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Old 10-07-2012, 08:03 AM   #1
Terapin
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Advice needed re: injury right before race

Hi guys-

I have been totally dedicated to training - my first half marathon is in 7 days. I have been following the RUnning Room Half Marathon plan with a running group and instructor.

About 3 weeks ago I started to feel pain in my left knee during runs. It would be a bit sore afterwards the next day - nothing much, I didn't even journal it. I have been seen by a sports med MD and dx'd with FP syndrome and mild arthritis of the knees (yay being 40!).

I ran a 10k on Sept 22 and it was a bit worse afterwards with swelling this time and more pain, but still mild. The course was hilly, which is worse for my knees. The next day I was scheduled to run 18k but turned back early and turned it into 13k. I wasn't able to run the last few km at all - I could just tell that it wasn't doing my knee any good so I walked it out at a good pace.

I rested all week and on September 28 did both the Halloween 5k and the ToT 10 miler. I felt pretty good going into it - my knee felt 95% better. My knee actually didn't feel too bad until I was done, and then there was swelling and stiffness and aching. I was aware of my knee during the race, but it was minor discomfort.

This week I was scheduled to ramp down my mileage in prep for my Half on OCtober 14. I missed a 6k run on Tuesday due to a bad head cold, but ran a crappy 6k on Wednesday as scheduled (I was still all head cold-y, my knee hurt, so my pace was slower, I took an extra small walk break up a hill). Friday I was supposed to do 8k but my knee acutely HURT while running. Mostly on the inside of my knee beside the knee cap. I managed just 2k then converted it to a bike ride and rode 8k. After the bike ride I felt better and my knee wasn't sore anymore, but it still felt crappy.

I was supposed to do 6 yesterday, and 6 today. I have 10k, 6k, and 3k still scheduled before the race.

I have another appointment on Wednesday to see the sports med guy.

I have been icing it, resting it, elevating it, taping it before running (both McConnell and the KT instructions for FP), and taking naproxen. I have also been rolling the whole leg (and wow that helps with the stiffness).

I am a heavy runner - just over 200 pounds but I started running at 270 last summer so I am getting lighter.

Over the summer I gradually worked up my mileage to the 35-40k/week range just before this happened, so I have a good base.

My plan is to participate in the WDW weekend by running the half and walk/running the full in a *gentle* way but within pacing requirements.

My questions are these:
1) The resting that I have been forced to do, will it kill my half marathon performance next week? Not running is *NOT* an option. I have fundraised almost $1000 for the charity supporting the disease my son has.

2) Can I still get back into the game for January if I am able to get back up to distances by the end of the month?

I don't think I have done a major injury. I think it is minor but causing inflammation. Perhaps a small meniscus tear? With 5 days rest it felt almost normal, and I was able to run 21k that day, plus I walked around the parks that day, and it wasn't until afterwards that I felt discomfort. I have no instability of the knee, nor was there an acute injury.

What would be your recommendations for me? Please be kind - I have worked really hard for this, and am feeling so disappointed that I am working with this injury. I have been 100% dedicated to my training schedule and put so much effort into this. I have only missed 2 runs in the whole year!! I want to recover smart but recover so I can keep running! I feel like I have lost my best friend!

Thanks for the advice.
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Old 10-07-2012, 08:17 AM   #2
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Here is a link to my journal if anyone is interested:

http://www.disboards.com/showthread.php?t=2761938

My plan for this weekend is to do some core and weights today, and to get a bike ride in for about 45 minutes. Tomorrow we are going on a family hike of about 5-6k. I don't feel like I have to stay off the knee entirely, but not run on it (wah!)
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Old 10-07-2012, 11:49 AM   #3
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I am by no means an expert but if it were me I would rest this week as much as possible to be able to do your race on Sunday. And take more walk breaks during your race. Since this race is for a personal cause you really do need to be able to complete it and if it is more walking than running so be it.

I went to a talk given by Jeff Galloway yesterday and his big emphasis is to remain injury free take walk breaks early so you can finish strong.

Someone also asked him about the Goofy and he said to walk the half and walk/run the full with liberal walk breaks.

