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Runners Knee - Patello-Femoral Syndrome (PFS)

Submitted by Ean Jackson on 8 May, 2006 - 15:42

Runners Knee - Patella femoral Syndrome

First it was the left one. Now both of my knees hurt. They hurt so bad some days I can barely walk, let alone run.

This sux. I have 17 more ultras to run if I am to complete 100 ultras during or before my 50th year. Time's a wastin'.

In the hope that you might benefit from my research and experience, I'd like to share my symptoms and the cures I've tried to date. If you have experienced the same problems and have some thoughts on a cure, please share your thoughts here so others will benefit. (Just go to the bottom of the page and type "Add new comment")

What is Runner's Knee?

The medical name for pain under and around your kneecap is Patello-Femoral Syndrome (PFS) Other names for it are Theater Knee and Jumper's Knee. The patella (kneecap) is designed to move smoothly over a groove in the femur (thigh bone). When the patella doesn't move or "track" properly over the femur, you can get inflammation or PFS.

Who gets Runners Knee?

PFS is apparently a common running injury. Non-athletes can get it, too, however. People of all ages can get it, so this probably isn't the arthritis your Grandma was complaining of.

Why do you get Runners Knee?

I've found several medical explanations:

it comes from muscle imbalances in the quadriceps. When your leg muscles are not balanced, the patella gets out of it's track and starts to cause damage to to the cartilage.
you may have oddly-shaped knee bones. People with knock-knees may attribute them to this problem.
the groove your patella sits in is too small, so your patella slips out.
your feet are causing the problem. Fallen arches, forefoot pronation and other foot issues may put your knee out of wack
an injury that causes you to compensate too much
ramping up the training too fast. Yes, you can get knee problems from piling on too many miles too soon

What are the symptoms of Runners Knee?

You have pain in and around your kneecaps. The pain is typically worse when you bend your knees by running (especially down hills and on trails. Dho!) or doing squats or leg raises in the gym.
Some people get swollen knees.
Some people get grinding an cracking when they bend their knees.
Some get pain when they sit with bended knees. (It *kills* me to drive some days.)

How do you treat Runners Knee?

This is the big question. Here are some of the treatments that I've heard of:

stop running. Not my first choice, for sure....but I fear it might be the smartest one.
get new running shoes. This to fix the angle your foot hits the ground and to provide cushioning. Did that.
get orthotics. This to fix the angle your foot hits the ground. Did that.
get a knee brace or support strap. This to keep your patella in its track. Got a neoprene brace with velcro straps..
taping. This is where taping is used to get the patella back into its track. Not tried this yet. I'd probably put the tape on wrong and ruin my knee altogether!
stretch. Do that a lot more frequently than I used to. Some doctors recommend knee drops to build up the muscles around the knee. 'Tried that. Lots of crunching and grinding. Ouch!
weights. This to strengthen the muscles around the kneecap so it tracks properly. Avoid bent knee exercises. Straight leg raises and posterior (hamstring or calf) muscle stretches are best.
massage. I tried that. Sort of. I went to a practitioner of Art - Active Release Therapy. He figured there would be an appreciable improvement after 4 visits. By touch, he was able to note that my left quad (the sore knee one) was smaller than the right. He found scar tissue from old injuries and mashed it up. After 4 visits both of my knees hurt!
icing. I confess I've not done much of this.
take anti-inflamitories. I'd been taking ibuprofen before I visited the sports med specialist. I usually take ibuprofen to keep the swelling down if something hurts. But the sports med expert proscribed something stronger for a month. I had a month of upset stomach and both knees popped and clicked more afterward.
try Glucosamine Sulfate. They say it helps with joint pain and arthritis. I've been taking the stuff but it doesn't seem to do much.
try ginger. A tea made of fresh ginger taken 3 times a day is supposed to help reduce inflammation. The tea is actually quite refreshing... but the knees still hurt
prolotherapy. This is where they inject some gunk into your knee and hope your body will react and cure the cause of the pain. The sports med guy is keen on this, but I've never heard of it and, at $100/treatment with a minimum of 6 required and no guarantees, it's a bit of a flyer.
acupuncture. This is where needles are used to stimulate the body to repair itself. I've been to 5 visits. Fun, but no difference in the knees.
physiotherapy. This is where the muscles are manipulated to bring the patella back into its track. I'll try this if acupuncture doesn't work.
arthroscopic surgery. Yikes. This is where they cut a hole and take a look around at what's actually going on under the skin
shaving the patella. Yikes again. This is where they get in and smooth the surface of the patella with a knife.
lateral release. This is where they get in and cut ligaments to shift the way the patella sits.

