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Advice needed: knee pain 2&5 weeks before marathons - DNS 2 week one?

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Advice needed: knee pain 2&5 weeks before marathons - DNS 2 week one? Empty Advice needed: knee pain 2&5 weeks before marathons - DNS 2 week one?

Post  Julie on Sat Aug 18, 2012 9:35 am

My knees have been sore off and on the last 3 weeks so I've been taking it easy, more rest days, cutting back on mid-week mileage. Well, today during my long run my right knee (meniscus area) became very painful. I ended up cutting my run short and walked home the last 1.25 miles because it was too painful to even take a step. This is much more pain than I've felt all training cycle and I don't understand why it happened after I only ran Wed and Fri this week, and relatively low pain at that.

My main question is, should I decide now not to run Michigan in 2 weeks? I have paid my entry fee but that's it. I was going to go with 2 friends (driving) and I know they'd be understanding if I can't do it. Or, do I take a few rest days and see how it feels on Thursday or so?

Or, if it's this painful just running 14.5 am I pretty much doomed to have a horrible marathon in 2 weeks? I have another marathon 3 weeks later which I really really want to enjoy. It's in California and we have plane tickets, we're going...and I worry that if I have a painful marathon in MI, that CA is not going to be good either. I'd rather skip MI and have a good time in CA. That is how I'm leaning right now but wanted some feedback from you all, too.
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Post  Mike MacLellan on Sat Aug 18, 2012 10:26 am

Will you be able to pull out of the knee acts up in MI? Better to take the trip and DNF than to DNS, IMO.
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Post  Julie on Sat Aug 18, 2012 10:44 am

Yeah, I think it would be hard but if it felt like it did this morning then yeah I'd pull out. The weird thing is it's just been today that has been so painful. I had two good 20 milers, a decent enough 17 miler this Sunday.
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Post  Schuey on Sat Aug 18, 2012 1:55 pm

Well Julie this is a tough one. I would say go and give it a shot but at the same time if the knee hurts after running 14 it could be a risk trying to run 26.2. Have you thought about seeing a foot doctor to see if there is length difference between your legs or some other foot issue that might be causing this pain?

The only reason I ask that is because this issue has seem to plaque you for some time now. I had some knee issue flare up my senior of H.S. when track started and we were building mileage and founded out that my left leg was shorter. I really feel that the best thing for you at this point is to find the root cause of your knee pain so that you can go back to training and feeling good and healthy.

I know what it is like to train when not feeling healthy and wonder day after day if today's run is going to hurt or not. And that is not a fun way to go through training or racing.

Is there a half that you can drop down to instead of running the marathon. Maybe you still go with your friends and run half of the marathon if they don't have a half and then support and cheer on your friends for the rest of the marathon?
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Post  Julie on Sat Aug 18, 2012 2:01 pm

Thanks Martin, my knees are always what hurt me anytime I get an injury...it's always knee-related so I am pretty sure I do have something physically wrong with me that makes me prone to knee injuries. There is a half that day, I don't know if I can switch. I don't really want to drive all that distance just to run a half, though (I think it's about 14 hrs one way and will be 3 nights away from home). It would still be a fun "girl trip" but I am trying to work on my 50 states goal and a half marathon wouldn't do anything for that.

One of my running friends is a PT, she has told me before it's probably muscle imbalance and I should cross train more/do some specific exercises. I am getting better about cross training but did a lot more running this summer than I had all winter so I knew I was asking a lot from my body. I didn't do any speedwork, though and I thought that would help. I'm really not sure what to do. I'm taking a few days off, for sure, and then I guess I'll see how it feels next time I run. It sure would be easier if today had been a painless run.
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Post  Schuey on Sat Aug 18, 2012 2:05 pm

2 things have you thought about trying to use that kiniseo (spelling) tape? And the other is if the goal is to get your 50 states can this marathon be a walk/run just to finish?
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Post  Julie on Sat Aug 18, 2012 2:08 pm

