Man was not meant to run, I swear.

April 24, 2009 7:17 PM

YANAD filter: Knee Edition

I know this is one of the most obnoxious questions, because a doctor can really help you and self diagnosis for knees is notoriously difficult, but the problem is I'm unemployed. Super unemployed as in Ramen and worried about rent unemployed. So, obviously, I don't have a lot of money, and no insurance. Going to a doctor simply isn't an option for a few months.

That said, here's the deal. Was running using the couch to 5K program from CoolRunning.com, and was on the sixth week. Two or three days after a run, all of a sudden my knee is killing me. It doesn't swell, but it hurts like a mofo if I have it bent. I sit out for a few days, then run again. It still hurts, so I cut back my running distance, etc. Doesn't help. So I stop running entirely, and haven't ran for over a month. It doesn't hurt much now, but prolonged sitting time with my knee bent still irks the knee. It feels best when stretched straight out.

The pain is specific - it really feels as though there is a muscle/tendon on the top of my knee, on the inside side of my patella that has been bruised or snapped. That is, the tendon feels like it's located on the left side of my right kneecap, on the top of my knee. If I do the Quadricep Stetch, I can't go very far because the pain gets very acute. I pronate and use insoles and have good shoes. It seems strange to me, because nothing happened on the actual run or anything. It just started to hurt. I've read everything on AskMe and CoolRunning, and Google, etc, but this doesn't sound like Runners Knee or IB Band Syndrome to me.

I'm fine with continuing to run if this is just going to hurt, but I'm scared of doing permanent damage. Does this sound like an injury you've experienced? Am I screwed without a doctor's assistant?

posted by OrangeDrink to health & fitness (12 answers total)

Am I screwed without a doctor's assistant?

Yes and no.

First of all, stop running. Switch over to cycling or other low impact options like elliptical. Whatever the problem is, running is only going to exacerbate it and possibly cause long term damage.

Second, you're not going to get a clear answer here about what your problem is. It's enough that this is a running related injury that will only get worse if you continue to run.

If you go to a doctor sans insurance, he's basically going to tell you the same thing: stop running, do something else, take it easy, etc. If you had insurance you could probe a little deeper, maybe get a MRI and see exactly what the problem is...
posted by wfrgms at 7:38 PM on April 24, 2009

Most likely, you have something that you really need a physical therapist for, not a doctor, since most running injuries are of the "something's misaligned or weak" variety rather than the "something's actually broken". Unless they have a reason to suspect the latter, the Dr. is going to send you to PT.

When I had an IT band flare up, the symptoms were exactly the same (on the other side of the knee, obviously), and no amount of rest or stretching helped; only PT. Obviously this is a problem without insurance, but you can always look at the running websites for the knee and hip strengthening exercises. Without getting a professional to look at it, you're probably not going to know for sure, of course.
posted by Dr.Enormous at 7:59 PM on April 24, 2009

Stay off if for some more time. If you had money you would get a physical terrorist who would help you do some painful exercises that in the end would help the pain. This is classic overuse. As long as you don't keep overusing it you probably won't have long term damage, or at least too much long term damage. After the pain has really subsided, take it much more slowly next time. It may be that running is not for you. It is incredibly efficient and incredibly hard on your body, especially the knees. If you run you are damaging your cartilage. Period. The game is to keep that damage to a minimum. Despite this I run, and so do many of the experts who work in this area. Keep your training increases modest and you will stay healthy even as you get to fairly high levels of working out. Push it too fast and you set yourself back months if not years, especially if you have soft tissue issues. Some people can never do things like run and need to stick with elliptical machines or even better swimming pools. Keep your joints healthy as all the so called repair mechanisms are really not ever going to get you that close to original health.
posted by caddis at 8:01 PM on April 24, 2009

Go to a free clinic, without x-rays or MRI the doctor will still be able to perform one of the various hands on tests of knee function (for example, the anterior drawer test and pivot shift test are good indicators of ACL insufficiency).

Any "minor" condition you may have developed (low grade tendonitis, bursitis, meniscus bruising) would have gotten much better with a month of rest, you're citing continuing pain in your knee, get it checked out before you potentially further any injury.
posted by zentrification at 9:58 PM on April 24, 2009

IANAD...

What Does Runner's Knee Feel Like?

Symptoms of runner's knee are:

* Pain behind or around the kneecap, especially where the thighbone and the kneecap meet.
* Pain when you bend the knee -- when walking, squatting, kneeling, running, or even sitting.
* Pain that's worse when walking downstairs or downhill.
* Swelling.
* Popping or grinding sensations in the knee.

from WebMD.
posted by BugsPotter at 5:13 AM on April 25, 2009

IANAD!!!!! However, I am a youth sports coach. This sounds like patella-femoral symdrome, very common among weekend athletes, who do just enough exercise to damage themselves and not enough, or properly enough, to actually strengthen the necessary muscles. It's caused by bad shoes, running on concrete, ramping up the activity too quickly, prior strains and injuries, and improper warm-up/cool-down prior to and following exercise. This can be a serious condition, and is easy to worsen. Do stop running, but don't stop light stretching. If you stop running it is probably not going to get any worse right off the bat, so you might be able to hold off until you have a job/insurance. If you have family who can front you money, you might consider going to a sports or bone-and-joint clinic and get assessed. You might get away with a single visit for diagnosis/assessment and a sheet of exercises.

