General Discussion Triathlon Talk » HELP! I have Runner's Knee Rss Feed  
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2009-01-28 1:03 PM

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Denver Colorado
Subject: HELP! I have Runner's Knee

 I have Runner's Knee, also known as Chondromalacia patella. I went to the doctor yesterday and he said that I need to build up my VMO muscle (Vastus Medialis Obliquus ). Apparently one side of my upper quads is pulling my knee cap to the high outside of my leg. This causes the cartilage grinding to happen on the knee because my knee cap has slid out of its groove/path.  He tells me that if I build up my VMO it will pull my knee back into position. Here’s the  F*cked up part... he said in about 6 months after exercising this muscle I can run again!!!!!!!!!!!!!!!!! F*ck THAT DOC!! No frickin' way bro! Not on your life... there has to be another way! 

 Does anyone know of somebody who has overcome Runner's Knee and still trained lightly enough to heal at the same time?! I have Kansas HIM in June and I just signed up with TEAM IN TRAINING for the 5430 Boulder Long Course. Plus, I love my running... pain or not, I will still run.. at least a  little.

  Also, I have been reading some things on the internet that the exercising and building up of your VMO is nearly impossible and doesn't actually yield the results the doctors say it will anyway. I don't know... I need some truth and I want to know of somebody who has actually had this injury and is able run pain free again on a regular basis after healing. 

 I want some answers!

(How long did it take? What did they do? How much did they run? How much did they not run? Do they still have problems? Will I ever be the same again as a runner?  Am I screwed for life and will this injury always show up if I up my mileage?


2009-01-28 1:27 PM
in reply to: #1933804

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Champion
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Northridge, California
Subject: RE: HELP! I have Runner's Knee
I trained through a bout of runner's knee that came on suddenly about six weeks before a marathon (and two weeks before an 18-mile road race that was my last key run for mary training). Several things to say...

1. I didn't see a doctor. Your situation may be more severe (though mine was quite painful). So nothing here should be taken as advice to blow off the doctor. Again, your injury might be worse than mine was.

1a. Specifically, did the doc say "chondromalecia patella"? The usual designation for runner's knee these days (and this is based on looking at some clinical paper abstracts when I was injured, along with the usual WebMD pages and such) is "Patellofemural pain syndrome" or "PFPS". From what I read "chondromalecia" is a narrower diagnosis that suggests that the injury has some degenerative characteristics beyond just inflammation. Again, it's important to be sure you have all the relevant info. If he's considering it degenerative, you might need to take this seriously.

Anyhow, assuming you want to rehab this...

2. Most of what I've read and my personal experience suggest that this often clears up with self-PT, ice, and ibuprofen in around 8 weeks. (Not the case if it is a chronic degenerative condition, which is sometimes the situation.)

3. No one knows exactly what causes runners knee and the explanation you got from the doc is the conventional wisdom. There are some explanations to be found on the Web that are a bit more nuanced and are worth doing a search on. However, I found that doing the simple isometrics recommended to strengthen the quad muscle in question does help (at least it did for me). Best one is lay on floor with sole of the foot of the UNinjured leg on the floor (healthy knee is up) and press the entire back of the injured leg flat down into the floor for 20-30 seconds and repeat. You should feel that isometric working on the muscle the doc identified.

4. If you have a desk job, find something to keep the leg extended and elevated WHENEVER you are seated. Flexion of the injured knee contributes to the inflammation. (Also avoid hills and stairs as much as possible while rehabbing...you'll find running down hills is the worst.)

5. As mentioned in 2, regular ice and anti-inflammatories.

6. Cut back on running as much as possible. I found that I could still get in one long run and that it set me back less each week as long as I was religiously doing the rehab. (In other words, monitor your progress...if you aren't seeing some improvement, shut down your running and cycling and just swim and walk.)

7. Knee straps (such as the Patt-Strap) are controversial, but I found they helped me. I tried a couple inexpensive brands and like the ACE strap the best of them. I do have an elite duathlete friend who is an RN who suffers from the related "jumper's knee" and he also recommends them...he wears a more expensive brand.

That's about it. I got through the 18-miler with modest discomfort (mostly had significant pain on the couple downhills) and then PRed my marathon (wearing knee strap, fwiw).

Make sure that you are clear on the diagnosis with your doc, do some homework on the Web, and, if you go ahead with training, be dedicated with the rehab and avoid things like hills that will set you back the most. And if you aren't seeing progress, reevaluate. But, again, this is something that very often goes away in an 8-week time frame...if it isn't one of the minority of injuries that turns out to be chronic.

Good luck.
2009-01-28 1:30 PM
in reply to: #1933804

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The Land of Misfit Toys
Subject: RE: HELP! I have Runner's Knee

I have never dealt with runner's knee, but let me share you a personal experience with running through pain from high school (quite a while ago for me now). Believe it or not, I was a decent runner in high school. I regularly ran well under 16:00 for 5k and even popped off a few 5ks that were pretty close to that magical 15:00 mark. My junior year of track began with posting PRs in the 800m and 1600m at a jamboree where I ran largely alone after the beginning of each race. While running the 3200m at that meet (my coach was a nut and had me triple that jamboree because he thought it would be a good opportunity to set benchmarks, whatever), I developed pain in my lower left leg. I ran through it and spoke with coach afterward. Not wanting to forgo a potentially great year in which recruiters were starting to look at me, we decided that I would ice it and run through it. I kept on running and eventually began popping ibuprofen before each run to help with the pain. I could manage to make it through workouts like that. I went to visit a doctor after a while who told me to take a few weeks off and aqua jog or swim to maintain cardiovascular fitness if it was that important to me. I didn't pay attention and kept running on it. Eventually, in a year that I was posting some of the top times in the state in the 800m and 1600m, I developed a stress fracture that ended my season and sidelined me for months.