More information:

Patello-Femoral_pain

Patellofemoral_Instability_and_Malalignment

Overview of knee pain

Ean Jackson's blog
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Comments

How'd you make out?

Submitted by VeggieK on 24 April, 2013 - 08:00.

Hi Ean,

I am many years late to this party but I stumbled upon this site while looking up solutions for my current knee issues. First of all, I want to thank you for such an informative post, from you and everyone else who contributed. You pretty much brought all the bits I have been reading about PFS onto one page which was awesome. Basically I'm just wondering how you're getting on now? Did your knee pain ever resolve? Did you find a solution that you wouldn't mind sharing with a very frustrated distance runner?

Forgive me if you've already answered these questions in another posting...I was too scared to venture away from this page and lose all the good information!

Run happy,

Kyrstin

Knackered Knees

Submitted by Ean Jackson on 24 April, 2013 - 11:03.

Hey Krystin,

Thx for your note. Sorry to hear you're having knee problems. Glad to hear you found the post helpful. 'Sounds like you're still hurtin', tho.

Unfortunately, there's no silver bullet when it comes to knees. My experience has been that some months I have more knee grief than others, but the low level grief is always there. Probably a combination of overuse and aging infrastructure. I've come around to living with it and doing the best I can with what I have. Speed kills... so I've eased-off on intensity of running workouts. Drop-squats seem to help. I think it also makes sense to run less far more often rather than do a weeks worth of running on Sunday morning.

'Hope this helps you!

IMS

Submitted by kcongra on 8 April, 2013 - 16:59.

Something you might want to discuss with your physiotherapist. Intramuscular Stimulation. It's amazing but like everything else, not for all situations. It could be a great addition for pain control. As it was explained to me, the needle (similar to an acupuncture needle) is inserted into the muscle, the muscle cramps around the needle, when the needle is removed the muscle loosens - further than it had been before and the internal blood helps speed healing. It's cured my foot problems (as long as I don't go back into the wrong shoes) and stopped my 2 year long love affair with headaches. I hope you find your cure and complete those 100 ultras

I am no doctor, but ever

Submitted by gldmeier on 19 September, 2011 - 00:07.

I am no doctor, but ever since I switched to "barefoot running" I have had no knee pain. it is not really barefoot, as I wear Vibram FiveFinger barefoot running shoes.
A number of my fellow runners with knee injuries, especially ITB, have switched and have been able to run painlessly.

if the injury is recurring, or if it just bothers you to be sidelined for that much time, it might be worth considering to take a look at the Vibrams...

PFS is not FUN!

Submitted by Kim19 on 12 September, 2008 - 08:02.

So I fell hard, square on my knee on a gym floor. Bruised both top and bottom of my kneecap. The overcompensation for my bruise is causing my alignment problem, giving me the wonderful new diagnosis of PFS, aka, "runners knee". Doc gave me a slim, very attractive, solid black brace with a small hole for the knee to hold everything in place where it needs to be. and although it tends to bunch in the back, behind my knee, I noticed a difference within an hour. the pain was nearly gone. Doc is sending me to physical therapy to build up certain muscles to help fix the alignment problem. I also called my chiropractor, (since chiropractors ultimately correct the body's alignment). I'm hoping after all of this, i should be ready to ski and snowboard in November, and get back to volleyball in the spring. :) So for anyone who is struggling with finding a "cure" to the pain, i highly recommend this brace. its a Sock type brace, no velcro. it pulls on over the knee, and it fits under clothing, hardly noticeable through the fabric. I feel 10 times better, and i've only been wearing the brace for 2 days. Good Luck to everyone!

