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RUNNING WITH A CHANCE OF KNEE PAIN - PART 2

(click here for Part 1)

I’d been enjoying pain free running in that 4 – 7 mile range.  I never really imagined running more.  But I joined a friend on a run one day, and she was running longer distances at a slower pace.  (That’s a whole other topic that I can’t wait to tell you about!)  By our second run together, we’d adjusted our paces, and we ran over 9 miles together.  What a thrill!  Who knew??  I felt like a million bucks.  I couldn’t wait to run again, and push beyond the 9 miles.  So over the next several weeks I ran 10, then 11, then 12 miles.  Wow!  And I was trying to be pretty good about the ITB stretching (but I was not doing the yoga like I used to).  The ITB issue was kept at bay, but some new knee pain presented itself.  Specifically, kneecap pain.  SIGNIFICANT.  Ugh.  As much as I didn’t want to, I had to rest it, and rest it I did, and iced it, wrapped it, but several days later it was still hurting with walking and sitting, let alone running.

Patellofemoral Pain / Runner's Knee

Kneecap pain, or patellofemoral pain syndrome (PFPS), can be complex and is often caused by a number of different factors coming into play.  Here’s a detailed article that includes a complete overview and treatment options based on clinical research.

This is a blog, and it’s about MY knee pain, so I’m going to cut to the chase and tell you what seemed to be causing my kneecap / anterior knee pain: muscle tightness (ITB!), excessive pronation of the foot, and (therefore), patellar tracking abnormalities.  The fix?  A stretching program (specifically, my hamstrings, gluteals, gastrocsoleus (calf) muscles and iliotibial band (ITB)), a gait analysis by a podiatrist and custom orthotics to better support my foot and prevent excessive pronation, a patellar tracking knee strap, along with some pain management therapy (interferential current therapy (IFC) and low intensity infrared laser), and a traumeel injection.  My knee felt substantially better with the combined therapies.  However, when I went on a gentle run (a few miles) before my orthotics arrived, the knee pain kicked in again, more mild, but definitely present.  I was depressed.  Would my love of long distance running be over before it even began?

So I waited with much hope and anticipation for my orthotics.  When they arrived, I had my podiatrist fit them into my running shoes.  I walked in them for several hours.  They felt very stiff; they definitely required some getting used to.  I felt like I had grown an inch and my posture was impeccable!  The next day, I went for a run.  I was supposed to do a short run to try the orthotics out, and to gradually allow my body to adjust to the new mechanics of my foot and, therefore, my entire lower chain.  Good plan.  Guess what?  I felt so good that I found it impossible to stop running!  I went to plan B and ran 18 miles!  (I would NEVER advise this.  It was really risky, and I clearly should know better.  But I’d caught the (distance) running bug and I’d been missing the long runs terribly.  I’d been doing therapy and had the pain under control too.  I guess the combination of no pain and the gorgeous ocean breeze that seemed to be carrying me down the boardwalk affected my sensibilities.)

The saga’s not over though… a week later, on my next long run, my kneecap was a tad bit annoyed.  AND I felt significant pressure on my left tibialis anterior tendon at the front of the ankle.  It really hurt.  Ugh!

The tendinitis of the tibialis anterior that was developing was more significant than the knee pain, so I had to fix that first.  It felt like my tied shoe was causing such significant pressure on the extensor tendon.  Is it a shoe problem?  I think so.  And it’s a new problem (with my previously comfortable New Balance running shoes) since getting my orthotics.  It felt like the shoe didn’t fit anymore.  I had to relieve the pressure on the tendon, so back to the New Balance store I went.  I tried proper running shoes a half size bigger to better accommodate the orthotics (and padding).  That was the answer.  The pressure was substantially relieved.  I bought the New Balance Extended Web TS2 shoe (wide to best accomodate the orthotics and prevent pressure on my Morton’s neuroma in my left foot – more on that later!)

