Knee Pain, No Swelling

author : AMSSM

comments : 0

Persistent "Runner's Knee" after Ultra

Question from Member completelyhis:
"I did a 50 mile ultra in October, the first ultra I've done, and I loved it. it was on a mostly paved path, but enjoyable enough. My left knee began hurting some time in, but didn't feel like anything more than good old fashioned "runner's knee." Now, more than three weeks later, it still wakes me up at night if I sleep wrong, and if I even try to walk more than a mile, it begins to hurt to the point of causing me to limp, and then stays that way for a couple days. I haven't even tried running on it.  

It just feels like runner's knee though; no swelling or discoloration.  

Thoughts?"

Answer by Ryan Lingor, MD 
Member AMSSM

First off congrats on your first ultra!  A wonderful accomplishment but unfortunately the toll on the body can have lingering effects.  Knowing what is normal versus when to see a doctor is a frequent question.  Soreness for several weeks after a major event may not always be abnormal, but you’re right, it is not something to completely ignore either.  Runner’s knee (also called patellofemoral pain syndrome) is irritation to the undersurface of the patella caused by friction with the femur.  At three weeks of continuous pain the red flags start to come up, especially if the pain wakes you at night, or your pain seems to be getting worse.
 
The knee joint is comprised of four bones, the femur, tibia, fibula, and patella.  The femur and tibia are the major weight-bearing bones, while the patella and fibula function more for muscular attachment and stability.  The bones are surrounded by cartilage that create smoothness and are lubricated by joint fluid.  The meniscus of the knee acts as a shock absorber and secondary stabilizer between the tibia and the femur.
 
The major concerns for the type of injury you are describing are a stress fracture of the femur or tibia, a defect in the cartilage surface of the bone, or a tear in the meniscus of the knee.  These can be caused either by repetitive loading on the joints or a misstep or twisting while running.  If untreated, each of these can progress to further injury and problems down the road. Some concerning signs that might prompt further evaluation of any knee problem are swelling, feelings of instability, locking of the knee, an inability to bend or straighten the knee, or an inability to bear weight.
 
Things your physician may suggest are obtaining an x-ray and an MRI or CT scan.  Treatment options depend on the pathology discovered or in many cases, treatment may be offered once more serious injuries are not discovered.  
For this problem, I would recommend an xray and an MRI.  If the imaging does not show significant pathology, treatment options would be likely geared towards controlling the irritation and inflammation in the joint.  This can be done with physical therapy, icing, an oral anti-inflammatory medication, or a cortisone injection.
               
In some cases, a cartilage defect or osteoarthritis can be treated with an injection of hyaluronic acid, commonly referred to as viscosupplementation.  These injections are felt to lubricate the joint and alleviate pain in patients with mild to moderate pain.
 
Prevention for these types of injuries may be achieved by gradually increasing mileage during the base period and by regularly performing core strengthening exercises.   Weakness and fatigue of the gluteal and thigh muscles may cause a malalignment at the hip and knee joints which can place excessive stresses on the body and contribute to many different types of injury.
 
Ryan Lingor, MD
Tri-County Orthopedics
197 Ridgedale Avenue
Suite 300
Cedar Knolls, NJ  07927
Office:  (973) 538-2334  Ext. 208
Fax:  (973) 267-6882
Cell:  (605) 216-3916
[email protected]
https://www.tri-countyortho.com/our-experts/ryan-lingor-md

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date: February 29, 2016