Good luck on Sunday and stay injury free.
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Old 10-07-2012, 12:59 PM   #4
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Thanks for the response. I appreciate the input.
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Old 10-07-2012, 02:01 PM   #5
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Head out and run the race. You will not do anything permanent based on the diagnosis - more commonly called Runners Knee. Do get a script for some PT. You really need support in learning how to stretch the IT and outer leg while strengthening the inner quad and hammies.

If the doc suggested an NSAID feel free to take them up to the last few days pre-race. Do not take them during the race... up to the first race will help the inflammation more manageable.
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Old 10-07-2012, 02:45 PM   #6
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Thanks for the response. My main questions are around if the two weeks of not running much will affect my half performance much, and around getting back into training for January.

What should my week look like this week? Knee is still a little swollen, unable to bend knee all the way (for instance, cannot tailor sit), and some pain.

I was given naproxen (Aleve) and take it. It's strange though, the swelling seems worse with it, than without (I know, it is rx'd for swelling and inflammation). I also did some PT for the knee, but she had me working on strengthening my glutes and working on range on motion in my ankles. I fell off the PT wagon though.

Thanks for the responses.
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Old 10-07-2012, 07:28 PM   #7
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2 weeks off should not affect performance more than a few seconds per mile. What will more than likely occur on race day is a reoccurrence of the negative feelings in the knee. That by its nature will force a slowing in pace. The other issue that can occur here is a secondary, often acute injury to the strong side due to a compensation effect of from the currently injured knee.

Thinking a little more here... see if you can also get a script for a J sleeve. It is simply a 'j' shaped pad supported under the patella by a neoprene sleeve. Once fitted, the "j" is tightened via a couple straps to gently pulling the patella inward.
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Old 10-07-2012, 08:19 PM   #8
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Quote:
Originally Posted by cewait View Post
2 weeks off should not affect performance more than a few seconds per mile. What will more than likely occur on race day is a reoccurrence of the negative feelings in the knee. That by its nature will force a slowing in pace. The other issue that can occur here is a secondary, often acute injury to the strong side due to a compensation effect of from the currently injured knee.

Thinking a little more here... see if you can also get a script for a J sleeve. It is simply a 'j' shaped pad supported under the patella by a neoprene sleeve. Once fitted, the "j" is tightened via a couple straps to gently pulling the patella inward.
Thanks! I will ask about that sleeve. The pain is getting better with rest but not the swelling. Icing and naproxen.
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Old 10-09-2012, 05:35 PM   #9
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Just a follow-up:

Busy day! I bumped up my appointment with the sports med MD and she confirmed, through a thorough exam, that it was just bad Patellar-Femoral Syndrome causing my pain. She recommended staying on the anti-inflammatories, consider more PT, and to consider a brace.

I was able to see a brace fitter at another location and tried on a few braces. I settled on a new kind of brace that uses a spider web design. Feels very supportive, but will not be too high-profile. Here is a link to what was Rx'd:
https://www.djoglobal.com/products/d...ion-knee-brace

Then, I saw a sports chiropractor who did lots of ART and man that hurt. My range of motion was immediately improved, and the pain was reduced back to uncomfortable but not damaged feeling. I also got acupuncture. My swelling was so reduced after these treatments. I have a follow-up on Friday in prep for Sunday.

Tomorrow my Learn to Run group that I am pacing is meeting I am planning on going out for their short run with them (2:1s, for 30 minutes, slow pace) and try out the brace.

I also bought new shoes: my same Saucony Guide 5s, just new ones as my old ones have about 300k and it can't hurt to replace them. I will wear them around this week and they should be fine for the weekend as I am wearing the same model now.

Going to start back on strengthening my quads and glutes as recommended.

Glad to be told that it is just PF. Unhappy that I may need to manage this always. Oh well, so much better than an acute injury!

Thanks for the support. I miss running - hope that Sunday feels ok!
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Old 10-09-2012, 06:18 PM   #10
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Quote:
Originally Posted by Terapin View Post
Just a follow-up:

Busy day! I bumped up my appointment with the sports med MD and she confirmed, through a thorough exam, that it was just bad Patellar-Femoral Syndrome causing my pain. She recommended staying on the anti-inflammatories, consider more PT, and to consider a brace.