Now back to the kneecap pain… I started to investigate other patellar tracking straps as the thin, rather flimsy one I was using did not seem to provide enough support to my kneecap.  I discovered Mueller’s Knee Jumper at my local Big 5 Sporting Goods.  This product has a tubular insertion that supports the kneecap better than the Fabrifoam knee strap that I tried first.

Mueller Knee Jumper

Fabrifoam PattStrap

After weeks of ups and downs managing the patellofemoral pain, I’ve since run a bunch of short runs (7 miles or fewer), a 23 miler, The Camarillo Half Marathon (13.1 miles), and a mid-range run (8 – 10 miles) with NO PAIN over the past several weeks.  Sweet relief… I can say now that I’m training for the LA Marathon that’s on May 25, 2009.

Long distance running can really take a toll and can emphasize weaknesses, as I’m seeing (I’ll share all my other “discoveries” with you too).  We’ll see if this soon-to-be 39-year-old body can take the test.

I’m training for the LA Marathon by following the advice of Jeff Galloway (Olympic runner who has run over 100 marathons) in his book “Marathon: You Can Do It!” It’s an exciting run / walk method that I believe is going to be key in keeping further injury at bay.  AND I’m training at least 1 run / week with my friend, which is a huge motivator that keeps getting me to the next mile marker.

Galloway’s book has been truly enlightening and inspiring, running regularly with a partner has been a thrill, and long distance running for a big goal has been a trip so far.  Sir Roger Bannister said it when he said, “The mile has all the elements of a drama.”  More on Galloway, running partners, and “the drama” of a first-time marathoner… (click here for Part 1)

Happy Trails,

Meredith Soelberg, MPT, MBA

RUNNING WITH A CHANCE OF KNEE PAIN - PART 1

(Click here for Part 2)

Knee pain is one of the top complaints of runners, and it sidelines them more often than any other pain.  Different kinds of knee pain during running have burdened me over the years.  Let’s get into it about iliotibial band tightness and tendinitis, patellofemoral pain sydrome, pronation, distance running, and marathons.

Several years ago, I struggled with iliotibial band syndrome (ITBS).  I felt the pain on the outside of my left knee, sharp and debilitating, especially with heel strike, or the time during my gait when my heel would hit the ground.  Ouch!

Being a PT, I got to work to address it.  After acute management of the flair-up with rest (I didn’t run for a week) and ice over several days, and then a focused and regular stretching program for it, I was feeling great and was back to running pain-free for the 4 – 7 miles I was doing a few days / week.  The stretching was key; if I ever slacked off on the stretching for several runs in a row, I’d start to feel the tightness and the beginning of the pain again.

The ITB is tricky to stretch properly and it’s not a delightful feeling stretch to those of us with really tight ITBs.  It hurts!  It can even take your breath away.  In addition to ITB stretches after warming up (don’t stretch cold muscles!), and then after my runs, I also committed myself to regular yoga.  At the time, I was getting to yoga a couple of times a week, where I was getting the overall body stretching and strengthening, and I was also getting at the ITB more.  I felt great and even ran some 10K races.  The running and yoga combination worked wonders.  Don’t underestimate the value of proper stretching!

Here are two great stretches for ITB tightness:

This is the ultimate of ITB stretches that gets at both the hip portion of the muscle and the knee (straightening the knee as much as possible helps to stretch the knee portion of the band).  A way to modify it and make it a bit easier depending on your level of flexibility, is to use the left hand to support the right knee.  And to enhance it, use a towel or strap around the bottom of the foot for support and use the left hand to hold the strap and create a deeper stretch.  Hold each stretch at least 15 seconds and gently move into it as the muscle relaxes.  Repeat several times.

When you don’t have the luxury of laying down to stretch, you can try this one:

And here’s a very thorough (and clinical) Medscape article on ITBS from overview to treatment options.

Run and be (pain) free!  And stay tuned for Part 2 about my long distance running (marathon training!), patellofemoral pain or kneecap pain, shoe wear, orthotics, and more!  (Click here for Part 2)

Meredith Soelberg, MPT, MBA