Braces

Submitted by Ean Jackson on 14 September, 2008 - 20:38.

Hey there,

Glad to hear the brace works for you. I tried one, as well, but it didn't seem to change much for me other than to make me look injured.

Get well soon!

Has anyone tried running as a cure for PFS?

Submitted by Ean Jackson on 5 September, 2006 - 23:18.

I know this is going to sound stupid, but after trying just about everything for my knackered knees, I figured I was going to start back to running. No more pissing time and money away on quacks and miracle cures. I figured I would either ruin my knees and have to take up stamp collecting again or I would somehow suffer through and at least get some Zen.

It has been painful. It still is painful. Where I once floated over the pavement and trails like a gazelle, I now shuffle so that I don't bend my knees. My 80-year-old friend BJ (a world age group marathon record holder, I might add) tells me I now run like an old lady. But at least I am running...and the pain in my knees is no worse than it was when I was not running. So I am a way happier camper than I was a few months ago when I started this online whine.

I actually spoke to an arthritis specialist on a radio call-in program today and he said that he often prescribes movement for PFS. (He said swimming and cycling are better because they have less impact.) If our battered knees are like old, rusty hinges, moving them loosens them up. The name escapes me, but there is apparently some viscous goop in our knees that is created when we move. More movement, more viscous goop... or so I understand it.

Anyway, the pain was excruciating as I sat in the back seat of my buddy's car during a road trip this past weekend. But it was far more manageable when I ran almost 50K on trails for 9 1/2 hours. Go figure! I hope it works for you, too.

"Runners Knee"

Submitted by MKD on 11 August, 2006 - 18:27.

After writing to you Ean, I hope that i might be able to give my opinion and it might help someone.

I'm 26 years old and i've ALWAYS had knee pain in both knees. It never stopped me though. Yet it was always excruciating. I was a kid that was always outdoors and always active, my mom could never get me inside to do homework.

But anway, I've been to see so many different people over the years to try and help me with my pain. I was first told it was just growing pains and i'd get over it. I was told it was some wierd name that meant i just had grown too fast. Well being 6 feet tall i would say so! But it was going to countless chiropractors, Myotherapists, and regular medicine doctors that NEVER helped. I was always told i would outgrow it.

One thing i would say is if you have kids, and their knees hurt, it might be growing pains, But it also might not be. No one ever recomended me to go to a specialist, and it never occured to me to ask. It wasn't until my sophmore year in college that i was FINALLY diagnosed correctly. (and it wasn't for lack of trying by everyone else).

I was told that i have Patella Femoral Syndrome type 3.

http://www.healthcentral.com/encyclopedia/408/633/PatelloFemoral_Syndrome.html

They said it's VERY common in young women, and that it could have been treated a long time ago (not cured, but treated). Meaning that i could have done something about the pain. Not just icing it and using all sorts of knee braces (that could've hurt me more) and taking TONS of pain killers. My doctor then told me i had three options. One... surgury, I could have my knee cut away and reattached in the correct place and then let the muscles heal around it... Leaving me immobile for a while.

Two... See a physical Therapist, And try restructuring my muscles to straighten the knee cap back to place. This would be a constant issue. Everyday, as often as possible.

or Three... Not do anything. now this last choice was not a solution just an option.

After being angry for years of not ever being told to go see someone like my doctor, and then scared that i might have to have surgury, I finally swallowed and went to the therapist.

It was AWESOME. She gave me exercises to do everyday. Idealy I was supposed to exercise everyday, three times a day. (who can actually do that unless it's your job?) Well it wasn't until i was forced to use the gym everyday in college that i noticed the first Results. The main reason i'm telling my story is about one option that Ean mentioned. Taping the knee. It's something that was taught to me by my therapist. It was used in combination with a specific knee brace.

My knee brace covered from my ankle to high in my thigh. Not the most flattering (but now they make a small one that fits under your clothes.) but it worked none the less. It is a brace that's built with two gears on the sides that give you resistance when you walk. Which then builds the correct muscles in the knee to help support (and idealy correct) the knee cap. When i added taping my knee (can be uncomfortable) it allowed my exercises to target the specific muscles and retrain my knee to work the way it's supposed to.

