Chronic Knee Problems
February 18, 2010 12:32 PM   Subscribe

Resurfacing of what was once chronic Knee problems. Looking for advice from runners/doctors/anyone.

Hey all. I've had a resurfacing of major knee problem in recent months. I'm sort of at a loss about where to go from here.

Background: I was a big competitive runner in high school. Running sub a 4:30 mile and could pound out 10 miles a day no problem. I was set up and had a scholarship for college. My senior year I had one bad day where I noticed my knees hurting (not a singular moment) and it started a chain of injuries in both knees. Patella inflammation syndrome > bursitis > full blown tendinitis > horrible damage to my sciatic nerves. I saw an orthopedic surgeon who thought surgery wouldn't be the best option for some reasons I can't recall. They made sense and a second opinion agreed. I wish I learned more about the procedures that WOULD HAVE been. But alas... So I rehabbed and it never healed correctly. It prevented me from ever running the same again. In college I didn't run, just played some fun inter-mural stuff but I could never do distance and wasn't really interested. Post college I decided to get back into running cause suddenly I found my super awesome metabolism wasn't super awesome anymore. I had to get in shape. With all those years off the damage to my knees seemed to heal more or less, and I was fee to work my butt off. I didn't get back to where I was, but I was decent again. And more importantly I could run without pain. It was glorious. I was like a kid again.

Cut to last October when I'm trying out yoga w/ my ladyfriend and doing some stretch I wasn't comfortable with and instantly feel two sharp pains in my legs running all the way down the sciatic nerve. I know this feeling instantly. I am overcome with dread. The next day I try to run and my knees swell up instantly. I am furious. I try to ease into it with all my rehab and cautionary stuff. But still it's not good. I take a few days off. No good. Later that week I'm running at night and I don't see a rock and I have a severe sprain on my left ankle. The sprain itself is not problematic. I go to the hospital. I take care of it. I've had so many ankle tweaks in my history that I know EXACTLY how to rehab. Within a month and half it's completely healed and gives me no problems (even with full rotation). But I try to return to running and worry the time off may have crippled me (I've put on about 10 pounds). The first weeks are good even though I can still feel the problems in my knees like everything was fien. I want to stregnthen. A couple weeks ago the pain and swelling become excruciating. I can't run anymore. I try taking time off, doing all the things you're supposed to do. But it's not getting better.

I vaguely know the kind or rehab ahead of me. Years. But I am so tired of it and out of patience. I thought I was finally in the clear from my knee problems. But no.

I have to go to the doctor. I know this. But because of my last visit and some insurance stuff, I'd rather spend as little time as possible going to the doctors. I know I have to in some fashion.... but I thought I'd throw out my situation here first.

I'm looking for an advice, stories, help from/about runners with knee problems. Or any medical advice on why I'm having chronic swelling and pain. Even if it may seem tangential. And how it might be the same/different from my injuries in high school? How can I point my doctor in the right direction and avoid a lot of trial and error in diagnosis? How are injuries like this usually treated? Is there any procedures or checks that I want to ask for? How can I get through this all when money and time is sadly an issue for me right now?

The specific location of the pain is on the outer and inner sides of both kneecaps. The most pronounced is on the left knee on the inside, closer to the ball of the inner femur.

I am at a loss and just looking for direction. Thank you all.
posted by Lacking Subtlety to Health & Fitness (6 answers total) 4 users marked this as a favorite

I am not a doctor. Listen to pain. Be careful. But this is good stuff.
posted by zeek321 at 12:58 PM on February 18, 2010

I certainly empathize with you. A lifetime of being morbidly obese killed my knees. It wasn't until I lost all the weight and became much more active that the problem made itself evident. The best advice I can give you (which is something you probably already know) is to strengthen the muscles that support the knees. I joined a gym and got a personal trainer (only because I know diddly-poo about this kind of directed weight training) to help me focus on boosting my leg strength and it has helped some. It's only been a couple of weeks, but I am hopeful that the next few months will provide greater improvement.

It doesn't sound like you have an injury, just wear & tear. I'd give up running (brutal) and focus on building strength.

BTW, my specific problem with my knees is with the cartilage underneath my kneecaps. I completely forgot the medical term, but it's bad enough that bone spurs have started to grow.

