Dodgy Knees & London Marathon

Hi all,

I'm currently in training for London Marathon and i'm feeling utterly miserable as i've just seen my physio about my aching knees and he's told me that i shouldn't do my long run this weekend and generally need to lay off the running for the time being. The thing is, i'm supposed to be doing the first of my three biggest runs before my taper this weekend- 19 miles and i'm terrified that if i miss this run then it's going to ruin all the hard work i've put in to date.

I've had achey knees (right knee especially) with pain that began around the inside of the knee since i started going over the 13 mile point and now the pain seems to be more in the middle of the kneecap. As my mileage has been increasing so had the pain. Physio seems to think it's due to an imbalance in my muscles- basically the muscles at the top of my right leg/hip aren't working as they shoud, putting pressure on my knees. 

 I need to listen to the physio right and not do a long run this weekend? Has anyone been in a similar situation? Does anyone have any advice in terms of cross training or just generally keeping my fitness up so that i don't lose it whilst i'm laying off the running? And can someone please say nice things like it's going to be ok and i will be able to run the marathon! One of my friends has just had to pull out because of a knee injury and i'm terrified!

 Thank  you

Hi Angela

I'm in a similar situation.  My training was going well until my 18 miler 3 weeks ago.  I completed it but then couldn't walk the next day.  After seeing several doctors and resting for two weeks (no running or anything) I went to see my friendly sports therapist.  She beat up my leg, stretched and pulled me this way and that, used ultrasound and gave me some more exercises and stretches.

My problem is supra patella bursitis, an inflamed sack of fluid just above the knee cap.  I've also been prescribed some stronger anti inflamitory tablets and have been doing my exercises vigerously this week.  So far its feeling better and I go for a bike ride this evening and a short (5 mile) run tomorrow.

Back to the sports therapist on Tuesday.  In total I've missed about 3 weeks of training at a crucial time but I am convincing myself that the base fitness will still be there and so long as I can run on Sunday pain free, I then have 2-3 weeks to do some LSR's.

Did your physio give you exercises to strengthen the appropriate muscles?  If so, do those like crazy, swim lots (I should have done) and don't worry too much about the long runs.  If you miss one or two thats fine.  Its time on your feet and the most important thing is being fit to reach the start line.  You'll be amazed at what your body can do on the day.  I have a friend who never trains to more than half distance but just goes and bashes out the full marathon on the day.

 Good luck and chin up.

Paul

Dear Angela.

I had a very similar problem which was put down to muscle imbalance. I was given some exercises to do and I later took up Pilates (which if you don't do already then I would highly recommend - it's made a huge difference for me). You won't lose your fitness that quickly and presumably can cross train in the meantime? Don't worry - as Paul says time on your feet is more important than pure distance but more important is to be fit so make sure you get better! I think that 20 milers are more of a psychological boost as anything unless you're looking for a really good time - if you miss a few runs you'll still be fine. Think of all the hard work that you've already done - that's what'll get you across that finishing line!

Good luck!

Hi both,

Thanks so much for your responses- they have made me feel a lot calmer. It's nice to know that i'm not alone! 

My physio has given me a number of exercises and i'm doing them three times a day- I'm going to test out the knee with a light run tonight, but i'm really anxious that the pain won't feel any better.

I haven't done any cross training to date but i think i'm going to incorporate some swimming and pilates as suggested to keep up my fitness. Really want to be able to do my 20 mile run the coming weekend so fingers crossed!

 Angela.

Paul,

There is no such condition as suprapatella bursitis.

Angela,

You have just over one month until the Virgin Marathon.

Your knee pain may be due to a non-mechanical cause and running is not going to do you more harm than good.

However, you may have a mechanical cause for your pain like plica syndrome or Hoffa's posterior fat pad impingement syndrome and running will do more harm than good. Chondromalacia is a precursor of osteoarthritis

Do not struggle on without a diagnosis. Ask you GP for a referral to see a COnsultant in Orthopaedics and Trauma with an interest in knees.  You should then be assessed with a history and examination as well as an MRI scan.