With Ean's help i'd like to share with you some websites and my recomendation, that if you'r in a situation like me... ask everyone if there's anyone else. only relief i was given by any doctor other than my sports doctor was only TEMPORARY! and the pain always came back usually after 15minutes.

http://www.newmediaexplorer.org/chris/2003/08/26/tape_your_pain_away.htm

http://www.hughston.com/hha/a_13_4_5.htm

http://www.rice.edu/~jenky/sports/pfs.html

I hope that this might help someone or their kids. It Never hurts to ask more questions and see a specialist, especially if no one is offering multiple options. I just have this beliefe that if a prescription type doctor isn't willing to look at homeopathic or any other kind of medicine as a combination treatment then they aren't the one for me. Basically i like doctors who use other sources to make sure YOU are OK.

Please write me if i can help... AND GOOD LUCK EAN!!!!!

Oh and PS.... Don't stop ICING your knees. If you don't get the inflimation down before working out or putting more stress with running then you might only do more damage. That and it feels sooooo goooooood after a lot of pain.

RE: Runners Knee

Submitted by rhub on 1 September, 2006 - 22:23.

I'm glad I found this site and this GREAT post! Thanks for starting it Ean.

So, my knees have always clicked a bit (highschool and beyond) and I've always had 'Theatre knee', but it wasn't until I twisted too far with my knee planted (playing Ultimate) that it became really serious for me. Unfortunatly, I didn't get it attended to for years - thought rest would fix it - and now I can't do much athletic activity with my legs without a fair amount of pain after 5-10 minutes... which is very sad for me since I loved to sprint (no, not jog. go figure). So finally I see my doctor and he says that I have PFS (did an xray and moved my leg around; definitely got worse after he did that). Also I seem to have a [swollen] bump on the bottom right-ish side of my knee cap - left leg - which may be a inflammed patellar tendon. I don't think the doctor noticed that and I forgot to mention it.

BUT, my question is directed at MKD.
You said:
"...It is a brace that's built with two gears on the sides that give you resistance when you walk. Which then builds the correct muscles in the knee to help support (and idealy correct) the knee cap."

Can you tell us what the brace's name is and/or where you can get one like it? Because I've finally decided to get serious about fixing my situtation and I suspect your brace would be great for me (my doctor has suggested something called a 'Generation II FX' brace, but yours sounds much bettter !).

THANKS.
- Rhub.

Knee Braces

Submitted by MKD on 2 September, 2006 - 07:10.

I totaly believe that in my case, knee braces have done nothing for me if i don't combine it with building up the muscles that correct the problem... so...

My knee brace is about 7 years old. They still make them but it's Huge. It's not for playing sports with it's something you wear while working out or while moving around the house or walking outside. It's a Protonics knee brace made by the Inverse Technology Corporation. They have a pretty good website...http://www.protonics.com/ . THis website shows the brace i have and it's huge. It runs from your upper thigh all the way to your ankle. I recieved this from my insurance but i believe through the website you can purchase one. It really helps to have a trainer, doctor person that will help you with using it. THere were certain exercises i do that makes it a little more productive. Do note that this is not a one time cure. If i stop keeping the muscles strong then i usually have to start all over from the beginging of my work out. and it takes me about two months... starting with really simple exercises then gradually getting to bigger stuff, for my knees to stop hurting completely. It's not for everyone. Each person needs to see a doctor before making certain assesments but this really helps for me if i stay on top of my work outs.

I did look up the brace you mentioned, the "generation II fx" and i actually think it looks pretty good. I'm not sure what severity of your knee problems are but if you think your doctor missed something then maybe a second opinion wouldn't hurt. you could bring with you the research of the two braces and find what works best. I do have to mention that two years after i recieved my brace they came out with something similar, Without the gears, in a much smaller format. A friend of mine had it. She said it helped tremendously. I have yet to find it online but if you do, please let me know. I'm not even sure what it's called. all i know is that it's the next step from my knee brace.

