It's been a stressful few weeks since my knee pain began. I still can't run half a mile without horrible pain and the Hawaii marathon is less than two months away. What's worse: the marathon registration fee is non-refundable, my plain ticket is non-refundable and my Airbnb lodging reservation is only 50% refundable. I stand to loose a lot of money if I don't make this trip happen. Although a trip to
Hawaii always sounds nice, everything was planned around this marathon. The thought of going without being able to run is a bit agonizing.
Part of me wants to play it safe, throw in the towel and just look for a future marathon without any more worry. On the other hand, there's still time and I have nothing to lose by sticking with it... other than my sanity and more severe injuries, right? Here's the clincher: I don't think the worst case scenario is not running the marathon; I think the worst case scenario is giving up and wondering if I could have run the marathon.
So that's where I stand. I want to run and I'm not giving up yet. I've got a plan, but first let me lay out the scenario...
Here are all the (not so) gory details of the injury:
- I feel pain in my lower outer knee, right leg only.
- I can run a short distance, about half a mile now (up from .03 miles two weeks ago) before the pain starts.
- It begins as a numbing sensation that quickly escalates into a consistent sharp pain, like running with a knife jabbed just below my kneecap.
- The pain disappears completely when I stop running, if I don't run through it for too long. I don't feel it at all when I walk, bicycle, use an elliptical or even run in place. As soon as start running forward, however, it begins to flare up. If I run through the pain long enough, as I did initially, then it persists after I stop and I can feel it when I lift/bend my leg or walk up and down stairs.
Here's the diagnosis, thus far:I was originally convinced it was either runner's knee (PFPS) or IT band syndrome (ITBS). I originally ruled out ITBS because I thought that only caused pain on the upper outer knee, whereas mine was lower. This made me lean heavily toward PFPS, until I read some posts about ITBS from people who actually did feel it in their lower outer knee.
My miracle-working doc examined me yesterday and didn't think it was either of those issues. On the contrary, he said the pain seemed to focus on the joint where my lower leg bones, the tibia and fibula, meet just below my knee (proximal tibiofibular joint). For some reason, they may be grinding together harder than they should as I land. After doing some muscle-testing, he was surprised how tight my calf muscles were—especially the soleus. He told me this is a difficult muscle to stretch since it is so deep, buried under other muscles, and could be the cause of the pain. He believed this fit in with where and how I felt pain, especially since the pain wasn't consistent and stopped completely when I was on an elliptical.
The good news is that inflammation doesn't seem to be an issue since the pain comes and goes. If it was inflamed I would feel it constantly, like I did when I ran through it for 7 miles a couple weeks ago, and inflammation could mean no working out. Also good news: it doesn't appear to be a sprain or any torn ligaments, either. If it were, I would have to give up hope right now.
So what does that leave me with? Well, this is a high priority for me so I'm eager to do anything and everything that may help. Even if it seems far-fetched, as long as it doesn't make anything worse then I'll give it a try.
The Plan:This is how I intend to overcome my knee pain and continue training to run a marathon on January 19.
1. Elliptical, Elliptical, Elliptical!
As I said in my last post, the elliptical machine is my new best friend. Thank god I was conned into getting that cheap gym membership offer that I haven't used in over a year. It's valid till April 2014 and I'm definitely getting my money's worth now. I know the elliptical isn't a perfect substitute for the motions of running—if it was then it would cause pain in my knee—but it's the closest I'm going to get. I'm following my training plan and doing the same mileage at the same pace on the elliptical as I would on the road, and I can do it 100% pain free. The elliptical is allowing me to keep my fitness level up while continuing to strengthen leg muscles and improve my cardio. I still take energy gels, snacks and water like I would at an aid station, too. It's not so pleasant "running" inside as opposed to the beautiful Oregon scenery on my regular route, but it is a lot warmer. I'm actually more comfortable running in the cold air as my body heats up, but I realize this is closer to the warm temps I'll be (hopefully) feeling in Hawaii. I also continue to incorporate cycling cross-training, which I can also do without any pain whatsoever. Every now and then I try stepping on the treadmill to see if there's any improvement, but I stop the moment I feel the first twinge of pain. Sadly, it doesn't take long.
previous post, they're my favorite torture tools for massaging knots and loosening tight muscles. If my chiropractor is right then those knots in my calves could be the source of my pain, but I'm doing work over the whole leg as well. This includes a long daily routine on the roller going over my quads, hamstrings, glutes, IT band in addition to all the tight spots in my lower leg. Since the upper soleus is very difficult to stretch I'm also just digging in with my hands throughout the day, although the lacrosse ball seems to work well, too.