I was able to see a brace fitter at another location and tried on a few braces. I settled on a new kind of brace that uses a spider web design. Feels very supportive, but will not be too high-profile. Here is a link to what was Rx'd:
https://www.djoglobal.com/products/d...ion-knee-brace

Then, I saw a sports chiropractor who did lots of ART and man that hurt. My range of motion was immediately improved, and the pain was reduced back to uncomfortable but not damaged feeling. I also got acupuncture. My swelling was so reduced after these treatments. I have a follow-up on Friday in prep for Sunday.

Tomorrow my Learn to Run group that I am pacing is meeting I am planning on going out for their short run with them (2:1s, for 30 minutes, slow pace) and try out the brace.

I also bought new shoes: my same Saucony Guide 5s, just new ones as my old ones have about 300k and it can't hurt to replace them. I will wear them around this week and they should be fine for the weekend as I am wearing the same model now.

Going to start back on strengthening my quads and glutes as recommended.

Glad to be told that it is just PF. Unhappy that I may need to manage this always. Oh well, so much better than an acute injury!

Thanks for the support. I miss running - hope that Sunday feels ok!
Actually, once you get past this through strengthening the VMO and loosening the IT area muscle, you will not need to worry. It becomes part of a strength training and stretching program.

Also, look at chi running or midfoot landing for a change up of gait. You will naturally move this direction as you strengthen the weaker muscle, but it is good to see where you are looking to go.

Oh, the brace is really cool. Remember, it is a crutch and a reminder to work on your legs. In 3-6 months (on the outside) you will no longer need it.
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Old 10-09-2012, 06:44 PM   #11
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Quote:
Originally Posted by cewait View Post
Actually, once you get past this through strengthening the VMO and loosening the IT area muscle, you will not need to worry. It becomes part of a strength training and stretching program.

Also, look at chi running or midfoot landing for a change up of gait. You will naturally move this direction as you strengthen the weaker muscle, but it is good to see where you are looking to go.

Oh, the brace is really cool. Remember, it is a crutch and a reminder to work on your legs. In 3-6 months (on the outside) you will no longer need it.
Thanks for the reply. I started today on VMO dips, and will also do side-lying leg lifts and pelvic lift-ups for the glutes. Any other exercises you would recommend?

I am a pretty good mid-foot lander, although there is room for improvement and I am conscious of trying to land mid-foot. Will look into the chi running again, but have applied the principles in the past. I have also had my gair analyzed by a running chiro and plan on making an appointment for more in-depth work. He said that from the side I have good running form, but from the back need to be a bit more efficient with how far up my heel goes (i.e. it looks a bit too high right now), and to work on strengthening my feet to help with a little over-pronation.

The brace feels good on! The 'web' is kinda sticky and somewhat stretchy, and is pretty adjustable.

I'd like to strengthen things so that I can shed it - that is my goal.

Thanks again for the expert advice. I appreciate it. Hope to see you in January to say thanks in person!
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Old 10-10-2012, 09:14 AM   #12
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Originally Posted by Terapin View Post
Thanks for the reply. I started today on VMO dips, and will also do side-lying leg lifts and pelvic lift-ups for the glutes. Any other exercises you would recommend?

I am a pretty good mid-foot lander, although there is room for improvement and I am conscious of trying to land mid-foot. Will look into the chi running again, but have applied the principles in the past. I have also had my gair analyzed by a running chiro and plan on making an appointment for more in-depth work. He said that from the side I have good running form, but from the back need to be a bit more efficient with how far up my heel goes (i.e. it looks a bit too high right now), and to work on strengthening my feet to help with a little over-pronation.

The brace feels good on! The 'web' is kinda sticky and somewhat stretchy, and is pretty adjustable.

I'd like to strengthen things so that I can shed it - that is my goal.

Thanks again for the expert advice. I appreciate it. Hope to see you in January to say thanks in person!
You are on the right track. Keep it simple for 3-4 weeks with what you are doing. It would then look to back lunges then front to back lunges. Squats are also a staple exercise. Form is critical for both squats and lunges. Toes must be in front of the knee on the lunge with great posture. For the squat, you want to push through the heal, not the toes. If you toe out as you perform a squat, you will isolate the VMO just a bit.