Moral of the story: Listen to your doctor! My situation is a bit extreme because I had a lot of indicators that I should have backed off earlier, but you have no idea what the consequences of trying to tough it will be. The consequences of momentary stupidity can be very long term and harmful.

Besides, you are not without options. You can aqua jog and focus on your other disciplines to improve them while you recover. Then, you can always go in for a reevaluation in a few months. To see if the doctor would like to reevaluate that time table.

Sorry for the length

2009-01-28 1:37 PM
in reply to: #1933804

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Memphis, TN
Subject: RE: HELP! I have Runner's Knee
Strengthen your hip abductors and external rotators. Also check for overpronation. This is usually caused by the femur medially rotating too much at mid-stance. This caused the patella to track laterally and wear out the back of your knee cap.
2009-01-28 1:48 PM
in reply to: #1933878

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Subject: RE: HELP! I have Runner's Knee
Thank you so much for your advice! It's very helpful... and my doc did actually call it "Patellofemural Pain Syndrome". I just couldn't remember what he called it... until you mentioned it. That's a tounge twister! LOL! So is Patellofemural pain syndrome less seriouse.
2009-01-28 2:22 PM
in reply to: #1933804

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Master
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Subject: RE: HELP! I have Runner's Knee
i got a knee strap from k-mart for $12 and it has helped a lot.  i got it after an 11 mile run, and just took it easy for about 5 days before a half marathon.  seems to be ok now!


2009-01-28 2:37 PM
in reply to: #1933804

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Subject: RE: HELP! I have Runner's Knee
i used to get runner's knee, I couldn't run more than a mile without it kicking in.  Make sure you have a good pair of shoes and orthotics (if necessary), this should really help out your knees.
2009-01-28 4:09 PM
in reply to: #1933804

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Subject: RE: HELP! I have Runner's Knee

I trained through and ran a marathon. These things helped me heal:

1. exercises to strengthen my quads (wall squats, leg lifts with weights, etc.) these were given to me by the Physical Therapist.

2. The chopat strap mentioned above. This really helped me. REALLY.

3. $600 worth of PT (exercises, massages, taping)

4. ice and ibuprofen after regular runs. Ice baths after hard runs.

5. Immediately after my mary I decreased my mileage significantly to about 15 mpw and very slowly built back up.

All in all, it took about 5 months for me to be able to run pain free without the use of the strap, but once I was over it, I've never had any other patellar tendonitis problems... *knocking on wood*

Once again, YMMV. This is just what happened to me. I was not going to give up my mary, which was also with Team in Training.

2009-01-28 4:33 PM
in reply to: #1933804

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Subject: RE: HELP! I have Runner's Knee

Yes Ive been there too.... some of the steps I took were:

1. Learning how to strap the knee cap (with strapping tape) so it would track properly all the time (I would change the tape every few days)

2. Pt exercises... starting with clam shells and bridges before moving up to squats, one legged squats and lunges as I improved my knee tracking... I dont engage my glutes generally either so that needed work!

3. STRETCHING... part of what pulls my knee cap out of alignment is not just over/under developed muscles but tight muscles pulling out my leg tracking

4. Custom Orthotics: anything that throws out my running form is bad so having these was something that I noticed made a major improvement

5. Bike fit/new cleats: I found for me changing cleats to increase float and getting a change in fit took pressure off my knees so they were no longer being aggravated by riding a bike

I didnt get back into running for quite awhile but I also didnt have a goal like one you are aiming for either

Good Luck!

2009-01-28 5:43 PM
in reply to: #1933938

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Subject: RE: HELP! I have Runner's Knee
Triathlon Sean - 2009-01-28 11:48 AM

Thank you so much for your advice! It's very helpful... and my doc did actually call it "Patellofemural Pain Syndrome". I just couldn't remember what he called it... until you mentioned it. That's a tounge twister! LOL! So is Patellofemural pain syndrome less seriouse.


Well, depending on where you look, they are either both synonyms for "runner's knee" or CP is specifically used when there is evidence of damage to the cartilage on the back of the kneecap. There doesn't seem to be a standard. What I read suggested, though, that PFPS is now preferred in general usage to refer to the presence of pain (the "syndrome") without specifically-identified cause (I think the real word for "cause" here would be "etiology", but I'm not a doctor).
2009-01-28 5:56 PM
in reply to: #1933804

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Memphis, TN
Subject: RE: HELP! I have Runner's Knee
Chrondramalcia is a result of a lateral tracking patella disorder. It is very common and when it causes knee pain they call it Patella-Femoral Pain. The key is to figure out why your patella is laterally tracking. USUALLY it is because your illiotibial band is too tight. It is usually too tight because it is having to work as you primary hip stabalizer during midstance. That is due from having weak hip abdutors and weak core


2009-01-28 8:09 PM
in reply to: #1934489

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The Cold North
Subject: RE: HELP! I have Runner's Knee

I was recently told I had this again.  I had issues several years ago and went to a lot of physio with no relief.  Previously, it resolved itself (I wasn't a runner then).

This time, I happened to mention it to my chiropractor while we were chatting and he did ART on my knee/leg.  It only took 3 treatments and for him to show me some very specific stretches and I was pain free.

Just a thought on a different course of treatment, if you have ART available to you.

2009-01-29 4:13 PM
in reply to: #1933804

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Subject: RE: HELP! I have Runner's Knee
Two and a half years ago I gave up on running because of runners knee.  I bought an elliptical trainer and used it regularly.  As it turns out, I read this is one of the best ways to improve runners knees because of how it strengthens the quads.  I got in over 800 running miles last year.  Strengthening the quads and stretching are key.  Ice after exercising, too.
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