Last thing i'll harp on is that it did help me (sometimes) when i worked out using anti-inflamitory medications. Because it allowed the swelling in the knee to go down (which reduced the pain) while i worked out and made it a whole lot less painfull to build the right muscles back up. It's not for everyone but it's something to ask your doctor. and P.S. Ice has always been my best friend. It makes the work outs less depressing when the pain is unbearable.

I hope this helps in some ways. I know i tend to ramble on... please write if you have any more questions...and good luck Rhub

I'm Impressed

Submitted by arbotto on 27 June, 2006 - 08:12.

Ean, Wow, I am impressed with your goal of 100 ultras. I hope you get back to running as soon as possible! I, like you, am having my first experience with PFS. I live in San Francisco. I'm 35 years old and had always been a casual runner since I graduated from college. Almost 3 years ago I got involved with a running group and realized how much I enjoyed training and taking part in races. A few marathons and several triathlons later, I only want to continue and move towards my own lofty goals. Lately, it's been hard. I started feeling some discomfort in my left knee in February and it turned to pain during my first 3 hour training run for the Boston Marathon. I started seeing a chiropractor, who is a member of my running group, and a physical therapist that is on her staff. They got me through Boston, although it was a very painful experience. If it were any other race, I would have skipped it, but it was Boston and I had my heart set on it. It's been over two months since the race and I'm still in recovery mode. I was cleared to swim and bike as long as I didn't feel any pain. A little pressure under the knee cap is OK. I bought new shoes, got custom orthotics, and I now run with the little Cho-Pat under my kneecap. I started with short test runs (about 30 minutes at a time) about 3 weeks ago and was doing OK. Unfortunately, I overdid it last week by attending our BootCamp workouts twice and increasing my mileage a little. This doesn't count the 2 bike rides... I know... I know... my knee is swollen and I learned my lesson. What type of doctor are you seeing? What does he/she tell you in terms of getting back to where you were? My doctor thinks I will be able to get back and run fast again, it's just going to take time. Lots of PT and rest. I also hear people point out that PFS is not an injury, it's a condition. I'm very scared I'm going to have to deal with this forever. Do you always feel something in your knee(s), even if it's not pain? I do. I'm told it's inflammation and I hope it will eventually disappear. Time will tell. I want to thank you for posting your blog. I was looking today to see if I could find anyone to communicate with that had my same problem. Thank you so much! I hope we can all heal soon!

knees

Submitted by labmonkey on 26 June, 2006 - 06:20.

Hi,

I am a patello femoral syndrome sufferer, I went to the Docs and he diagnosed me pretty quick (just as well because I could barely walk) he gave me a leflet with a load of stretches on it, pointing out that they help out in most cases, he also sent me for physio. Basically my physio told me that all my muscles around my knee were pulling my patella to the outside of my leg, so i need to strengthen my quads, inner thighs and stretch my hips. He also noted that my muscles are very stiff (and my feet are biomechanically messed up i.e. collapsed arches). He said i should go strengthen the right muscle groups at the gym. I found cycling and yoga helped a helluva lot - with the caveat that if it hurts - stop. My knees are mostly alright now - i tend to get twinges every so often, usually sitting in seats with no leg room - but I am back running. Now I am getting my screwed up feet sorted with orthotic inserts.

Physio could really help with figuring out why you are getting PFS. hopefully if its just muscle tightness, strength or biomechanics it can be easily sorted out (without surgery). Plus yoga classes are mostly full of women so it must be a great place to pick up women ;-)

Wonky knee muscles

Submitted by Ean Jackson on 26 June, 2006 - 08:26.

Hey Labmonkey,

Looks like we go to the same doctor! (Possibly yours is either Jack Taunton or one of his students?) I was going to post the stretches I was given but the photocopy I was given is dog ugly. If yours is clean, please send me a pdf and I'll attach it to this thread so others will benefit.

I'm curious about how long it took before you got your running knees back?

wonky knee muscles

Submitted by labmonkey on 26 June, 2006 - 19:16.