Best of luck. Not much time!

John Hardy

Hi John

I've been told that the supra patella bursa is inflamed which is causing the pain, along with some maltracking of the knee cap due to weak muscles (can't remember the specific name) which probably caused it.

The exercises and stretches seem to be working and I've got a lot less pain now and managed a 5 mile run without the usual pain and stiffness afterwards.

I know you haven't got much info to go on but in your opinion, what do you think it might be?

Thanks

Paul

Hi all

I'm in the same position as Angela with the VLM in 4 weeks. I ran Hastings half marathon on Sunday and ran far too fast on the downhills, walked 2 miles back to my car and then felt as if someone had stabbed me in my left kneecap. My GP isn't back from holidays until Friday and I'm scared I've done some serious damage to my knee. It doesn't hurt when I walk around and I'm working at home this week with the leg on a stool and I've iced it but what have I done?

Hi Angela, I've been struggling with the tendons in my right ankle since the start of Feb, when I prob over did it too soon. I couldn't do any running for a month, but kept myself on the bike and in the pool. I got myself through a 10 miler before running Silverstone, and doing a 16 miler last weekend, but don't feel confident to do any more than that in the week.

I've found that the pool, bike and cross-trainer have really helped keep my fitness levels to get me through my long runs, and that's my plan until race day. So just keep off the knees and make sure you are there on race day!

Paul,

There are 2 bursae around the knee the prepatella bursa and the infrapatella bursa. Inflamation of the former results in Housemaid's knee.  Inflammation of the latter results in Clergyman's knee.

If this is a persistent problem ask you GP to check for Gout using a simple blood test.  Have the blood test just as you feel the symptoms coming on again. This is because serum uric acid levels fluctuate during the day and rise to a peak days before the peak painful period.

The bursa can get infected but this is usually if you get a cut infected on your toe or get an ingrowing toenail.

For an explanation of patella maltracking have a look at the last thread I contributed to in reply to Flibberty.

John Hardy

Dear all,

If you get a sudden stab of pain behind the patella when going up or down stairs one day then try the "Hardy Patella Shuffle":

1. Stop where you are on the stairs.
2. Find a place of safety (don't fall down the stairs)
3. Straighten you knee to relax the patella.
4. Hold the edges of your patella between thumb and index.
5. Shift the relaxed patella left and right (thats it side to side!)
6. Then bend your knee back and forward and repeat until you feel the bit of gristle that got between the patella and trochlea is out of the way.

Works for me and friends and patients who have only recently started noticing this and may avoid a try to the GP!

Hope this helps.

John Hardy

Hi John

First, I couldn't do that (it's gross) - anything to do with knees makes me feel funny so I don't know how you can operate on them.

Secondly, is it worth booking myself in for a private MRI/consult via my GP or should I "wait it out?" - I will try my physio tomorrow as an initial step. Your views would be appreciated.

Thanks

Corky2,

Sorry for the late reply but I have been at our annual meeting in Oxford.

Yes. You need to have an assessment by someone who knows about knees.  I would not have an MRI without an assessment. Why? Because occasionally if your surgeon suspects a subtle problem they will get you to have a run before going onto an MRI scanner at other times they will not. A good Orthopaedic Surgeon will have an idea about your problem before the MRI. Beware the doctor or specialist who settles for an xray only in a runner like yourself.

Be careful about paying for an MRI. Some are cheap and useless some are expensive and useless. Others are expensive but gold standard (BUPA Cromwell circa. £900) others are very good but less expensive (Gloucester MRI, Cheltenham circa £218).

Hopes this helps.

John Hardy

Hi John

Please could I have some advice as well? I have been getting a pain in my knee on going up stairs just after running for the last week. It is under the patella on left and only lasts for a day - it was only bad on the day I did a long run and more of a twinge after shorter runs. After the long run I had pain in the knee when I bent it to do a soleus stretch as well  but that went away the next day.  