3. Stretch Like Gumby
Much like massage, regular stretching is also part of my routine to help loosen those muscles. Stretching is a little more delicate, though, since it can also lead to injury and make everything worse. There are a lot of theories on the proper way to stretch and I've long planned to write a post about them. For the time being, here's my normal practice: dynamic stretching, after a brief cardio warmup, often right before a workout. Then PNF or static stretching right after the workout (I was doing AIS stretching but I'm preferring PNF now... more on that in a future post).
Stretching is easy, right? View post on imgur.com
4. StrengtheningI'm trying not to take on too much because the last thing I want to do is overtrain my leg muscles while I'm trying to recover from injury, but I have begun some basic strengthening exercises for my quads, hamstrings, glutes, hips and IT band. I've learned these muscles play an important role in overall knee health. Even though it now looks like they may not be the culprit in my injury I still don't want to rule them out. I'm not doing strengthening exercises every day, but a few days a week—often right after a workout when all my muscles are warm and loosey goosey. If it's not a workout day then I still go through the dynamic stretching warmup routine first.
5. KT (Kinesiology) Tape
People swear by this colorful elastic tape. I picked up a roll at a local sporting goods store and have tried a couple different patterns on my knee. I can't say I've noticed any difference, and I really don't understand how having tape on your skin is going to affect muscles and circulation, but it seems to work for some people. This falls into the category of "it's not hurting anything, so why not?" As a related option, I've tried patellar and IT band leg straps with no noticeable effect.
My latest pattern, based on suggestions online. They converge on the pain.
Pretty standard: chill regularly.
Like the tape, if popping a few pills each day may help without any negative side effects, then why not? The difference, of course, is that supplements have much more evidence supporting them. I've already been taking a few, mostly to boost my immune system to ward off illness, but now I've added more. Unfortunately, I think the effects of supplements are more long-term and probably won't be seen in the immediate future. Still, they won't hurt. This is what I'm on and why:
- Fish Oil: Anti-inflammatory (I know I said inflammation doesn't seem to be a concern, but I still think it's a good cautionary measure)
- Turmeric: Anti-inflammatory
- Magnesium: Muscle Relaxer
- Acidophilus: Because if your gut is healthy, your body is healthy
- Apple Cider Vinegar: Ditto
- Zinc: Immune Booster
- Vitamin C: Immune Booster
- Vitamin D: Because Oregon winters are really dark, and there seem to be more health benefits from D than I can mention.
This hasn't changed much since I was already a conscientious eater, but I'm getting more strict about it. I'm not counting calories, but I do try to follow a couple guidelines. They're very simple: avoid sugar, dairy, gluten and trans fats. Eat lots of colorful vegetables. 'Nuff said.
I've gone through phases of practicing meditation for mental/emotional health, but since relaxing muscles could solve my problem then I hope to reap physical benefits from it as well. I try to do a mindfulness meditation for at least 15 minutes before bed. It seems to help me sleep better, too, which brings me to the last point...
These can be the most challenging. I want to stay up late every night massaging, stretching and strengthening my knee, but I know that rest days are important. It really tests my patience, because I see how close the marathon is coming and the thought of sitting around thinking there must be something more I can do to fix my injury is excruciatingly painful. Still, I know that much of the work I'm doing wears down my muscles and they need time to rest to grow stronger and healthier. And yes, my body and brain need sleep, too.
So there you have it. If I'm not at work then these are the things that are absorbing my life right now. The days are going by fast and I keep telling myself to stay positive. It's a challenge, but if it gets me running in Hawaii then it will all be worth it.
And if you have any more tips then please feel free to share!
Photo Credits: Copyright 123RF Stock Photo