My PT friend does know how to tape, I'll ask her. I am totally fine with taking it as slowly as I need to, but truly walking home the 1.25 miles today was painful and I don't want to hobble for 10 miles, you know? If it was just slow running mixed in with painless walking, that I would be very comfortable with. Maybe we ran too fast today (well, I know we did) and it was also quite hilly. I did ice it and take ibuprofen after my run.
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Post  Michele "1L" Keane on Sat Aug 18, 2012 2:58 pm

I was going to say what Martin did with regards to determining the root cause of the knee pain. My knees used to bother me alot when I was younger and it was due to muscle weaknesses in my glutes and although my ITB was fine, it was always notoriously tight.
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Post  Julie on Sat Aug 18, 2012 5:15 pm

Do you think a PT would do that? Or would I go to my physician?
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Post  Schuey on Sat Aug 18, 2012 7:29 pm

@Julie wrote:Do you think a PT would do that? Or would I go to my physician?

My opinion would be having a doctor help find the source of the problem and than a PT to help rehab the problem once known. Unless you feel a PT is certified to help diagnose the problem?
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Post  Julie on Sat Aug 18, 2012 8:11 pm

@Schuey wrote:
@Julie wrote:Do you think a PT would do that? Or would I go to my physician?

My opinion would be having a doctor help find the source of the problem and than a PT to help rehab the problem once known. Unless you feel a PT is certified to help diagnose the problem?

I'm not really sure. My doctor is a family practice physician and I've never seen him for a running injury.
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Post  Michele "1L" Keane on Sat Aug 18, 2012 9:26 pm

@Julie wrote:
@Schuey wrote:
@Julie wrote:Do you think a PT would do that? Or would I go to my physician?

My opinion would be having a doctor help find the source of the problem and than a PT to help rehab the problem once known. Unless you feel a PT is certified to help diagnose the problem?

I'm not really sure. My doctor is a family practice physician and I've never seen him for a running injury.

Since your friend is a PT, I would ask her advice. Most PTs are quite knowledgable and you already have a positive relationship with her.
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Post  Julie on Sun Aug 19, 2012 7:19 am

Thanks Michele, I'll ask her. I run with her so I see her pretty often.
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Post  JohnP on Sun Aug 19, 2012 2:35 pm

Julie, I agree this seems to plague you a lot. Do you wear orthotics? What type of shoe do you wear (motion control, stability, etc). Then finally, how did you arrive at the answers to those two questions (e.g., trial and error, doc visit, running store salesman)?
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Post  Julie on Sun Aug 19, 2012 10:14 pm

@JohnP wrote:Julie, I agree this seems to plague you a lot. Do you wear orthotics? What type of shoe do you wear (motion control, stability, etc). Then finally, how did you arrive at the answers to those two questions (e.g., trial and error, doc visit, running store salesman)?

I don't wear orthotics. I wear Saucony grid omni which are moderate stability/motion control. I got them from a running shoe store so a very good local runner helped me get them. I've been wearing them for 6 years now.

My sister looked at my knee today (she's a PT assistant) and thinks it's my meniscus. I will ask my PT friend in the next few days. For sure I am taking another 2 days off. It was sore just walking around today. But yes you are right in saying this is a common injury for me. I had this pain in 2008 during Twin Cities and definitely last fall, too.
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Post  JohnP on Sun Aug 19, 2012 10:53 pm

I really feel for you, this is not a good thing, especially because I know you are going for the 50 state club. Once the dust has all settled with these two marathons, is it possible to visit a sports podiatrist? I know we are all experiments of one and we all differ but I'll still give you my experience. I had bad knee pain some years ago and went to a doc. He prescribed orthotics and motion control shoes. Using them, the knee pain then went away. Fast forward 3-4 years and I started having ankle pain. After seeing a doc, she watched me run and walk and said I didn't pronate any longer. So I dumped the orthotics and motion control and worked my way to cushioned/neutral shoes. On the other hand, I know there are plenty of people (I think of Michele) who wear orthotics still after many years of running. The doc told me that a combination of losing weight and running more efficiently changed my need for orthotics.

