Knee Pain

Question
QUESTION: I have been running pain free for more than a year. I have been concentrating on running form and low impact forefoot strike. I am recently 51 years old and have comfortably been running 15 miles per week. A 6 mile run once a week had been no problem. I am fit and thin - not overweight at all. Ever since that PR I find that 1.5 miles into my run my kneecap feels like it is pulling down and my shin gets tight. When walking I can complete the mileage but resuming running brings the discomfort right back. It seems to have begun right after completing my first sub 8 min/mile pace run.

Does this sound like PFPS? I initially thought ITB but the symptoms don';t seem right.

Very depressing.

ANSWER: Len, Great job on working so hard. Don't get depressed. The prognosis is excellent.

First, it could be either PFPS or ITB or something else. It really doesn't matter. The key is to find out what helps it.

https://www.youtube.com/watch?v=Rf-AKupMPNk

https://www.youtube.com/watch?v=YiesZvSVa7c

https://www.youtube.com/watch?v=dGsBVoYNGac

https://www.youtube.com/watch?v=CiqvDV8pzRk

https://www.youtube.com/watch?v=MEtrqCu8Ne8

Perform these exercises 5 of the next 7 days. Perform enough to be a little tired, but not overly tired. Also, run 1 mile 5 of the next 7 days. After the 7 days try running more than 2 miles and then add a mile each day until you are satisfied with the distance or the pain returns.

If the pain returns then please send me another message with whether the pain is any different. Different means different place, doesn't start till further in the run, different intensity, etc. If these 5 exercises fix it then there's no reason to look further. If they don't then there's other things that we can do, they are just a little more difficult to explain in a couple of paragraphs.

The bottom line: Don't be discouraged. This is easily, easily fixable. If I can't help you via allexperts.com then I can suggest the type of physical therapist that can help you quickly.

Best of luck!

---------- FOLLOW-UP ----------

QUESTION: Thanks for your quick response. I checked out the videos of the exercises you suggested. I do a lot of that already on a regular basis. My routine had been 3 mile runs (hills, speed work  and recovery run Sunday, Tuesday, Thur) with  dynamic warm up before and stretching after including some relatively light squats with and without weights. I would do 2 sets of 30 heel raises standing on a ledge and the days I run I do 2 minutes per leg 3x during the day - standing on one foot and balancing to strengthen my ankles) and a 6 mile run on Saturday. The off days I did some curls, push ups and abs. As part of my after run stretch I do side leg raises for the hips and front and back leg raises for hips and glutes.

You would think that I would be stronger after a year of running and not weaker. I have been doing a lot of stretching all the time now hoping that will help. Does not seem to help. I will try adding the exercises not covering what I am already doing. In the meantime I am walking and using a Nordik Trak x country skier to replace running.

Thanks.

Answer
Thanks for the follow up Len. That's great you've been doing other exercises so well. A few points you'll want watch.

1) Make sure to do the sit-to-stands on 1 leg. This is very, very different from regular squats.

2) Make sure to do the side-lying hip abduction against a wall. By not doing so can contribute to IT band problems.

3) Clamshells are excellent at recruiting proper muscles to relieve IT band problems.

4) Make sure to perform the calf raises on 1-leg very, very, very slow. This is a lot different than regular calf raises.

Let me know how it goes.  Making these few tweaks could very well be the difference.