Another thing to consider is that if you get it treated now, without insurance, you now have a pre-existing condition with a break in insurance coverage and can possibly be denied coverage for a year for the condition by any new insurance company, depending on what state you live in. (IA also NAL) Just in case you're not feeling bummed enough.
posted by nax at 5:21 AM on April 25, 2009 [1 favorite]

So, almost the exact same thing happened to me when I started the couch to 5K plan. I did have insurance and went to the doctor. They took x-rays of my knees. Basically, what was happening was that my kneecap groove wasn't very well defined and my kneecaps were popping out of their grooves.

I was told that the only thing they could do to help me would be knee surgery where they would have to tweak the lengths of various tendons to hold my knee centered better. I was also told that this was NOT worth it (and I agree). Finally, I was told that some people's knees just aren't made for running. I was really sad about this because I loved running - sometimes when I see people jogging in my neighborhood I get a little pang of sadness.

But yeah, there's a good chance that you are one of those people who running is just not going to take off for. Sorry. There are still lots of fun sports out there, like biking and swimming. After my whole knee debacle I got myself a bike (cheap, from Walmart) - turns out it is super fun and you can cover so much more ground in an hour than you can with running!
posted by sickinthehead at 6:15 AM on April 25, 2009

Doctor here, what I am going to say is some general advice and I want to make it perfectly clear that without examining the knee, it's impossible to say for sure. Could be cancer or serious infection for all I know.

With that disclaimer out of the way...what you're describing sounds like patellofemoral pain or chondromalacia patellae. A small meniscal tear is also possible but that pain is usually right at the joint line, associated with some swelling/stiffness, and will generally hurt with any weightbearing, not just movement. But a mensical tear would explain persistence after a month. These sometimes require surgery, unless you are happy to change activities. All of these things will be worse if you continue to run through the pain.

I usually avoid jumping in to these threads because sending someone down the wrong diagnostic path is often a Bad Thing, but with the knee it is really true that 90% of common problems can be solved with rest, quad strengthening, NSAIDS, and ice.

Stop running altogether, until you are pain free. Swimming would be best, but cycling is acceptable.

Without a trainer or weight bench, the best quad exercise is isometric extended leg lifts. While sitting on a couch, extend the knee and lift your whole leg up off the cushion. Hold it for 30 seconds. Can you feel your thigh muscles contracting? Over time, that toned up quadriceps muscle is going to pull your patella back into the natural groove that goes over the front of the femur and tibia while you run. Repeat 10 sets of this several times a day, maybe while watching TV. Add ankle weights if you like.

Ibuprofen and ice are pretty self explanatory.

Most likely, with a little self-directed rehab, you will be able to get back to running. You're doing the couch potato to 5K, so you're asking your legs to do things they aren't used to and it is going to take a little coaxing. If things aren't coming along, you are going to have to decide: give up running, or seek professional help? Like I said, there is a chance there is something else going on, so know when to take it to the next step. I have infinite sympathy for people without access to health care, so good luck.
posted by Slarty Bartfast at 10:19 AM on April 25, 2009 [5 favorites]

IANAD, but Slarty Bartfast is right on. That's exactly what the doctor told me when I first started running 6.5 years ago and my knee was killing me. That stretch? The leg lifts? Sheer MIRACLE. I'm running my fourth marathon next month. Take 'er easy, there!
posted by cachondeo45 at 10:34 AM on April 25, 2009

nax has some good advice about the stretching and sb about the leg lifts. You might want to combine this. Stretching while not warmed up can cause more trouble than it cures. If you do the leg lifts first (even if these do not solve your problem, they are a really good thing for any runner to do to avoid injury) you will get some blood flowing and then you can stretch. If you decide not to do the exercises or for some reason can not, then you might want to schedule your stretching after a warm shower when blood flow is increased. Another way to keep your quads strong to protect your knees while running is some cross training on a bike, but this is probably not wise when your knees are already hurting.
posted by caddis at 6:54 PM on April 25, 2009

Phew! Great answers from everyone as always! Thanks for your info. Even if the answer wasn't what I wanted to hear (try stretching and exercising and give it another shot after the pain goes away, and if it doesn't, give up on the running), it was still a good answer.

Thanks everyone!
posted by OrangeDrink at 8:14 PM on April 25, 2009

To add a bit more to this, Stumptuous has a good page on Patellofemoral syndrome that you might find handy. As with most aches and pains, I personally found in the long term running less, lifting more pretty much cured it.
posted by ch1x0r at 1:42 PM on April 26, 2009