All I'm trying to say is maybe you don't need the stability shoes, and using them is putting pressure on your knee. As a start, do they have the running stores by you that do the treadmill video analysis? You can watch the foot in slow motion to get an idea of if you are pronating. ANother option is Running Warehouse - http://www.runningwarehouse.com/learningcenter/footwear.html?video=FOOT05 - you can use a digital camera or camcorder and record yourself on a treadmill and they will analyze it for you.

The meniscus is a dangerous thing. If you can hobble through the Michigan marathon using a jog/walk strategy, it might not be a bad idea. Once you get all 50 states, it will just be a good story about how you snagged Michigan. No one is going to ask your time in all these marathons, or if you walked. It will just become another part of the 50 club story you'll tell your grandkids.
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Post  T Miller on Mon Aug 20, 2012 8:15 am

Hi Julie, I'm sorry to hear that you're facing this delima. I have a few thoughts/ questions.

Are you cross training on a bike? I know that if your seat is too low that it can cause knee pain.

How many miles do you have on your shoes? I like to have a shoe rotation so that I'm not always running in the same shoe.

Wendy is currently having knee pain and her doc says that it is a result of having tight calves.

Where is your pain located? I know that Wendy relies on taping her knees before every run and uses knee straps.

I've had knee pain in the past and I was able to get past that injury by strenghtening with single leg squats off of a step.

I hope you can get past this in time for your marathons.
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Post  Julie on Mon Aug 20, 2012 9:16 am

Thanks John, I might be able to find a sports podiatrist. I have never tried but they are probably in Lincoln. I didn't have gait analysis when I got my shoes, but it wouldn't be a big hassle to go back to the running store (which is also in my city so not a huge trip or anything to get there). I believe they do offer that or at least I could talk to the owner again and see if my needs may have changed in shoes. It's kind of funny because I had thought about going a few months ago to see if I should be using new shoes but never bothered. I will double check but I think there's a 6 hr time limit on the marathon so honestly if I started with walk-running rather than going all out running and crashing the last 10 miles or so, I probably could finish in less than 6 hrs (I would hope).

Thanks Tim, The shoes I'm in right now I just started wearing a week ago. I don't cross train with a bike. I have a workout dvd (Jillian Michaels 30 Day shred which is strength, cardio and abs) that I use for cross training. My pain is my right knee on the inside, if you were facing my knee it would be right around 2:00, very specific about 2 cm little band of very intense pain.

I didn't run yesterday or today. I will take tomorrow off, too and then Wed or Thurs do a little trial run and depending on how that goes try to make a decision about MI and then hope it all comes together for race day.
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Post  Julie on Thu Aug 23, 2012 12:33 pm

I have a physical therapy eval tomorrow. I'll let you know what I find out. Still undecided about Michigan next weekend.

I found out I internally rotate my hips which is putting more pressure on my knee. She showed me some exercises and stretches to do and also had ultrasound and E-stim therapy. I will go back Monday but she thought I shouldn't run MI with CA 3 weeks later. So, it looks like it'll be my first DNS marathon. Oh well, I just want to take care of this problem and enjoy some pain free running.
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Post  T Miller on Mon Aug 27, 2012 7:18 pm

@Julie wrote:I have a physical therapy eval tomorrow. I'll let you know what I find out. Still undecided about Michigan next weekend.

I found out I internally rotate my hips which is putting more pressure on my knee. She showed me some exercises and stretches to do and also had ultrasound and E-stim therapy. I will go back Monday but she thought I shouldn't run MI with CA 3 weeks later. So, it looks like it'll be my first DNS marathon. Oh well, I just want to take care of this problem and enjoy some pain free running.

Hey Julie,

I'm really sorry to hear that you're going to have to take a DNS. Hopefully that will enable you to run CA without any pain.

I think Wendy is having the same problem and I would love to know more about the therapy that you're receiving, if you don't care to share.

Best of luck!
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Post  Julie on Mon Aug 27, 2012 10:12 pm

@T Miller wrote:
Hey Julie,

I'm really sorry to hear that you're going to have to take a DNS. Hopefully that will enable you to run CA without any pain.

I think Wendy is having the same problem and I would love to know more about the therapy that you're receiving, if you don't care to share.

Best of luck!

