Talk Me Off the Ledge: Knee Pain 5 weeks out from IMCdA
I am having some real troubles with my knee right now and it's making me bonkers. Hubby thinks I should pull the plug on CdA, but that would about break my heart. For one thing, it's been 6 years since my last IM and with one kid entering college and another looking at elite performing arts schools, it may be another 5 years or more before I get another opportunity. Wah!
So background: I have run, biked, and swam since 1989 with no knee pain whatsoever. Even a knee injury during skiing in the early 90's (never repaired, just rested) only took me out of triathlons for 6 weeks. The origin of this pain is a bit of a mystery. There are three culprits:
- I went on a 3-hour bike ride in which (without my knowledge at the time) my seat came slightly loose and slid backwards on the rails. After experiencing a lot of back pain, I pulled the plug and came back early at 2:20. When I got home, noticed the seat was all the way back. So possibly my knee was hyper-extending during the ride. However, no pain that evening or next day.
- Other possibility: my RETUL Fit guy put new insoles in my bike shoes, which I just remembered. I am taking them out today. They had much higher arches (possibly forcing me onto outside of feet?)
- Next day did first long run rehearsal at race pace (EP + 30 seconds for first 6 m, EP for rest). For some reason, the really slow pace was bugging my legs and hips. I have had problems running this slow since i started practicing it. For whatever reason, I can run 10 minute miles and have a "groove" at that pace, but something about the shortened stride at slower paces was bothering me. Still, no sharp knee pain or anything or I would've pulled the plug on the run.
The next morning (after bad-seat ride and long run), my knee was REALLY sore on the inside and stiff (if I sat for awhile with it bent, then I couldn't easily stand up and walk on it).
Since then (3 weeks) it's been giving me fits after running, but biking doesn't seem to bother it. Last long run was this Wednesday (2.5 hour) and it is still slightly sore today.
My current plan: Take all next week off of running and bump up biking miles instead. See how it feels.
I guess I'm looking for input on this: given that it only seems to be bothered by running: how much running should I do in the next 5 weeks? None? Some shorter stuff with no intensity? If I don't run between now and CdA, will I survive the marathon? I am probably not in Kona qualifying zone, although if the conditions are really windy and horrible I would have a better chance (I was an hour away from qualifying at last IM). So if my time was slower than expected, I wouldn't really be losing out on much except a bit of pride
And, does the brain trust here think I should absolutely give up on IMCdA? Or plan on a run/walk with no run trianing between now and then, or what?
Comments
Any swelling???
I like your plan, but I would not up the biking...just skp the running and keep everything else the same...I would also do lots of icing and maybe even some anti inflamatory type meds to see what happens...then reevaluate next week.
I don't think you are in the catagory of skipping CDA bacause of this injury...You may be in the catagory of adjusting your race day expectations. Having said that, if its just a strain, you might be just fine in a weeks time. skipping a week of running isn't that big a deal...you still have time... and a lot of fitness in your legs..
keep the faith.
Are you making time to ice after workouts? That is probably time well spent since it should prevent the inflammation that is creating the post-workout stiffness.
With 5-6 weeks until the race, it seems really early to pull the plug, even if you have to lower your expectations for the race. I'll be interested to hear from the more experienced members, but I think it is worth the plan Nate suggested, just back off the running and see if the pain subsides.
@ Robin I think backing off the running for a while and not upping the biking sounds like a plan. Hopefully, this is something solely caused by you seat position change and the run.
Having said that, I want to go back to one of your sentences early in your post -- something about a skiing injury in 1994 that only kept you away from tri's for 6 weeks. That sounds really familiar to me. Did you ever have your knee checked out then? I tore my ACL in 85 playing basketball overseas and never had it looked at. Took me many years (17 actually) and over 100 tri's to start having knee problems, when I found out that not only did I have a severely ron meniscus, I also had seperated my ACL. I never had pain or swelling (after the first 4-6 weeks) except occassionally.
My point is, I do think you should get it checked out by an ortho, just in case you have a long-term chronic issue you didn't know about.
I agree with the others that likely re-setting your raceday expectations will likely mean you can still race -- assuming your ortho says you won't do further damage.
Good luck!
