"You're gonna blow out your knees by the time you're 40" someone told me, when I took up running a number of years ago. Well... here I am almost 40 and, yes, I have had some significant knee problems recently.
All those miles on pavement I was told, would wear down my knee joints over time. My standard response was that having good form and not over-doing it would prevent this outcome. I still think that can be the case. After all, there are runners in their eighties doing major events like marathons and Ironman triathalons. When you're running right, you can feel the shock being transmitted through your body, safely past the knees. And, at a moderate pace like mine, the shock is not particularly large.
But what happened in the past few months is that I neglected to follow the common sense guidelines.
Dec 27th. In the evening after doing a PR < 23 min 5K, I banged my knee on the side of something and later felt a sharp pain on the side and middle of my right kneecap. I thought maybe it would go away and tried biking on it, and doing a short run in the next couple of days, but it hurt pretty badly. I was hobbling to work; going down stairs and even sitting were pretty painful.
After doing some research and eventually seeing a doctor it was clear that it was Patello-Femoral Pain Syndrome, sometimes called "Runner's Knee." It basically means that you've worn away some cartilage on the underside of the kneecap. This is usually due to bad form, where your patellar-femoral tendon is moving at too great of an angle relative to the knee. It's actually more common in women because they naturally have a higher "Q angle" here--more of a Y than a guy. Probably some asymmetry in my motion set up the condition for this to happen. One stupid thing I sometimes did was to pull my knees inward while cycling. Then I read that it basically has no aerodynamic advantage so, you know, don't be stupid. I'd also injured this knee years ago in a skiiing accident so that definitely could have contributed (my rehab for that, once the initial swelling was gone, was to do nothing, another thing that was also not smart).
But once I got serious about my right knee and started doing RICE (Rest, Ice, Compression, Elevation) it began to get better. On the advice of the doc I took maximum doses of Ibubrofen for a week (which was literally all I could stomach). After that week I was able to do a 10K again, not at my planned pace or anything, but without making things worse. Cycling still hurt, I think because the full flexions aggravated the condition. All told, it was about a month before I could run at the same intensity level and a few more weeks for cycling--and the bulk of that time no doubt has more to do with my failure to treat it immediately and appropriately.
Mar 1st. I went for a big trail run, taking on some long, steep sections. Not only was that new for me, but I had only allowed less than two days for recovery from an event that had left my quads really, really sore. What's more, I really hammered my knees on the rocky descent. Well, the next time I went out running, after about ten minutes, I noticed a pain developing on the side of my left knee. It got worse and pretty quickly, I was walking home.
At this point I was basically hoping it would go away. A few times over the next two weeks I'd go for a run and the same thing happened, within minutes my left knee felt so bad that it was clear that continuing was not wise. It wasn't a typical pain--pushing through it seemed possible--but I had to figure out what was going on. After seeing the doc and doing more research on the net, I found an exact match for my symptoms--Iliotibial Band Friction Syndrome (funny enough it is sometimes also called "Runner's Knee") or ITBS.
It's bad news. It's nearly always caused by a spike in training--pushing yourself well beyond what your body is comfortable doing. It hides--you feel fine, you feel strong, you feel like running and so you do, but by the time you feel it again, you're doing more damage and are back to square zero. Furthermore, the more often you experience it, the more likely you are to encounter it again. It's not uncommon for people extreme cases of this condition to give up running.
It's not actually in the IT band itself, which is a tendon that extends from the hip to the knee on the side of your legs. Rather, it's an inflammation where part of the IT band attaches to the tibia, in particular where it crosses over the "lateral epicondyle", which is a bump on the side of your leg just below the knee. At about 20 degrees of knee flexion the pressure on the tissues between the lateral epicondyle and the IT band are the greatest. Inflammation builds progressively here and begins to interrupt your gait. A few minutes of rest can be all that is needed for the pain to go away. But--it's a weird thing--when you become accustomed to a certain level of capability, accepting any limitation of it is very frustrating.
I bought an e-book (free sample here) by Paul Ingraham who reviews what's known about this condition, what works to treat it, and what doesn't work. It's a fantastic investigation, a hard-nosed look at the evidence versus unsupported misinformation (of which there is quite a bit). He suffered from ITBS for a long time himself after surviving a grizzly bear encounter and running down a mountain, a treated patients with it as a massage therapist. I really appreciate his skeptical, evidence-based approach, going to primary sources as well as his own experience to determine what is actually known here and what actually works. His advice can be boiled down to rest and "megadoses of well-timed icing." (If you suffer from ITBS and want to know all your options, I highly recommend purchasing his book).
So I tried it. Another week with no running (or cycling) and some time spent applying ice to the side of me knee. Finally I went running again and the severity of the problem was reduced by maybe half. A significant improvement, but I was hoping it would be completely cured, so this was still pretty distressing. More aggressive treatment was required! So for three days straight I was icing the knee pretty much every waking hour. "ITBS may consist entirely of inflammation" is one of Mr. Ingraham's conclusions. My own interpretation of this is that it is not a muscular problem but a circulatory problem. Perhaps the leg uses the compression created by the interaction of the ITB and the lateral epicondyle as a pump to get blood up past the knee to counteract the forces in running that drive blood down to the feet? You can feel the swelling when ITBS is just starting, even if it is not visible, it feels to me like your muscles are starting to twist.
By this time I had become aware of subtle differences in the way my knees felt and had formed a goal of not running until the left as good as the right. After another three days of infrequent icing, I tried running again, and this time felt major improvement. That was five weeks after the initial symptoms, five weeks where I couldn't do a continuous run longer than a couple of miles.
That doesn't sound like a big loss (and again in this case, it probably could have been shorter--say two weeks--if I'd known exactly what I was dealing with up front and had been smart about it). But running gets to be an addiction to the point where, even faced with the need to stop it for a few weeks can seem like a major problem that you would do anything to overcome. Your plans for being at a certain level months ahead suddenly are in jeopardy. You may have to cancel events. Your friends will be posting their workouts and you'll burn with envy. You've lost, as I said, some of your core capabilities, with some threat that they are compromised for good.
Another week after the "comeback" run I completed a fairly challenging event (Sabino Canyon) at a pace slightly faster than my time last year (when I was majorly sore--at this point muscle soreness feels like sweet relief compared to knee pain). That was a week ago, and, if things continue to go well, in another month I'll be back at the level where I was last in December (and, briefly, in February).
Now I'm a zealous advocate of the "10% rule" (never increase your distance or your effort more than 10% per week). Lesson learned!
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