Good luck.
posted by SoulOnIce at 1:00 PM on February 18, 2010

Previous knee questions: 1 2 3

Full squats with a barbell are often recommended as an effective way to strengthen all of the tissues surrounding the knee. Unlike many other athletic endeavors, the load in a barbell squat can be adjusted precisely and gradually increased, meaning you can begin at an appropriate level and get stronger slowly but steadily.
posted by ludwig_van at 1:15 PM on February 18, 2010

Best answer: Full squats with a barbell are often recommended as an effective way to strengthen all of the tissues surrounding the knee. Unlike many other athletic endeavors, the load in a barbell squat can be adjusted precisely and gradually increased, meaning you can begin at an appropriate level and get stronger slowly but steadily.

Squats (done correctly) are a good way to strengthen a lot of the muscles that support the knee, but I'd suggest you avoid them until you get an opinion from a doctor you trust about what's going on and clearance to perform that kind of resistance training. You may have some sort of mechanical problem or scar tissue or nerve impingement or who knows what that actually might be made worse by this sort of resistance training. Squats, particularly against resistance, are the sort of thing that really do benefit from excellent kinesthetics and the ability to balance load through your legs (a bum knee may complicate that).

I hate to say it but this is a situation that the internet isn't necessarily going to be that helpful with because even a doctor's visit may not be enough without things like MRIs and other tests to figure out what's going on.

As a former runner and current doctor, my one piece of practical advice is that shooting nervy/sciatic type pains are probably not the kind of thing you should just run through. Make sure you can clearly describe to your doctor what this "sciatic nerve" pain felt like and where you felt it. Was it below and above the knee? Was it in both legs? Was there back pain too?
posted by drpynchon at 1:46 PM on February 18, 2010 [2 favorites]

Response by poster: Thank you drpynchon for your advice. I'm emailing my doctor as I write this to set something up (my reluctance was more financial than well... sensible).

As far as specific information on the nerve pain, it runs along the back outside portion of both legs and feels located to a long thin sharp pain underneath my larger leg muscles. It does not run the whole length about leg but just a good portion: specifically about 5 inches below the knee and about 12 inches up the thigh. There is no real pain along the upper thigh or hips, but there is discomfort in the back. I know severe back pain is usually indicative of a problem in the sciatic nerve, but during my high school injury there was only a similar discomfort and not a major pain. Perhaps I was misdiagnosed back then, but all the symptoms seem to be in common w/ earlier injury.

I'm in my late 20s by the way if that matters.

Thank you.
posted by Lacking Subtlety at 2:24 PM on February 18, 2010

Best answer: I'm a runner with my own extensive back catalog of knee problems (mostly stemming from poor biomechanics in my case). My issues are probably different from your issues, but here's what's helped me:

1) Getting leaner. You probably aren't as overfat as I was, but tweaking my diet to lose extra fat definitely helped with my knee issues.

2) Finding, and regularly seeing, a good sports chiropractor. A good PT who specializes in sports-related injuries would also be a good bet. My chiropractor doesn't just do spine-cracking; he also does a soft-tissue therapy technique called ART (Active Release technique), which has helped me a lot with my issues (patellofemoral pain and IT band syndrome). A good chiro or PT will also help you figure out the underlying reasons behind your injuries (in my case, a weak posterior chain) and prescribe you exercises to help correct any muscular imbalances.

3) Proper shoes. Hopefully this isn't so-obvious-it's-insulting advice to a runner whose past accomplishments completely dwarf anything I'll ever be capable of, but your shoe requirements are likely very different from the kinds of shoes you might have trained and raced in as a high-school athlete. If you haven't already done this, going to a quality running shop with your old shoes in hand is a wonderful idea. They'll check out the wear patterns on your old shoes, and analyze your running gait, to make sure that you end up in shoes that are right for you. Personal anecdata: I started out running in a pair of neutral shoes, completely wrong for an overpronating flat-footed heavyweight runner. Motion control shoes = instant reduction in throbbing knee pains. Then, later, I decided that I would just buy a repeat pair of running shoes online since I "knew what I needed." Except that in the intervening six months, I had lost about 50 lbs. and made my stride way more efficient. After some brand-new shooting pains, I went back to the running store and discovered that the shoes that used to be perfect for me were overcorrecting my gait; a different pair of shoes fixed me again.

4) Run on yielding surfaces. It's easiest for me to run on roads and sidewalks here, but they're usually weirdly crowned in addition to being all poundy and hard. The crowning, in particular, aggravates my knee problems if I put in more than 20 mpw on it. So, I try to make it onto a crushed-limestone trail, or a dirt trail, or a track, or even the treadmill, at least once a week. It's also nice to have the variety of surfaces; trail running is my favorite because of all the wildlife and nature I get to see (although definitely don't run trails at night without a bright headlamp!)
posted by kataclysm at 8:11 AM on February 19, 2010 [1 favorite]

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