Member Case Study: Knee Pain

author : AMSSM

comments : 0

Last weekend I did my first 1/2 marathon. At about mile six I felt a slight pain in my left knee. By mile eight it really hurt and I hobbled to the end. What can I do to fix this?

Member Questions from GaryRM

"Last weekend I did my first 1/2 marathon.  At about mile six I felt a slight pain in my left knee (left outside and back side).  By mile eight it really hurt and I hobbled to the end.  That day I iced it, barely able to bend it but it would start loosening up the more I used it.  The next day I started off with the knee being stiff but it cleared somewhat with usage.  I am now left with a slight pain on the outside left and I only really feel it when I take a bad step.  I am planning a couple of weeks off but wondering what happened?  What can I do to prevent this?"

Answer by Chris Koutures, MD, FAAP
Member AMSSM

Bummer about the knee pain- probably not the souvenir you were wanting after your first ½ marathon!

The most likely cause of your knee pain is iliotibial band syndrome, an irritation of the large muscle and fibrous band that starts at the iliac crest (where you put your hands on your hips) and travels down to attach just below the outside of the knee.  It can be inflamed by an increase in intensity or volume of running, excessive hill running, or the camber of the road.  Discomfort occurs in the tendon that attaches the band to the shin bone or from irritation of the bursa (fluid filled sac) that reduces friction between the tendon and the bone. Stretching of the iliotibial band along with ice massage can be helpful. Weakness in the buttock/gluteal muscles and an unbalanced pelvis can predispose one to iliotibial band issues and should be addressed to allow for a more successful return to running.

Another potential cause of lateral knee pain is a tear of the lateral meniscus (shock absorbing pad on the outside of the knee between the thigh and shin bones).  Degenerative tears are common over the age of 35-40.  The pain can spontaneously occur with running or also come on slowly over time.  People who have a meniscal tear often have a sensation of the knee catching or locking especially with bending the knee.  Some tears, particularly those in younger athletes, will scar down and heal themselves with time and rest.  However, other can require surgical intervention (repair or removal of the torn tissue).

To make a more accurate diagnosis and to develop the best rehabilitation program for you, I would recommend you schedule an appointment with a sports medicine physician.

In order to prevent future knee pain with running, you should increase your training by

Good luck, Gary!
Chris Koutures, MD, FAAP
Pediatrics and Sports Medicine, Anaheim Hills, CA
Team Physician: USA Volleyball and Cal State Fullerton
www.koutures.com

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date: January 9, 2010