Member Case Study: Knee Pain from Marathon Training

author : AMSSM

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The long runs, before your training was up to speed, likely started-up some overuse injury. Inflammation occurred in the front part of your knee where the extensor mechanism of your knee functions.

Member Question
I've got a knee issue. It started aching while under-training for a marathon in October....I didn't put in the mileage during the week, but still did the long runs on the weekends. Net result...on the first run of over 20 miles (pre-mary), it was starting to hurt. Two weeks later, at the first marathon, I ended up DNF'ing at 18 (not due to my pain, but the pain was significant). And two weeks after that, I completed the Marine Corps Marathon with a moderate amount of pain.

The pain itself manifests itself right under the front edge of the kneecap on my left knee, slightly on the inside (maybe 1/2 inch off the center of the kneecap). The pain is nonexistent while sitting still, knee bent. Extending my leg in front of me, the pain increases as my leg approaches full extension, and can be felt with any tension on the knee joint from an extension-type motion.

Here's what I've done since: lunges (don't seem to hurt it), leg extensions (very low weight, don't seem to hurt it), going downstairs (hurts a lot), walking (sort of OK), and swimming (can feel it a little if I kick hard). I've not run or biked as I'm trying to stay off it until Thanksgiving.

Any clues as to what this might be?

Answer

It sounds like the pain in your anterior and medial knee may be due to irritation on the cartilage behind the patella (kneecap) or possibly from a tender medial plica (see below as to a definition for a plica.) The long runs, before your training was up to speed, likely started-up some overuse injury. Inflammation occurred in the front part of your knee where the extensor mechanism of your knee functions (that part that moves your leg from bent knee to straight leg).

Physicians will sometimes refer to the patella cartilage getting worn or inflamed as chondromalacia. Another term used for this irritation, when it occurs with the quadriceps and patella tendons becoming overworked or inflamed, is patellofemoral pain syndrome (PFPS).

A plica is a redundant fold in the tissue that helps hold our knees together. This band of tissue can be felt with your finger on the medial (inside) side of your patella (best felt with your knee extended and relaxed). You will feel your finger clicking over a soft, linear object. It can get irritated and inflamed from trauma or overuse (sometimes referred to as plica syndrome) and this condition can also be included under the PFPS term described above. Once these areas are inflamed, there is pain with stress on the knee (e.g., stairs) or when moving knee from bent state into extension against resistance.

The typical treatment for these conditions is rest from activities that aggravate the symptoms, anti-inflammatory medication, and icing (~20 minutes a few times daily). Physical therapy can be beneficial as well. Orthotics/arch supports can help correct some arch and alignment problems that can lead to these conditions. Local injections can be done in more severe cases that don't respond to the above remedies.

Hopefully, this helps give you more information that can get you back out there training again soon.

Douglas McDonald, M.D.
Team Physician, University of Florida
Member AMSSM

 

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date: January 16, 2007