Discussion: Knee Pain

I'm wondering what other people in the AP world have done for knee pain in the past. I have patellar femeral pain syndrome and have managed to control the pain with leg strengthening and core work since I first injured myself last August.

But lately, especially when pushing against a force (biking, going up stairs, squating, etc) I get pain in both of my knee caps. It's almost like a strong aching sensation below the cap itself.

I've done the usual - ice and rest but just wondering if there is anyone else who has experienced this type of pain before and what you've done to combat it.

My similarly-named condition was from doing not very much, then doing an adventure race, rinse, repeat. Doc sent me to PT - there, they had me doing leg strength exercises, stretches, the stimulator, massage, and ice, that and a more sensible build in exercise volume seemed to fix it up. In December before PT, I couldn't even get an hour into a race without pain; after ~six weeks in PT and more consistent exercise after PT, I did 10 and 15 hour races in the late spring and early summer pain-free.

The other thing was that the head PT guy had me switch from stability/motion control shoes (thanks, shoe store) to neutral cushion.

Occasionally I notice hints of it if I do something stupid like have a week off work, and stack too many bike rides back to back, well outside of my typical volume.

Thanks very much - yeah that's what I was wondering too (increase in training too much) after doing a 5 hour mountain bike 2 wknds ago. Endurance wise I can handle it, just not sure my body is ready for the hours as quickly. I have an 8 hour race in 2 weeks so will gradually taper before that to give some rest.

How many hours a week do you typically train in order to be pain free for the races? And doing what types of training do you feel the most pain?

And doing what types of training do you feel the most pain?

I've had a few bouts of knee pain, and a combination of leg strength training and general caution have made it a non-issue over the past few years.

One big change was to increase my cycling cadence, which means using a smaller gear that is easier on the knee. This is better technique anyway so it was well worth doing. I bought a bike computer with cadence measurement and used it on my trainer in the off-season to get a feel for cadence. I also have one on my road bike but my mountain bike doesn't need more things attached to it.

I was also advised to be cautious about the way I did leg strength training. No machines, no leg extensions, avoid bending the knee past 90 degrees during some types of strength training, slow partial squats with emphasis on glutes/hamstrings, etc. I'm also careful about turning my body without turning my foot. That's one of the ways basketball players tear a meniscus but I also read a paper about young people who had torn a meniscus that way in daily life, e.g. by doing a sudden twist while lifting a box or even just turning to answer the door.

These days, the thing that hurts my knee most is sitting in an airplane. Yipes!

Hope your knee comes around soon, and if it doesn't, go for a second opinion. But stay positive... There are lots of Olympians who have overcome knee problems and gone on to great success! I went through a couple of months where walking down stairs was excruciating, and I wondered if AR was over for me. That was 6 years ago, and I've recently done a couple of 80+ km trail running races on that knee with no pain. Time is a great healer but often it's a slow one!

Thank you so much Bash, that is great advice and good things to keep in mind...especially about the cycling cadence. I think what I'm going to do once I've completed the two races I have left this summer is go "back to basics" and build up better (again haha) over the fall months into winter.

For me, what seems to set it off most is hard biking on road. Nowadays it presents as a dull sensation of my knee being "off"; at its worst, it was a very sharp pain walking down stairs.

For the 10-15 hour races I did well by my standards with something on the order of an average of (1) television show per day, rotating between erg rower, bike on trainer, and treadmill. Not much running, mostly brisk walking, except at o meets (soft surfaces being much more friendly to me). And off trail, being very conscious to short step on uphills, right along Bash's knee bend angle suggestion.

I know what you mean about the frustration of having more lungs than legs. I would love to go on a nice long run, but I would probably crack my tibias. It is very hard to get motivated to get ready and roll out of the house for a lousy mile or two as part of a responsible conservative mileage build. I'd rather go out and do eight miles, other than it putting me out of commission. ARGH.

I agree a lot with what Mr. Wonderful said and his approach. I find running really results in problems, and I think the biggest issue is too much, too quickly. I once hear a rule not to increase volume by more than 5% a week.

For cycling, I also agree on the spinning. When you try and push too big a gear, it can result in issues too. Keep is low and just spin it out.

