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Guys, diagnose my medial knee pain.

12/08/2012

My post-marathon return to running encountered a bit of a curveball earlier this week.

I was trotting on flat ground past boathouse row, 3.5 miles into what I imagined would be perhaps a 7-8 mile run, when I felt a novel tightness creep into my medial knee area just alongside the knee cap. It got a little tighter and a little tighter. I decided to turn around and start heading back, but jogged on through it hoping it would shake out and subside. It didn’t. Half a mile later, I called the run quits and walk-limped the remaining three miles home.

Nothing preempted the pain, no acute incident. I was jogging easily on flat ground. I’ve never had this kind of knee pain before.

Figuring that marathon recovery month would be an asinine time to acquire an injury, I opted to walk home and take a few more days off. I have my erg (rowing machine) here with me so I did some erging on my off days. Erging doesn’t bother the knee, dancing doesn’t bother it, going upstairs doesn’t bother it, and even walking is mostly fine. The only thing that seems to hurt is the pull-back/pushoff motion during running.

I jogged easily today to see if it had subsided and gave up after 20 minutes. Running downhill (even on slight declines) seems to exacerbate the pain. Something about this just feels… unwise to run through.

I keep wondering if it’s a meniscus issue, but a lot of the letsrun people (hey, I’m not the first one to use letsrun as a diagnosis tool) say that squatting down should cause pain. It doesn’t. Nothing seems to cause pain except for running. It doesn’t feel super localized; sometimes I can’t tell if it’s moving around a little or what. Some kind of tendinitis/inflammation issue? Something with the pes anserine (which I had never heard of prior to letsrun…)?

My knee pain is located in that medial oval with a caption that says, “Pain on the inside part: meniscus or collateral ligament tears and arthritis.”

If I have to be injured, three weeks post-PR-marathon at the beginning of winter is the perfect time for it, but… let’s hope it will ultimately be another case of me overreacting. In the meantime, I’ll  keep up with the erging and try to address some of the weaknesses (glutes?) that might be instigating the pain. I’m pretty out of shape for rowing, so I really can’t be going at the volume I’m accustomed to, which essentially means I’m going to continue to take it easy with exercise.

Whenever I have a pain that lasts more than a few days, I do start questioning my entire running existence and wondering if I’m doing something bad to my body. Recent posts from Gracie and Roserunner on this matter really struck a chord with me in terms of whether distance running and high mileage are really… worth it in the long term. Should I go back to being a combination athlete? Maybe I should just become a person who is chill and walks and does yoga and stretching and some light casual jogging here and there. (UGH NO NO NONONONONONONO. Maybe when I’m 40 or if I have little kids or something, this approach will be fulfilling. But for right now, I still have the bug: the hunger, the desire to train, improve, compete.)

Anyway, yeah. That’s what’s going on. Otherwise, things are pretty low-key. I’m nearly done with all my work for the semester and of course it’s the ongoing saga of feeling like I generally don’t have my act together in life, but… day by day, right?

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21 Comments leave one →
  1. 12/09/2012 09:48

    Oh wow. I wish I had advice to give you but I’ve only had pain in my knee once before. I went to a physical therapist and after an obscene number of tests they decided my hamstrings were not doing any work (because I lacked so much flexibility) and my knee was taking the brunt of it. After stretching and weighted leg lifts (bended knee). Wishing you a quick recovery!

    By the way, the desire to kill your Pr’s will not go away when you have little kids! 😉

    • 12/10/2012 09:19

      Hahaha, I wondered if you’d have something to say about the little kids comment. 🙂 I do wonder about my ham strength relative to quad strength sometimes… I guess a little rowing (all sorts of hamstring activation!) is probably good for me on that front.

  2. xc_girl permalink
    12/09/2012 10:27

    Hey! I’ve been following your blog and haven’t commented before, but I felt like I had to because I had such a similar injury in college. I had medial knee pain (the trainers diagnosed it as pes anserine tendonitis) that came on suddenly and randomly. I kept on running on it, even though it wasn’t getting any better after going to the trainers (stretching, STIM, massage, etc.) because it was my last season of track. Long story short, it wasn’t getting any better with running, and I finally ended up going to a chiropractor who specialized in ART. He said my tight hip flexors were the problem, and after 2-3 of his treatments, the issue was resolved, and the pain hasn’t returned since (it’s been almost 2 years). Good luck, and I’d really recommend seeing a chiro or PT!

