Knee pain and cracking with running...

Ari Kestler · 05-01-2008, 08:04 AM

About 6 months ago, I did a wilderness medicine course with a lot of trail running ... at the time I was in reasonable shape, there was plenty of rest and warm up in between the runs, none of which were longer than .5 miles at a given time... I distinctly remember running towards the end of the day and landing funny on one step in my right leg...I was running through some thickened mud and my foot set funny when I struck the ground... I kept going and by the end of the day I couldn't really run cause I would develop this weird sensation on the outside of my right knee, it just felt like osmething was being pulled...it was a minor pain, not really dull or achy, sort of sharp and pulling...I went home and it didn't really go away, it was significantly worse going up and down stairs, bending my knee...but walking was fine... It subsided a few days later and I thought nothing of it...

fast forward...I've started doing a little more running ( I am not a runner) and yesterday doing a WoD with 5 rounds of 400m run, by the end, I had the exact same pain, I can also feel my knee crunching when I bend it...afterwards it hurt to go upstairs and it still does...walking isn't as bad...

Thoughts? Part of me was thinking maybe this is iliotibial band syndrome, but I don't think I run enough to have that, and I never had any problems before that trail running event...

I have no aspirations of regularly running 5ks, I would like to do some sprint work maybe 1-2 times a week...

Garrett Smith · 05-01-2008, 08:54 AM

Ari,
Here's what I would suggest.

Foot drills (always done barefoot), before every workout, particularly running.

Foam roll the hamstrings, quads, hip flexors, and ITB at least 2x/week, definitely after the foot drills and before running.

Stretch those same muscles after running.

Learn to run POSE or Gordon Pirie style, and get some "unpadded" shoes for running.

Oh yeah, with a lot of cracking, I always look to the nightshades as well.

Mike ODonnell · 05-01-2008, 10:52 AM

Quote:

Originally Posted by Ari Kestler

Thoughts? Part of me was thinking maybe this is iliotibial band syndrome, but I don't think I run enough to have that, and I never had any problems before that trail running event...

I once did an 8 hour adventure race....couldn't walk up stairs for the next 2 days because that exact same pain. ITB is the #1 place to start. I got better with foam rolling and stretching the ITB, Hip Flexors and Hamstrings. Work on more 1 legged exercises like lunges and squats. You have a tight ITB along with instability in the hip. Trail running will make it worse because of all the angles your foot lands and the inward motion of your knee most likely. Watch your knee as you run...it is likely caving inward therefore pulling on your ITB...forget running inserts and that crap, fix the source of the problem...weak knee and hip stabilizers (posterior chain too). Work 1 legged RDLs and Floor Hip Raises. 2 legged work builds good mass....1 legged work prevents injuries and transfers to sports movements. Good program should have both.

As for cracking...could be calcium deposits, leaky gut or an overly acidic diet (or all 3). Try some ACV couple times a day and drink water with lemon....may help all of the above. Also check out the healthy gut post...as you may find something in there as well (like nightshades and lectins/gluten intollerance). Everything starts in the gut......everything.....

Ari Kestler · 05-02-2008, 05:40 AM

Thanks Dr. G and MOD...I'll try implementing some of these suggestions...

Dr. G the first link is showing up dead for me...

Garrett Smith · 05-02-2008, 06:40 AM

I corrected the link. Sorry 'boot that.

Dave Van Skike · 05-02-2008, 02:53 PM

Quote:

Originally Posted by Ari Kestler

About 6 months ago, I did a wilderness medicine course with a lot of trail running ... at the time I was in reasonable shape, there was plenty of rest and warm up in between the runs, none of which were longer than .5 miles at a given time... I distinctly remember running towards the end of the day and landing funny on one step in my right leg...I was running through some thickened mud and my foot set funny when I struck the ground... I kept going and by the end of the day I couldn't really run cause I would develop this weird sensation on the outside of my right knee, it just felt like osmething was being pulled...it was a minor pain, not really dull or achy, sort of sharp and pulling...I went home and it didn't really go away, it was significantly worse going up and down stairs, bending my knee...but walking was fine... It subsided a few days later and I thought nothing of it...

fast forward...I've started doing a little more running ( I am not a runner) and yesterday doing a WoD with 5 rounds of 400m run, by the end, I had the exact same pain, I can also feel my knee crunching when I bend it...afterwards it hurt to go upstairs and it still does...walking isn't as bad...

Thoughts? Part of me was thinking maybe this is iliotibial band syndrome, but I don't think I run enough to have that, and I never had any problems before that trail running event...

I have no aspirations of regularly running 5ks, I would like to do some sprint work maybe 1-2 times a week...

