Knee Burning

Question
QUESTION: I am a runner and have started biking for the past few months. I was doing PT for weak quads and knee problems for a couple months. The past couple weeks I have noticed that my knees (mainly right above it-the quad tendon perhaps and the inside of my knee will burn. They don't hurt, I just get a burning sensation when I run and even after and the next day. It will happen somewhat after biking although not as bad. Also, the tendons in the front of my lower legs will ache from time to time, nothing bad though. I've been doing strengthening exercises every night for my quads and hips, I'm just not sure if I should keep up with the running and biking in moderation or what. My muscles still get a little tired after running and biking so I'm sure there is still some weakness going on. Also, I have noticed that my knees are popping a lot more than they usually do. I just bought a brand new bike to start training for a sprint triathlon so I would like to still keep running and biking. Thanks for the help.

ANSWER: Hello.  The first question I would ask is what was your previous knee injury?  Also, what is the "popping?"  My first impression of your injury is "chondromalacia".  The fact that you had previous knee problems, pain on top and inside of knee, and "popping"...I'm assuming when you bend the knee.....all point to chondromalacia.  The quadriceps strengthening that you are doing is typically helpful, although I worry that you may be doing too much to irritate the knee...running, biking, and strengthening...all in a short period of time.  Did you back off of your running when you introduced cycling?  If not, then the situation looks like this.  Regular runner, knee injury, injury resolves, runner attempts to get back to previous mileage while also introducing cycling.  This is an assumption, but a very common scenario.  Given what little I know about your specific situation, this is what I would do.

Cut back running and cycling training volume (mileage) 50% for next 2 weeks, no hard/fast runs/rides, ice 20 minutes a day especially after exercise, back off of knee strengthening exercises until pain is gone, emphasize hamstring and IT band flexibility, ensure that you are wearing proper shoes that properly control your foot pronation.  If symptoms don't clear in 2 weeks, I would continue the same regimen w/ no exercise that irritates your knee (swimming, elliptical?) for 2 more weeks.  After this period, if pain continues, then I would visit a sports-medicine minded doctor.

Oh, almost forgot, the pain in your shin is likely caused by the same thing....runnning and cycling both stress the anterior tibialis muscle tremendously.  

I'm making many assumptions, but sounds like too much, too soon.....something we all do occasionally.  Good luck, Larry





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

QUESTION: Thanks for the quick reply! I'm not having any pain, just a burning feeling above and to the side of my knees (worse in my right). I was seeing a PT previously because I had extreme tightness in my left knee and weakness in my quads, especially the left one. I actually introduced the cycling prior to seeing the PT as well as upping my mileage and doing hill work which she felt brought that on. During PT she encouraged me to ride my bike and keep running as long as I didn't feel any pain along with doing the strengthening everyday. Anyways, the tightness has gone away and my left knee is feeling better, now it's just the burning sensation which is manageable but annoying nonetheless. The popping happens sometimes if I flex my quads or when I turn when I'm standing. It really feels like my the burning is in my tendons around my knee.

Answer
Ashley,

I still believe chondromalacia is the culprit as it often presents with only symptoms of burning in the absence of true pain.  Other possibilities could include irritation of the quadriceps at or near the patellar tendon.....and/or plica, tendonitis, bursitis.  It really is complex and would require an evaluation to specifically diagnose you.  However, the treatment for all of these conditions is similar.  MRI may definitely answer your question, but you should just treat based on symptoms w/o unnecessarily spending money on a definite diagnosis.

Good luck, Larry