    • 12/10/2012 09:26

      Thank you so much for your comment!! You’re right, I should really just see a doc. I’ve had hip issues before, so it wouldn’t shock me in the least to discover that this is another one (chiros have commented on/laughed at my hips’ tightness in the past…). I hope it didn’t end up wrecking your track season!

      • xc_girl permalink
        12/10/2012 12:31

        Hopefully once you find out what’s causing the pain, it will get better quickly (at least it did for me!)! I didn’t end up having a great season (due to another injury not related to running), but looking back, I had other really good track seasons 🙂 Good luck, and I hope you’ll get back to pain-free running soon!

  3. Kara permalink
    12/09/2012 19:43

    Hi, I’m also a Philly runner. Like the poster above, I don’t usually comment, but I had Pes Bursitis so thought it might help to share. I actually got the bursitis from swimming breast stroke while laid up with a different injury. The main symptom was medial knee pain when walking down stairs. The pain was located pretty low on the joint–so low that one PT thought I had a tibial sfx. However, an early symptom was some tightness higher up on the knee when water jogging, so it seems possible you could be having trouble with one of the many muscles that connect there. In my case, the treatment was lots of ART for the gracilis. I think the tricky thing with medial knee pain is finding the actual source of the tightness, so it might be worth consulting someone if it continues. Good luck!

    • 12/10/2012 09:33

      This is helpful, good stuff to think about. (Also kind of makes me want to ratchet down my rowing so I don’t end up hurting something completely different… nice cautionary tale…). Yeah, there is so much going on in knees that I think the take-home is I need to get my lazy ass to a doctor and figure out exactly what’s going on. It’s kind of nuts that one of the PTs suspected a stress fracture for you! How many ART treatments/how long did it take for the issue to resolve? (ps. I wonder if we’ve ever crossed paths running around Philly?!)

      • Kara permalink
        12/11/2012 05:13

        Well, you’re probably a much better rower than I am a swimmer. But yea, the whole experience was a reminder that just because it’s not running doesn’t mean it can’t hurt you. I was in PT for something like 16 sessions, but it took the first 4 or so to figure out the exact problem. I was pretty uncomfortable even walking for a couple weeks before I started though. Maybe we have crossed paths–I definitely spend a lot of time on the river trail. Hopefully you will be back out there soon!

      • 12/11/2012 15:05

        Thank you so much for your responses. It’s very helpful to hear how the process has gone for others… even the exact nature of the injury might be a little different. Happy river path running!

  4. 12/10/2012 08:21

    My knee injury debacle last year was caused by scar tissue in the bursa getting dislodged and traveling into the meniscus and quad. It started as a similar sort of tightness, then later just felt like something was sort of….loose in there? At it’s worst it was tight I walked a little funny, but mostly it just felt WEIRD as hell. Roll the shit out of it for starters because for such a minor injury it took A LONG FUCKING TIME for shit to work its way through. (6 ART sessions – and a couple massages – helped.) ART guy (and he does Ironman and coaches runners, so he knows his shit) said its pretty hard to avoid picking up minor knee injuries like this after years of the grind, but as long as you’re careful and don’t do anything stupid – you should be able to work it out, assuming its similar to whatever the hell i had going on.

    As far as my thoughts on putting actual effort into training? Allow me to ramble: (You don’t want me too? Pish. Already started).

    I don’t bother. It takes away from my drinking time. I’m too fat and too old to get very fast, so I definitely think about the diminishing returns involved. I mean if I buckle down I could run what, sub 3:15? Is it worth sacrificing anything for that? Probably not. There is nothing impressive about that. On the other hand, at least saying you can break 3 is legitimately solid, which distinguishes you from the beer swilling hobby jogging underachievers like me.

    That said: I think there is something to figuring out how many miles you can safely tolerate and keeping it there as long as you can. But at the same time, while I’m a firm believer that MILES MAKE CHAMPIONS…I don’t think it’s the ONLY way. Cross training done properly won’t hurt you in the long run, especially if you’ve got any borderline injuries. Or sore sports.

    But I’m a beer swilling hobby jogger so what do I know.