I wrote a paper on ITBFS a long time ago, I later ingnored that knowledge and developed a wicked persistant case of it which was corrected. Two surgeries, rehab for 4 years. (slow learner)

You probably don't have the full blown "syndrome" as of yet but you've primed the pump. All the stanndard advice works. foot health and hip health, posture etc.

Were I in your shoes I would:

Go to a........wait for it....

Doctor.

I go to a sports med as my GP, he's stingy with the pain meds but he understands the need for speed. he will give you physical therapy. you will do it no matter how stupid it seems. you will also overdo it with the reasonalbe suggestiosn of MOD, such as one legged DL and RDL. This is good. until you learn to overdo it during PT, you will never actaully know how to do it. Rehab is 1 step forward 17 steps back plus 20 forward 3 back then 4 forward 10 back...this is as it was intended..

Stop running now... (and forever, but at least for now)

Address your hip mobility issues:

you have them, you may not know it yet but you do.
Psoas adn other hip flexors are the usual suspects

Address your hip strength deficit:

no one's hips are strong enough. one legged work is a good way to not hurt yourself. whil buildign some strength. take time to work your VMO individually as well. terminal knee extensions, quad sets (to tolerance)

If you're forced to back off quad centric work for a while it's a perfect time to work your overhead press, dips or whatever other gymnastical fetishes you may have.

Stretch your hamstrings.

I won't get all doctor science but your hamstrings are too tight. How do I know? Well, you speak english, and you are not a ballerina~ergo hamstrings are too tight. For real. They are.

Ice

The biggest benefit I get from ice is disrupting the pain cycle so it's good to have around while doing PT.

crackling...that rarely means anyhthing unless it's directly associated with pain. A lot of knees crackle. When mine were at the most screwed up they were silent, now they are great adn make all sorts of squeeky noises. I wear knee sleeves to cover the sound.

Craig Loizides · 05-02-2008, 06:35 PM

Lots of good suggestions so far. I've found Walt Reynolds' ITB special to be very helpful. It stretches and strengthens the key muscle groups. I do this after most runs.

http://www.sportsinjurybulletin.com/...e-injuries.htm

Also, overhead squats fix everything and pistols are good for correcting imbalances.

I saw this recently I find it to be true for me.

"How does this imbalance happen? Well, sometimes it can be related to running in worn shoes or on crowned roads, both of which happen to be commonly cited reasons for ITBFS. More often though, I think it goes back to postural habits, such as persistently bearing weight on one particular leg, or crossing one leg over the other when sitting, as I mentioned in an earlier column. One way you can tell if you have developed this is to lie on your back with your legs out straight. Relax completely, letting your legs fall out where they may. Lift your head and look at your feet. If they do not tilt outward at the same angle (say, the left foot is pointed at 10:00 while the right says 1:00), you may have this type of hip rotator imbalance. If you suffer from ITBFS, I'd be surprised if you didn't."

My right leg tends to turn out more than my left leg if I haven't been keeping up with my stretching / prehab work. This is my warning that injury is around the corner. Don't ignore those little imbalances.

Garrett Smith · 05-03-2008, 06:11 PM

As Dave said, taking a break from running while you rehab is crucial.

I've had ITB syndrome and trochanteric bursitis from distance running. Back then, I fixed both (they were at different times) through much less "real" running (much more aquajogging), ITB stretching, and yoga.

Steve Ericson · 05-08-2008, 07:54 PM

Dr G.
Those foot drills seemed like a great idea, but do you think it is worth it to add those drills into my already rather lengthy warm up if my overall leg health is decent (have had some injuries in the past)? What do you do?

Thanks, Steve

Garrett Smith · 05-09-2008, 06:55 AM

The most crucial areas to do joint mobility drills for are:
Ankle/foot (the foot drills, done properly, take care of both)
Hip joint
Anterior-posterior thoracic spine (Robb W's kyphosis artice can take care of this)

On days where I'm lacking time, I only do those areas plus a little jumprope as a warmup, with maybe one set of my first exercise done light. I do the foot drills or the Z-Health ankle/foot stuff nearly every day I work out, I find it that important. I do have a history (way back in high school) of multiple twisted ankles on both sides. My ankles and feet have given me no problems since I started doing this stuff.

IMO, if you wear shoes during the day, you need to do something to counteract that "casting" of your feet as often as possible.

Don't let your warmup get out of control--been there, done that. Use your rest days to do stretching and mobility stuff if you can, so you can save time for your workout. Remember that not everything has to be done every day!

Also, I try to incorporate as many different movements as my current goals will allow, both for mobility/flexibility purposes and to decrease the amount of mechanical wear patterns from doing many sets over time of (nearly) the exact same movement. For example, doing normal and "B" squats, normal and sumo deadlifts, cleans and power cleans, etc.

Let me know if that didn't cover your question well enough.