Given all the limitations identied above, thats why I think they say it truely takes 3 years to properly train for something like an ironman. (but I'm not expert, so take that with a grain of salt)

One other important point is that your knee is connected to the rest of your body. If you haven't been checked out by a professional, it's worth doing it. A running biomechanics expert determined that much of my husband's knee pain resulted from a lack of foot strength and a push-off from the outside of his foot. He was given a series of foot exercises to make his knee feel better. I know other people who have learned that their knee problem comes from tightness and asymmetry in their hips. You are already working on core strength which can be another factor. Other people need to get therapy to loosen up their IT bands. Etc. etc.

I used to have some bad ITBS.  I went for therapy but it didn’t really help.  The ITBS is gone but now I have a problem with my calf muscles.  The tendon that runs down the outside edge of my calf muscle gets super tight and painful.  I quick message with my thumbs on the race course or a foam roller at home seems to help but the issue persists.  I think it is related to poor stretching (I don’t do much) and footwear.  My feet like to lean inward (this is pronating correct?).  I have been meaning to go to a specialist to get their input (my dad wears orthotics so I wonder if I have inherited his issues).  Another fix I have found is to wear the straps used patella straps across my calves.  This dulls the pain and allows me to finish a run/race.  I think a better running technique might help as I believe I am too rigid but I cannot seem to loosen my legs enough to improve my techinque.

Do you live in southern Ontario, Tim? If so, write me and I'll put you in touch with 'Bent who can give you the info for the running biomechanics doc he went to see in Orillia. He works with Olympians too so he knows his stuff.

I do, that would be great Bash

What Bash says here is a good point to keep in mind:

I was also advised to be cautious about the way I did leg strength training. No machines, no leg extensions, avoid bending the knee past 90 degrees during some types of strength training, slow partial squats with emphasis on glutes/hamstrings, etc.

Any twisting motion as she goes on to say is an irritation of a different part of the knee (meniscus) but it is all connected as stated.

The funny thing is PFPS (Patellar Femoral Pain Syndrome) the term is a crap shoot, a syndrome means that they don't know exactly what is wrong so it gets put under that heading.

Making suggestions on the internet is tough and often misleading for this sort of stuff so I agree with seeing someone that deals with people that do sport injuries and make them aware of the length of AR races you are doing.

With that being said, from your description it sounds like Patellar Tendonitis, if you are having pain going down stairs now as well it is starting to get a bit worse (unfortunately).

Stretch, stretch, stretch, lots of quad stretches, and ice the knee - those are the most important things. I'd probably suggest avoiding hill workouts right now as well and anything that increases your load, but increased frequency and lower weight is good (such as higher cadence...).

PT - chances are they will U/S the patellar tendon, IFC it for pain with ice and give you exercises which should help. If it is not improving fast enough then I would suspect there to be lots of adhesions in the quad muscles which in turn will increase the tension on the tendon - therefore massage would be better, but again, I'd find someone that deals with athletes preferably.

A good resource for that is the Canadian Sports Centre (wwwcscontario.ca) the therapists listed there deal with National Level Athletes frequently so you can rest assured that they should be able to help.

There are lots of causes for tendonitis, crappy shoes or worn out shoes I have found to contribute to pain in the medial aspect of the knee.

As for InTIMIdator - ITB pain can be a pain in the ass! but that it has settled is great - the dull ache you are feeling in the outside of the calf is a line of muscles that actually have a relationship with the ITB... so in a sense it may not be completely gone but has just shifted itself somewhat. Continue to massage those muscles on the outside of the calf and stretch the entire calf as best you can.

Hope all of that is somewhat helpful (and I know I am stepping into a can of worms..)

D

Luckily no pain going down stairs but I agree with the quad stretching, it really relieves the tightness around my knee when I do it!

Thanks all - I am seeing my Osteopath tonight actually so it will be good to have her take a look at things as well. Appreciate all the tips that you have provided from your own experiences.

@osteo... showoff. ;)

:)

Just enough info to try to be helpful but not too much that creates confusion! (and is can be taken incorrectly)

The CSCO is a really good resource, but regardless making the therapist truly understand our sport and the length of time that we are out there is key.

inTimidator, let me know how I can get Larry Bell's contact info to you.

'Bent I can be reached at timc_g4e@hotmail.com