For me knee issues can be dealt with by icing, anti-inflamatories and some light weights in the gym. Typically I use ice and weights to keep things at bay. I don't tlike to recommend the drugs but they do work wonders to get you to the finish line assuming it's just soreness and or overuse issues. I'm going to see my doctor on Tuesday.
If your bike position truely is not bothing your knees then possibly you could up the bike miles, but I'd go for more rest rather than taxing the knees. In the OS I thought it was my run that was the issue and turned out it was my clete position causing issues so be careful on ramping anything up this late in the game.
As for the plan you have put in the bulk of the long runs. I'd say it's a do what you can with so that the knee feels decent at CDA. Take the time off rest and then asses with some short runs, no intensity. By then you are probably in to taper, just don't get the urge for one last long run to test it. Save it for the race with the realization of walking or having to pull out should major problem occur.
For the record I only ran about 6-7 miles in 2004 and made it thougth the marathon at Lake Placid. It was mostly a walk but I knew that going in. So yes you can survive the marathon and if the knee does not get sore probably run most of it given the training you already have in.
Gordon
Thanks for all the input guys. Paul, this is the other knee. After all these years of karate, kickboxing, and triathlon, my original knee injury (Left) has never cropped up. This one is on the Right, which has never ever bothered me. But that's good food for thought!
Hi Robin,
Keep the faith! You're still a few weeks out - tons of time!
Stupid question: have you seen the doctor yet? My thought is a quick MRI would really solve for a lot of the "what ifs"...
Also, I agree to not up the biking. It may be "x" that is causing it and "y" that it expresses pain so overcompensating may backfire.
Keep us posted and good luck!
I was in the same boat last year before IMCDA. Did Calif 70.3 on a Standard crankset and beat the shiz out of my quads and knees going up those hills and then came home and rested for like a day and then back at it! Somewhere along the lines there was a change in my cleat/shoe setup as well and that also contributed to the problem. I remember coming home from RR Bike #1 of 112 miles and telling my wife "I'm done, I won't make it to CDA". Running really pissed it off, esp. the first 5-10 mins of running. I iced, I KT taped, I warmed it up with a hot/wet towel before rides/runs. Finally went to the doc and he Rx'ed me some Diclofenac Sodium and it was problem solved (for the most part). Doc said that Diclofenac is popular for knee issues because it's primarily used to target chronic arthritis and it just seems to work better than the other NSAIDs on knees. The Diclofenac combined with some really aggressive quad stretching (prone on the floor, pillow under hips/quads and pull foot back to butt) 4-5 X per day really helped. Was totally good to go for the race and then 3 days before I broke my foot...at that's another story.
Personally, I wouldn't bag all of the running. My minimalist approach to running with an injury is to knock it down to 5-6 days per week of 15-20 mins tops. No speed, no hills. It's amazing what you can accomplish with just a little bit of running. Stopping cold turkey just doesn't seem like a great idea. But I'm not an expert.
Yes see sports doc NOW. And get exercise rehab plan. Careful use of antiinflammatory.
Doc appointment today!
and what did the doc say?
sending good mojo!
Good news! No actual issues in the knee itself, no meniscus or cartilage problems whatsoever. He thinks that it's inflammation at the attachment points and some bursitis. Prescription: rest and stronger anti-inflammatory dosing, but in response to my questions about training/racing he said that I will not damage anything irreparably by continuing to train and race, and I should just let my level of pain/discomfort be my guide. I am going to go light on running this week and see how it feels.
More good news: My X-rays show "incredibly strong dense bones and terrific cartilage", especially for a 46 y.o. woman who has been running steadily for 30 years! Some mild patellar displacement (need to work my medial quads in the gym to balance out the stronger quads pulling the patella outwards) and he gave me an Rx for Physical Therapy to start immediately for the knee.
Oh yeah, and he recommended against a cortisone shot for the bursitis because it will mask the pain. I think that makes sense for training, but what think you brain trust on getting one before the race? Given that I'm going to do it anyways, and am probably not going to let any pain slow me down or stop me. So if it's between doing the race to the utmost of my ability with lots of pain, or doing the race without pain, is it bad to choose no pain? My experience with completing IMFL with a dislocated big toe proves I can go to a very dark place and ignore a whole lot of pain, but I'd rather not do that again.
Also, do not take ibuprofen on race day. Ups your risk of hyponatremia, definitely not worth it!