    • 12/10/2012 09:48

      WTFFF! Scar tissue just migrating around? Not even on my radar of considerations. Is it allowed to do that? Guh. Comment section consensus seems to be that I (well, A., need to figure out exactly what’s causing this) and B., need to get myself some of this magical ART.

      As for “worth the effort,” well, who knows — is there some line where marathon times suddenly get more impressive and worthwhile? Even if I were to run a 2:59, it’d still be an eternal 16 minutes away from the new trials standard, so hell, what makes me any less of a beer swilling hobby jogger at the end of the day? (Side tangent, I’m so glad I have neither the talent nor the compulsion to try and make a living running. I feel like being an elite would extinguish all the joy from it. What sweet relief it is to be a hobby jogger.)

      I’m completely, 100% on board with “miles make champions.” But I’m also coming around to the idea that lifetime mileage accumulation can let you get away with a lot, so it’s okay (good, even) to have some downtime. (On that note, when people who were “formerly high mileage runners” start telling me how much faster they got when they cut down to low mileage… I can’t help but suspect that they’re faster because of the cumulative effect of the BIG BAD HIGH MILEAGE periods they put in… not because they cut down the miles. I guess now I’m just rambling.)

  5. 12/10/2012 17:06

    I’m a star, my Debbie Downer post got linked by a real runner! lol
    I still think I’ll never run again. I’m quitting.
    But you shouldn’t. You’re fast. We need fast people. I don’t know what that pain is but I hope it will go away stat! And if you can diagnose the pain behind my knee that is also masquerading as hip pain, hamstring pain, and gastroc pain, let me know.

    • 12/11/2012 15:11

      You shouldn’t quit either. But it sounds like we both need breaks (of indefinite length). I maintain that so much in running is cyclical… and injuries, both short-term and long-term, are part of the territory for anybody trying to find out how good they can be. The uncertainty of the layoff is, without a doubt, the worst part.

  6. 12/10/2012 18:21

    I wish I pounced on running pain immediately like you do….instead of trying to fix it one year later…get that knee fixed. I recommend slipping on the beach, also known as the world’s cheapest chiropractor

    • 12/11/2012 15:15

      In acknowledgement of the winter season, my analogous strategy will be to get drunk at a holiday party and trip on something.

  7. Ewen permalink
    12/11/2012 20:29

    Some good ideas to follow up already, so not much to add. I like the idea of sorting out tight hips — also the one about strengthening the quads/muscles that support the knee and thinking about how your knees are aligned when you run.

    Yes, it’s worth it. Especially if you’re young (or even as ‘old’ as AR, which is still young — she could run sub-3). People respond differently to different levels of mileage/intensity/recovery. If you respond well to high mileage (and want to extend your running life) it could be worth running that mileage in blocks of X weeks/months interspersed with time at much lower mileage while working on different aspects of running — speed/strength/skill for example.

    • 12/14/2012 04:09

      Yeah, I’m having an interesting time identifying which muscles are doing some of the pulling on this knee. I tend to assume all my injuries stem from some kind of weird hip misalignment…

      Also, I want to print out your second paragraph and wallpaper my room with it. Periodicity in training, seasonal efforts in different areas… yes. I actually think this approach is analogous to my desire to focus on the 10k in the spring and the marathon in the fall, and am excited to get to it!!! (once this knee nonsense gets sorted out).

  8. 12/12/2012 21:52

    We started rowing at the same place and wound up in similar grad programs in the same city (wonder if you’re at Penn?)…too weird. Anyway, whatever, you’re a way more accomplished runner than I’ll ever be…especially since I am really old and injured and have a whole mess o’ kids now. Sounds like you’re prepared to take good care of your knee…here’s hoping it stops hurting soon 🙂

    • 12/14/2012 03:54

      Wow, what, really?!! Very cool! Yes, I am at Penn. I’m thinking if I get some injury that turns into a more long-term thing, it will at least be impetus to become a regular at boathouse row…

      • 12/14/2012 16:30

        Big Red Quakers.

        I was a very large gymnast in high school who became a very small rower in college.

      • 12/15/2012 16:34

        Oh man, I love this! Maybe you started a tradition, because we had a couple girls on the rowing team who were also gymnasts in high school. They were such great athletes!

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