Hey Ean,

We must have the same leaflet - mine is a dodgy photocopy too (could this be the result of the same canadian health service?) I got mine looked at by the Docs on campus at University of Calgary a couple of years ago. I was cycling after i started physio (in September), and the yoga, I was snowboarding again just after Christmas (possibly unwisely - but i didn't get out much), and I was back to light running in March - so all in all about 6 months from starting physio (it did take my ages to get a physio appointment, but i was stretching in the meantime). Dont underestimate the power of icing your knees because a lot of the pain is from inflammation (hence using ibuprofen or other non-steroidal anti-inflammatories) i am using ibuprofen gel on my heels at the moment (unrelated injury - my feet are in a bit of a state from collapsed arches). Another useful trick i picked up from the physio is moving my knee caps to stretch the ligaments on the outside of my knees - you definately need guidence on this! but it's a wow at parties.....

I found my physio stretches

Submitted by labmonkey on 12 August, 2006 - 01:43.

Hello knee people,

I was diggin around through piles of papers (have to write a report on my research and a couple of papers over the next 3 weeks, aarrrrggghhh) and I found a copy of the stretches etc that the physio gave me (i can't actually find the one the Doctor gave me). It consists of drop squats, seated spinal rotation, and a supine hip external rotation. If anyone wants a copy of it I can scan it....

I spoke to a guy in the newly opened running shop and he pointed out I should actually wearing my custom orthotics while running (oops - that would be me not thinking) and i found running a lot easier.

Me and my stupid collapsed arches!

80 yr old knees....already?

Submitted by Annie C on 6 March, 2007 - 06:14.

First came the back issues that wouldn't allow me to run. Few months off. Running here and there when the bod. would let me. Then came the torn miniscus. Few months off. Ran through the pain (barely) for a few weeks. Now five months after tear......the "good" knee is worse then the bad, and, when bad, it's excrutiating. UBC sports med tell me it's PFS which is extremely common with corresponding miniscal tears in opposite knee. Was told a drop squat programme is the answer? Am currently doing ART chiro, and yes the DS programme but haven't been given any stretches. A year and a half of little to no running is more painful than the knees and back combined.

So, Lab monkey, the exercises you mentioned 12th August, r they posted anywhere? Could I get a copy?

Thanks!

Hi Annie,I have been trying

Submitted by labmonkey on 6 March, 2007 - 09:01.

Hi Annie,

I have been trying to find the leaflet for a while, and no luck (I have moved 3 times since it was given to me). The key thing for me was that I had weak muscles on the inside of my knees. The drop squats are good strengthening exercises, I was stretching quads, hamstrings, inner and outer thighs and hips. I still haven't found the leaflet posted anywhere, my knees gotbad again justafter new yea, so I had to find some stretches quickly. These sites were useful http://www.bigkneepain.com/knee-exercises.html and http://www.aafp.org/afp/991101ap/2012.html (and the handout: http://www.aafp.org/afp/991101ap/991101b.html) . If they make it hurt, please stop and ice - I don't want to be responsible for making your knees worse. All the best, good luck!

My solution

Submitted by amacarthur on 23 May, 2006 - 07:57.

Hi Ean,

Sorry to hear about your knee pains. What you have described sounds amazingly similar to the knee pain I suffer from - although I have not tried all your solutions. I did visit many doctors before I finally got a good diagnosis from an orthopedic doc. While the recommendation was to find another sport besides running, I was not satisfied with that solution! So, instead I enjoy shorter runs (typically less than 2hrs max) and gradually build up my running if I have been off for a while. This seems to help. Also, if my knees are hurting a lot after a run, then I switch activities for a few days or a week. The rest seems to help. I also wear orthotics and a good "stability" running shoe. However, the best thing I can recommend is a specific type of knee brace, suggested to me by the doctor. It's called a "Cho Pat" knee support and is a small band that wraps below your kneecap (there are now newer models that provide support both above and below the kneecap). It's very small and simple, but I wouldn't think of running without it now. I notice a real difference, especailly on the downhills. While my knees may not allow me to tackle the Knee Knacker or some other 50km race, I can at least enjoy a couple good hours on the trail with only minimal pain now.

Hope this helps!
Amy

Cho Pat and Nackered Knees

Submitted by Ean Jackson on 26 June, 2006 - 08:29.