A little more advanced and not so weight intensive, try performing dips on a bosu ball (half stability ball). Start with the flat side down and take 2-4 weeks to master the motion. It will add significant work to the core as well as the little stabilizer muscle. Once that is mastered, flip the Bosu and start over. Start with a squat when the ball side is down, then work our way to dips... then weighted dips (a dumbbell in your hands). These latter workouts will work the VMO, Glutes and all the small stabilizer muscles. It looks hard and is hard if you do not engage the core and focus your site on a point about 5-10meters out. But once you master them, they are relatively easy. The great thing is that you are not working the main muscle so hard that it affects the run but you are creating bulletproof legs. Once a runner practices stability work regularly and has a good stretching program in place, injuries are few and far between.
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Old 10-10-2012, 07:26 PM   #13
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Thanks again so much.

I have a bosu ball, so I can use it to do these exercises. Thanks for the suggestions.

Started at hot yoga today and really found it useful to add to my training. Have unlimited access for a month so going to use that, along with the exercises we have discussed, to see if I can really build my legs up.

I went for a run today: very, very gentle, and only 2.5k with the Learn to Run group I help with and it went ok. I wore the brace. I had pretty good pain for the first few minutes in one of the muscles or attachment points on the inside front of my knee, but once I got going it dulled down and I finished the run just uncomfortable, but not in pain. Now that I am done that pain is back, but the rest of the knee is just a 1/10. It feels like a tiny little muscle or ligament attachment point that is the pain.

Going back to sports chiro on Friday, and this is all I can do.

Planning on a short 3k or so run on Friday or Saturday, and hopefully another session of yoga after tomorrow before the big day.

I've really had to dial down my timing expectations for the race. I would love to finish in 2:30:00 but between 2:45:00-3:00:00 is likely more realistic.

Good lessons in all of this.
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Old 10-11-2012, 06:54 PM   #14
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Argh. Saw another sports chiro today who feels I have damaged the meniscus. He doesn't feel that I have damaged it too badly, but acknowledged that he couldn't be sure. He recommended that I not run/walk this weekend, but understood why I would want to. He is a runner, too.

He did some ART, acupuncture, some massage and some laser machine treatment, and I am going back on Saturday. Our plan is to throw everything we can at it and hope that I can be comfortable enough for Sunday with a plan to take it easy. Then we are going to do a couple weeks of conservative treatment, and if it isn't responding then I will get a MRI.

I guess all along I felt that PF didn't explain it as I have been working with the PF for awhile now and it felt different. Also, never had swelling before.

Came home and took Tylenol and Ibuprofen, and elevated and iced it. Now feeling pretty good. Will ice more before bed and really rest it until Sunday.

Majorly bummed out that my year of training has ended like this. I can't really even think about it, it is too disappointing.

Going to throw myself into healing it, seeing as I can't run. :-(
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Old 10-11-2012, 07:00 PM   #15
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Quote:
Originally Posted by Terapin View Post
Argh. Saw another sports chiro today who feels I have damaged the meniscus. He doesn't feel that I have damaged it too badly, but acknowledged that he couldn't be sure. He recommended that I not run/walk this weekend, but understood why I would want to. He is a runner, too.

He did some ART, acupuncture, some massage and some laser machine treatment, and I am going back on Saturday. Our plan is to throw everything we can at it and hope that I can be comfortable enough for Sunday with a plan to take it easy. Then we are going to do a couple weeks of conservative treatment, and if it isn't responding then I will get a MRI.

I guess all along I felt that PF didn't explain it as I have been working with the PF for awhile now and it felt different. Also, never had swelling before.

Came home and took Tylenol and Ibuprofen, and elevated and iced it. Now feeling pretty good. Will ice more before bed and really rest it until Sunday.

Majorly bummed out that my year of training has ended like this. I can't really even think about it, it is too disappointing.

Going to throw myself into healing it, seeing as I can't run. :-(
i will not give advice that goes against a doctor who has seen you nor suggest that you ignore him. On the other hand, give your knee a little time and it may surprise you. There are several hundred runners in every marathon with issues that should really keep them out of the race. Hopefully you will get past the injury quickly; albeit, maybe not this race. Heal hard and keep after the treatments and the doc. It is always disappointing to come up injured so late in the process.

ADDED- Odd, the advertising crawler at the bottom of the page hit DonJoy after I hit send.
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