Saw physio (worried as I am training for VLM and don't wanrt any new niggles now!) He said there was no muscle imbalance or ITB problems and that it was just a cartilage issue. He advised glucosamine and Chondroitin which I have been taking since Tuesday and also icing knee after running. I was told there is no need to cut down running unless pain comes on during run, which it hasn't done so far (touch wood). Is this something your 'patella shuffle' would help? I have no pain now but patella feels slightly creaky if I move it around. Thanks for your help.

Dear all,

Crepitus is the crunching a joint makes under load when there is inflammation of the lining of the joint (synovitis) or cracking up of the surface cartialge of a joint (hyaline cartilage). 

Usually the cracking up of the surface of the joint (degenerate change) occurs if there is a bit of gristle that is getting caught between the kneecap (patella) and the thighbone (trochlea). It acts as a small area of high pressure (like a stone in a running shoe). It is made worse by cyclic loading (running) until it is moved out of the joint (Hardy patella shuffle - for those of you who can shuffle their patellae). Sometimes your physiotherapist will try McConnell taping to shift the patella off the gristle. Occasionally it takes a small operation to shave the gristle from between the patella and trochlea of the knee.

For those of you who have a background in engineering and understand tribology you can work out why in some runners the patella wears out and in some the trochlea wears out.

In my experience after having the opportunity to take a history and examine patients pain going up stairs occurs with early degenerate change. By the time you get pain going down stairs as well the wear between the patella and trochlea has progressed to bone on bone.

Regarding the Chondroitin Sulphate and Glucosamine sulphate boiled cockrell comb. If you had a stone in your shoe would you take cod liver oil in an attempt to heal the ulcer on your sole?

Hope this helps.

John Hardy

Jyo,

I am starting a brand new London Clinic on the Kings Road on Friday afternoon 9th April. This is 16 days before the VLM. If you are running for a charity, and can prove this, I will offer to assess you for half the price I normally see new patients.

This will not include the price of any special investigations that I recommend. However, it will include a letter to your GP and a copy to your email address. If you have had an xray or MRI in the past please bring them.

Google: Knee Surgeon to get my secretary's telephone number to make an appointment.

John Hardy

John Hardy wrote (see)

Usually the cracking up of the surface of the joint (degenerate change) occurs if there is a bit of gristle that is getting caught between the kneecap (patella) and the thighbone (trochlea). It acts as a small area of high pressure (like a stone in a running shoe). It is made worse by cyclic loading (running) until it is moved out of the joint (Hardy patella shuffle - for those of you who can shuffle their patellae).

Hi John,

Thanks so much for the offer of an appointment but the patella shuffle seems to have worked for me! The pain in my knee is gone and did not recur even after my 16 miler yesterday (touch wood!) I think it's brilliant and thanks so much for sharing it on the forum. You should patent it - perhaps we will see it in future Orthopaedic and Sports Medicine textbooks?

I will see if the pain comes back as I carry on training over the next 4 weeks and would be grateful for an appointment if it does. I am running for Breakthrough Breast Cancer.

Just one more question -  Is it worth doing the shuffle as a prophylactic measure or is it only necessary as and when you have knee pain? Thanks again for your help - it is much appreciated.

Jyo

I do believe there are more than 2 bursae around the knee, the suprapatella bursa being the largest communicating with the joint space...

Jyo,

Sorry it is so late. No it is not worth doing the Hardy Patella Shuffle if you have not got anterior knee pain in case you knock the gristle back between the patella and trochlea and this causes your symptoms to return. Wait until it hurts again. No pain means no wear.

Breast Ca is a great cause. Hope you achieve your goals.

Wriggles,

There are many bursae that can appear around the knee. However, I have operated on literally thousands of knees and read many books and have never seen a suprapatella bursa. There is a suprapatella pouch. The suprapatella plica separates the knee joint from the suprapatella pouch. Occasionally the suprapatella pouch  fails to coalesce with the knee joint and this causes problems in long distance runners and cyclists.

Hope this helps.

John Hardy

Thanks very much John. Knee is still OK so will wait and see.

Jyo