How are your knees holding out? Mine are still knackered and look like they will be at the start of the Knee Knacker! I've seen the Cho Pats advertised in the backs of running magazines. Is that were you got yours?

Cho Pat

Submitted by amacarthur on 27 June, 2006 - 04:01.

I got my brace at a local medical supply store near Broadway and Cambie (right next to the London Drugs). It's not the name brand "Cho Pat", but basically the same type of brace. I haven't seen them in the Drug Stores before, but I'm sure if you asked at any medical supply store that they could help you out. If you order online just be sure to measure your knee and check sizes first.
I haven't been doing too much running lately, so have to get my knees use to the pounding again. I want to try a longer trail race this fall, so need to start gradually building up my milage. I also hope to get out hiking this long weekend and will test them out on the descent! Good luck with the knee knacker and try not to get too frustrated if you need to take some days off!
Amy

Ean's PFS

Submitted by Curb on 21 May, 2006 - 11:21.

Hey Jackson, sorry to hear about your continuing injury woes. Its frustrating when you see a lot of different practitioners which can give you conflicting information and treatment - been there, done that. I'll give you my 2 cents worth on some of the treatments you've tried or will try.

Drop squats - this is the default exercise most sports med. docs will give you. Can be useful but its more of a textbook solution. Personally I find most sports med docs don't spend enough time to come up with a personalized solution. Knee hurts? Drop squats. Sprained pinky? Drop squats. Neck pain? Drop squats. Okay, maybe I'm exaggerating and I don't mean to downplay their knowledge but this has been my experience with a number of sports med. doctors. Have to look hard to find a good one.

Glucosamine - use the formulation that comes with chondriton, not plain sulfate. This will help your body absorb the glucosamine. Also, the recent research isn't as promising as the earlier studies. The experts now say that glucosamine does work but not for everyone as initially thought. If it does work for you, it works well. Also, you need to CONSISTENTLY take it for a minimum of 6 weeks for it to have an effect. You need to be taking a minimum of 1500 mg per day, usually amounts to 3 pills per day.

Anti-inflammatories - you definitely don't want to be taking these long term. As you found out, they can have negative side effects.

Taping - more of a band-aid solution. Will help the symptoms but usually done with other treatment like physio. Also, there's no way the tape will hold for long distance running...anything beyond 20 minutes & the tape will become too loose to be useful.

Prolotherapy - basically an injection of sugar solution. Helps you form connective tissue to add stability. Can be good but I'm not sure if this is the best thing for your knee. I've heard it work well for are SI or ankle injuries, where the joint was very unstable. Is your knee unstable or is it too tight and not have enough mobility? However, I'm not a doctor so what do I know.

Orthotics - research on this is mixed. From all the studies I've read, your odds are 50/50. I believe they work best for people with structural biomechanical issues. If your problem is due more to muscle imbalance I don't think they work quite as well, if at all.

ART - I find this a very useful therapy for many injuries but it may not be good for every injury. As with many therapies, you'll normally experience some worsening of conditions before things get better.

Ginger - haven't heard of this. But if you do have chronic inflammation I'd say you're better off using EFA's - essential fatty acids, especially Omega 3. Try a brand like Udo's Essential Oil. Also try the icing.

Physio - can be very good but there's so much this covers, hard to say what's best. Manipulation, visceral therapy, muscle stimulation, injections. Lots of options. Good & better physios out there...just like with sports med docs, search for one that looks at your individual case as opposed to giving you a textbook solution.

I believe every injury will respond to one form of treatment the best...it can be something you've done before or something new. It sounds like you're doing the right thing by going through different treatments. Remember not to do multiple treatments at one time as you won't know which one is working.

One thing I can say is that stretching & strengthening almost always improve things, though each injury will call for a different method of what needs to happen in what order. It also takes time so patience & persistence is key. Of course, I'm biased because of my profession but I've seen it work too often for it not to be valid.

Well, I hope you do find the solution you need. I'd like to see you reach your goal and get your fitness back. Take care buddy and hopefully I'll see you out on the trails. Give me a call if you have any other questions. Remember, these are just my opinions and not "medical" advice ;-)

curb

Ean's knees, hardly the Bee's Knees?

