Knee/Patella Pain
It is week 14 of NOS and I had been doing great up until week 13. I followed the plan, stuck to my training zones, and was feeling great about myself and my progress.
Last week my left knee/patella started acting up for the first time ever. When I run, even at z1 pace, my knee hurts every time I take a step.
It doesn't hurt when I ride on the trainer. There is no pain when I walk except for going downstairs.
I purchased one of the knee straps and tried that - pain still there. After reading a few articles on line about patellofemoral pain syndrome I'm wondering if that is what my situation is. The recommended treatments include strengthening of the quads, lots of hamstring, it band stretching, foam rollering, icing, etc. and of course not running. The articles did recommend swimming or using the elliptical.
My question is - What to do about running right now?
Should I stop for a while and work on stretching/strengthening?
Should I "walk" the run workouts?
Should I keep running at a much slower pace and just suck it up and hope it goes away?
Discouragement is creeping in....IMLP is still a long way off but I have a lot of work to do!
Comments
Strength work will also need to be increased some but I would not panic! You've got plenty of time!
I would try single leg squats bilaterally and see if one side is weaker or more imbalanced than the other.
I would check my shoes for wear.
I would check my bike cleats and see if they have moved.
I would pool run
I would do a lot more as I am a PT. Can you get a PT assessment?
Do not get discouraged.
We who suffer from adult-athleticism distinguish ourselves by our incredible ability to accept reality and adapt.
Now is the time to come up with some solutions.
x2! And then some...
Ideally, you would find a PT who "runs the run", if you will.
A good PT will tell you exactly what's going on with your knee and give you corrective exercises.
A great PT will also broadly assess your functional weaknesses and imbalances and give you a full routine.
You need to understand why your knee is hurting, and you need a good strategy for resolving it and then preventing it.
I have a great PT who has done much to enable my endurance addiction - but he is in Beverly MA.
Michael J. Stare, DPT, Orthopaedics Plus, 100 Cummings Center, Beverly. Depending on were you live and work, could be within reach...
I'm sure there is also a great PT closer to home for you.
In the meantime - if your knee hurts, don't run on it.
Don't underestimate the injury; don't risk re-injury, or even aggravation.
It sucks not to run, but hey, that's why we have 3 sports.
If you DO run on it, you run the risk (no pun intended) of significantly prolonging the injury, and that would definitely put your season at risk.
It would suck worse to have this impact your training longer.
Water running is the best way, to my knowledge, to maintain and build running-specific fitness without aggravating an injury
Learning menu / EN Wiki / Running / Modifications / ... and there are a few things to read.
Certainly, the General Pool Running Guidance, but also the 9 Week Plan.
The only problem is that it depends on your access to a pool where they have the belts and equipment.
Definitely work on functional strength, but you have to do so in ways that don't exacerbate your knee injury.
Knee pain can often be traced to core strength, hip strength - so I would also recommend some focus on that.
Strength training to generate more force will not help you swim/bike/run, but functional strength focused on core and keeping muscle imbalances in check will keep you healthy and increase your physical tolerance for hard workouts. I have a core functional-strength routine I follow religiously and benefit greatly from - there is also a lot in the same place in the Wiki under Modifications / Strength Workouts. I never did strength workouts as a runner until I ran into a string of injuries. Now functional strength is part of my day. Functional strength (glutes, hamstrings, core, hips) is more important then stretching and flexibility. Post back if you would like help putting together a routine; I can and would certainly help, although there are others here who know much more than I do (I suspect Carrrie Chavez does; I suspect Brenda does...)
I would also check out this:
http://tinyurl.com/an48jay
This is a great routine, but I would add in the clamshell:
http://reachphysio.com/category/rehab-exercises/
Scroll down to, Perform your clamshell exercise properly
I also like the Squat and Lunge a lot, but I recommend having someone check your form because done wrong they can cause injury.
Again, a good PT...
Summarizing...
Running right now? No, not if it hurts. No room for the risk.
Strength training? Yes - definitely - but specifically core and functional, as a way of life, to prevent injury. Everything is connected to everything. Knee pain could be ITB, could be glute weakness, could be... that's why you want a PT who does a broad assessment of your weaknesses and imbalances.
Walk the workouts? Not
Keep running at a slower pace? Also not - both of these can slow resolution and don't advance your run fitness
Eliptical - I'm not a fan - it feels like you're not doing enough to further your running fitness and you're not really letting the knee injury resolve either.
Water running - yes - definitely - if you can make it happen, do so.
Above all: Get a real assessment from a professional PT, ideally one who treats runners
Walk out with a routine that you can do every other day or every third day
Discouragement - definitely not - does nothing for your workouts, resolving the injury or preparing for IMLP
I've gone on for a while here, especially for someone who is not an expert, but I feel your pain.
We've worked hard in the NOS and I'd hate to see you lose momentum.
I've been in a similar place and I know what worked for me, and continues to work for me.
I went to a PT in town recommended by my PC, and he was overweight and didn't think running was good for you. FAIL!
Called around, talked to a local running coach, found Mike Stare, got on a functional strength program, and this has made all the difference.
Best of luck with this - keep us posted.
Just in time check it out.
@David, Brenda - looks like an interesting site - need to peruse it for a while...
Here's where I am now:
Have an upcoming PT appt
Replaced my worn running shoes
Have been doing stretching, foam rolling, and some of the beginner hip/knee exercises found on Physio Advisor
Stopped running, doing a little walking just for sanity
Cycling is still ok
Swimming feels great.
Sounds to be like ITB issues - especially the pain while going down stairs.
Some great advice above, especially with regards to strengthening hips and so forth.
Personally, when I had ITB issues, I found the most effective treatments to be:
1) Deep tissue massage of the quads and hamstrings for acute relief
2) Core strength - squats, lunges, side to side walk with band around ankles, clamshells, etc. All stuff to strengthen hip stabilizers to help keep the pelvis from dropping and coming out of position.
3) Regular yoga (specifically Bikram, because I've found it hits MANY areas beneficial for endurance athletes) once a week or so for maintenance of flexibility and core strength.
4) Improvement of running form. About a year ago, I found this article (http://www.chirunning.com/blog/entry/it-band-syndrome/), which completely revolutionized how I think about my mechanics with running, specifically how the pelvis is involved. I immediately signed up for an hour long session with a local Chi Running instructor (coincidentally also named Ryan Miller - but he does a sick 1:14 half marathon, so no way to confuse the two of us!) to help get some form refinement. I've not had any issues since - and when I get warning signs (happened twice), I know I've been sloppy with form recently, so I know how to adjust.
5) My ITB issues came about with intense running, primarily because of overstriding, which resulted in heel striking, which results in premature fatigue of the gluteus medius. So not surprising you are seeing this at the end of the OS, which obviously included a lot of intense running. It may very well have been the IP repeats that put your knee over the edge because of the extra intensity. Perhaps overstriding is the culprit there in your case as well?
EDIT: As far as what to do - give runnign a rest, and crush the bike. I injured my foot last spring, 9 weeks before IMLP. I hit the bike regularly, and to my surprise, it helped maintain a good deal of run fitness. My $0.02.