where do I go for help for knee pain?
May 3, 2012 6:17 AM   Subscribe

I've been experiencing sore knees after running and I think it's time for me to seek some professional help. Where should I go for help? I was going to make an appointment with my primary care doctor, but I'm afraid he's not going to be able to help me much. Should I go straight to a physical therapist or a sports doctor or orthopedist? I just want to be able to run without pain again.

I am a female in my mid-30s and I am not overweight. I've been running about 20 miles a week for years, but in the last couple of months, I've been experiencing knee pain on and off. I tried to cut down my running so I only run 3 miles every other day and I've been trying to strengthen the muscles around my knee at the gym for the past couple of week. It seems to be helping but my knees still feel a bit sore after I run.

I just want to be able to run regularly again. I'm really hoping I just have some biomechanical problems that can be fixed by certain exercises or stretches. I'll do them. I just want to know what I have to do. And if my problems are more severe, I want to know too.
posted by mbidi to Health & Fitness (11 answers total)
If your insurance covers you going directly to a sports doctor, go to a sports doctor. If you are required to see your primary care doctor first, see that doctor first.

You may need PT but again, see a sports doctor first if you want this covered by your insurance. They will probably want to see a prescription for the therapy.
posted by maudlin at 6:20 AM on May 3, 2012 [2 favorites]

I posted this thread the other day. My situation is different but there were a lot of great suggestions on how to manage my knee pain that could be useful to you.
posted by futureisunwritten at 6:55 AM on May 3, 2012

spots doctor or a podiatrist who has experience with runners...I went to ortho and he wanted to cut! went then to podiatrist and he made me orthotics and in two weeks all was well.
posted by Postroad at 6:55 AM on May 3, 2012

You should be icing your knees after every run. A styrofoam cup of water put in the freezer works great for this. It won't solve your problem but will keep it from getting worse. Similarly, taking anti-inflammatory drugs like Aleve, or even ibuprofen will help.

However, you still need to deal with some kind of biomechanical problem. Do you have good running shoes? Are your legs the same length? How do your feet strike the ground? Will orthotics help? Depending on how much money you want to put into this (and on how good your insurance is) you can either see sports podiatrists or read articles on the web and tinker with it yourself, or something in between. You can get referrals from other runners or running organizations (so you don't end up with someone who says 'quit running.')
posted by Obscure Reference at 6:58 AM on May 3, 2012 [1 favorite]

My general practitioner was surprisingly helpful when I had serious knee pain from hiking steep trails. I thought it was something serious and permanent, but she determined I just needed to do a very specific stretch. I started doing that stretch and have not had the problem again.

She did also recommend what Obscure Reference said, w/r/t icing. She told me to get the tiny Dixie cups and freeze a few with water. That way you can ice only and exactly what hurts.
posted by MonsieurBon at 8:45 AM on May 3, 2012

Start doing barbell squats 2-3x a week. If you do them CORRECTLY, i.e. with feet a little more than shoulder width apart, toes pointed out ~30 degrees, keeping your lower back flat and making sure you get proper depth (the crease of your hip should get just below the top of your knee), you'll strengthen the quads, hamstrings and hip adductors that all attach to the knee and give your knees greater structural stability. It will also strength and thicken up the tendons and ligaments in your knee for structural stability.

If you do them INCORRECTLY, especially if you don't go deep enough, you'll just make the problem worse.

Alternatively, and probably the best solution, is for you to stop running altogether. The benefits of that much cardiovascular exercise are really exaggerated by the fitness and medical professions. If you really like the cardio workout anyhow, try cycling or swimming to get your fix.
posted by imagineerit at 9:21 AM on May 3, 2012 [1 favorite]

Maybe your running form is not the best choice for your anatomy. My knee pain ceased when I stopped landing on my heels. Maybe there is another way to run for you.
posted by TheRedArmy at 9:51 AM on May 3, 2012

I would go to a physical therapist. There are some who specialize in running, which is nice if you can find one, but any PT should be able to help.
posted by The corpse in the library at 11:44 AM on May 3, 2012

It can't hurt to talk to a specialist. But if you're running on pavement, that's probably a pretty major part of the problem. You'll probably need to stop altogether, and when/if you're able to go back, you should try to stick to running on dirt, grass, wooden boardwalks, or treadmills. But obviously ask your specialist or doctor first.
posted by windykites at 12:43 PM on May 3, 2012

Cardiovascular exercise certainly has its benefits. Just today the Copenhagen City Heart study has determined the following:

"Undertaking regular jogging increases the life expectancy of men by 6.2 years and women by 5.6 years"

However, what's interesting is that they claim a U shape benefit curve, with too much exercise being suboptimal. Obviously any such claim needs careful investigation, but for what it's worth:

"Further analysis exploring the amounts of exercise undertaken by joggers in the study has revealed a U-shaped curve for the relationship between the time spent exercising and mortality. The investigators found that between one hour and two and a half hours a week, undertaken over two to three sessions, delivered the optimum benefits, especially when performed at a slow or average pace. "The relationship appears much like alcohol intakes. Mortality is lower in people reporting moderate jogging, than in non-joggers or those undertaking extreme levels of exercise," said Schnohr.

The ideal pace can be achieved by striving to feel a little breathless. "You should aim to feel a little breathless, but not very breathless," he advised.

Again, I wouldn't take that as gospel, but at least according to this study, you can certainly limit your jogging to as little as 1 hour week, in two or three sessions, and slow down the tempo to "slow or average tempo", and still retain optimal benefits.

While there is nothing wrong with exercises meant to strengthen your knee muscles, I am not sure this should be your sole recourse - after all, you've been jogging for years, and it's highly unlikely that while using those muscles for years they suddenly now are getting weaker... rather, it seems the opposite would be true, at least for the specific muscles you're using while jogging, because, well, those are the very muscles you are using, when jogging, duh. That said, I don't see any harm in strengthening exercises.

I think this is a classic case where you need to seek specialized medical care. It is possible that you are experiencing overuse injuries, or there are biomechanical problems that have crept in, perhaps your gait has changed. It is also possible that your jogging shoes are ill-suited. My knee pains went away when I was fitted with shoes that worked for my gait. I now jog a total of about 30 miles a week in 5 sessions, and experience no knee problems (plus I do Tabata sprints 5 times a week).

I would definitely consult a sports doctor and see what they recommend. Any suggestion for invasive procedures, such as surgery, and you should definitely seek a second opinion.
posted by VikingSword at 1:24 PM on May 3, 2012

Thanks to everyone who responded. The suggestions were all very helpful.
posted by mbidi at 7:00 AM on May 4, 2012

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