Submitted by rhonda schuller on 11 May, 2006 - 18:03.

Yikes! Reading the description makes me wince, so sorry to hear about the ongoing knee problems.
A friend, training for his 10th Ironman a few years ago, developed either the same or a similar problem. His was because of the overdevelopment of one set of muscles, thus forcing the patella off-track, or to track crooked. For him, that news meant ease up on the bike training and pick up some floor exercises for the inside thigh muscles, which I'm sure have more specific names.
From some of your description, I wonder when you first had problems? The second knee problem may be a compensatory injury, as you mention it was first one, now the other, and compensatory movement is also listed as a potential cause. I wonder if the first problems showed up after a particularly unusual demand on your knee? (ie What were you thinking would happen when you.....whatever?) If the injury did show up soon after, or reasonably soon after, a shift in stress or demand, then onset may have come with something like overuse or unusual use. I suspect if you had biomechanical problems you'd have had knee problems many moons ago.
Any cutting or shaving sounds radical, and like you, I'd probably be trying whatever else I could first...even ice and a steady course of anti-inflamatories :)
Sounds like you've got a good network of professionals behind you. I find knowing where to go for help and when is complicated. I wish a few more practitioners had chiro, physio, ortho and massage training all rolled into one, something like a GP for trail runners.
Whatever, this does not sound happy and I wish well in dealing with it.
Rhonda

Knee Problems

Submitted by Ean Jackson on 16 May, 2006 - 13:47.

Hey Rhonda,
Thanks for the shoulder to cry on! Well, I *had* a great team of professionals helping me...then I fired them all! Doing acupuncure now as a last-ditch effort to get fit for Knee Knacker. Looks like I might be hiking it this year...it seems the more "professionals" I try, the worse it gets. The good news is that the garden is looking good these days

That shoulder to cry on

Submitted by rhonda schuller on 18 May, 2006 - 20:53.

The clicjed opening- not to sound whiny, but....
I had to chuckle at the shoulder to cry on" because my right shoulder is the equivalent of your knee/s this year.
In retrospect, I suspect that in the short six months I enjoyed living in North Van and throwing myself into the fabulous tennis opportunities, without previous warning or prep for my aging arm and shoulder, I may have overdone it. No big deal, my stay in North Van was short, the tennis op and discomfort disappeared. A few months later I managed a fantastic fall on flatland, a few meters short of the Adams' aid station on a Fabulous February Fat Ass night run. I managed to drop onto that right should and roll.
I only rant on about this because after that fall, I soon found a new massage therapist and a new chiro and a new physio therapist, all in the False Creek area to which I had moved. At the formerly blissful massage sessions, my right neck and shoulder were screaming. The therapist said I seemed to have a lot of tension in the area. The physio wanted to focus on my lower back, saying much of my problems stemmed from, well, lack of abdominal muscles and overly taxed back muscles, a true Fat Ass if ever there were one. The chiro mentioned that I had a dislocated rib high on the right side and popped it back, although it regularly cruises in and out at its whim and my wincing.
Through that experience, spread out over a few months, I did not develop much confidence in the practitioner to consistently diagnose or offer corresponding prognoses for my shoulder.
For a four month period I have a time-out in Japan, away from any practitioner of anything to whome I can speak fluently. Here I hit the tatami mats with the tried and true Royal Canadian Air Force XBX program, and have been faithfully building in those old, untrendy exercises. I notice with some relief and pride that I have fuull mobility back in my shoulder, with a modicum of pain. The running terrain is mostly flatland, hoofing through the countryside looking at rice paddies and listening to frogs croaking. I have managed to stay upright, with no faceplants into the paddies.
Am I wiser? Not really. I suspect that I should have paid attention to my strained shoulder during the tennis days, but how I would have done that, short of dropping the tennis, resting the arm and slowly building strength before grabbing the racket again, is beyond me. I'm not sure if then, early days for a problem, any one of the cadre of health-support folks I see/or saw would have been much help.
Anyway, again, I wish you well with the acupuncture.
I am glad to hear the garden looks great. Do you have a convenient waist-high garden? How do you manage to garden with problem knees?
Rhonda

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