumper’s knee,” but is not exclusive to jumpers. The pain is usually over the tendon, but there can be pain over the inner part of the kneecap at its lower aspect where the tendon attaches. Medial plica inflammation is in a redundant fold in the joint capsule. The plica can be felt as a small spaghetti string-like structure to the inner side of the kneecap that is painful when irritated. Both are overuse injuries. A bone bruise could come from the repetitive load to the leg on race day and may take up to eight weeks to heal. Bone can bruise just like soft tissue if loaded either repetitively or with a sudden injury. A stress fracture is another possibility, but those occur more in the shin, thigh bone or at the hip.


Other contributors can include the flexibility of the hamstrings, hips, and IT band. Core strength, hip abductor strength, and pelvis alignment issues can also cause knee pain. Shoes affect foot and knee alignment and it is important to assess wear patterns and replace old shoes if needed. A custom Orthodox may come up as an option later if the problems persist.


Treatment includes icing the affected area for 15-20 minutes two to three times a day or after activity, taking over the counter ibuprofen or naproxen, and working on heel cord, hamstring, hip, and IT band flexibility. Strengthening focuses on the hip abductors and hamstrings. Knee extension exercises can flare up the pain. Cross training is very important, so swim or bike if you feel like it. More importantly, find some other non-swim, bike, or run activities to do for a good break. It is not a bad idea to take four to eight weeks off from any triathlon type activity after an Ironman, anyway, since it can take that long for the body to recover.


The reasons to check in with a physician for this problem include persistent pain despite home treatment, night pain, knee locking or instability, and joint redness and heat. Pain in the hip, thigh, and shin can raise suspicion of stress fracture and should also be checked.

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date: December 19, 2008

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

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The American Medical Society for Sports Medicine (AMSSM) was formed in 1991 to fill a void that has existed in sports medicine from its earliest beginnings. The founders most recognized and expert sports medicine specialists realized that while there are several physician organizations which support sports medicine, there has not been a forum specific for primary care non-surgical sports medicine physicians.

FIND A SPORTS MEDICINE DOCTOR

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