Thanks Tim, I'm sorry Wendy's having similar problems. I have a very tight/poor ROM in my right hip and then my left knee is hyperflexible (don't remember the exact word but when I press it down into the floor it goes too deep). I am doing strengthening exercises for my quads, although I have pretty strong quads that is supposed to still help my knees. I'm also doing hamstring and pyriforimis stretches. Then for the therapy, they have an e-stim machine and I've been having that on my left knee which is the more swollen one and then ultrasound therapy is for both knees, just the little u/s wand she rubs over it for a certain number of minutes which is supposed to help heal. She also used Kinesio taping and taped below both knee caps for support and I think I'm going to buy a roll of tape and start doing it on my own.

I go back Thurs and that will probably be my last PT session since she has taught me some good exercises and she is fine with my not continuing (but I'm sure more would be beneficial too, it's just hard with scheduling and having my husband take time off to watch our daughter, and all of that). I don't know what your state laws are but I just had to have my physician fax an order for the PT and he was fine with doing that just with my calling the office and telling them what the problem was.

I hope Wendy finds something that helps her long-term soon. That was really why I wanted to go, because this is so recurring and if I can get my strength and flexibility improved, I really hope to have some good injury-free running. She doesn't think my meniscus is really torn but just wear and tear from all the running after really not running a few months over the winter/early spring.
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Post  T Miller on Tue Aug 28, 2012 7:32 am

@Julie wrote:
@T Miller wrote:
Hey Julie,

I'm really sorry to hear that you're going to have to take a DNS. Hopefully that will enable you to run CA without any pain.

I think Wendy is having the same problem and I would love to know more about the therapy that you're receiving, if you don't care to share.

Best of luck!

Thanks Tim, I'm sorry Wendy's having similar problems. I have a very tight/poor ROM in my right hip and then my left knee is hyperflexible (don't remember the exact word but when I press it down into the floor it goes too deep). I am doing strengthening exercises for my quads, although I have pretty strong quads that is supposed to still help my knees. I'm also doing hamstring and pyriforimis stretches. Then for the therapy, they have an e-stim machine and I've been having that on my left knee which is the more swollen one and then ultrasound therapy is for both knees, just the little u/s wand she rubs over it for a certain number of minutes which is supposed to help heal. She also used Kinesio taping and taped below both knee caps for support and I think I'm going to buy a roll of tape and start doing it on my own.

I go back Thurs and that will probably be my last PT session since she has taught me some good exercises and she is fine with my not continuing (but I'm sure more would be beneficial too, it's just hard with scheduling and having my husband take time off to watch our daughter, and all of that). I don't know what your state laws are but I just had to have my physician fax an order for the PT and he was fine with doing that just with my calling the office and telling them what the problem was.

I hope Wendy finds something that helps her long-term soon. That was really why I wanted to go, because this is so recurring and if I can get my strength and flexibility improved, I really hope to have some good injury-free running. She doesn't think my meniscus is really torn but just wear and tear from all the running after really not running a few months over the winter/early spring.

Thanks Julie,

Have you had any positive results from the routine your PT prescribed?

I've been surfing around the internet looking for solutions and I've found this book that looks promising. http://anthonymychal.com/kneepain/?hop=rickkaselj

Tim

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Post  Julie on Tue Aug 28, 2012 10:14 am

I looked at the link, I'll have to look at it more later. I do have less pain, actually had a pretty decent 6 mile run this morning. I'm not sure how much is PT and how much is from cutting back on my running. I'm only running every other day right now.
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Post  T Miller on Tue Aug 28, 2012 1:47 pm

@Julie wrote:I looked at the link, I'll have to look at it more later. I do have less pain, actually had a pretty decent 6 mile run this morning. I'm not sure how much is PT and how much is from cutting back on my running. I'm only running every other day right now.

I hope it continues to improve for you.

Wendy has just completed a series of injections, on one side, that is supposed to have a significant impact. We won't know for another 10 to 14 days.
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Post  Julie on Tue Aug 28, 2012 8:55 pm

I hope they help and I hope she can figure out the root cause, too. Has she been running a lot this summer or training for anything?
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