Knee pain

[Dr Emily Splichal]

I guess Nick's reference gives me license to hijack this a bit towards my knee problem. I didn't come here earlier because the last time I posted a question, about tofp, no one replied, but I think this was before Dr. Splichal joined up.

Exactly a month ago I was less than a mile into a run when, on a step like any other, I felt an acute pain in my left knee. I turned around and walked 100-200 yards then ran slowly back to the car, but the next day I could barely walk. I was limping heavily. I was lucky enough to get in to see a sports medicine doc the next day and he said my knees looked great in the x-ray--no sign of degeneration or anything--so he concluded it was nothing serious. And sure enough, the injury has healed pretty quickly and today I just ran 4.4 miles, no problem. I began running two weeks ago after giving the injury two weeks of complete rest.

Here are two photos:
View attachment 1072View attachment 1073

I drew a dark circle where the pain is/was located, on the lower inside of my left knee. A BRS member has said this looks like a MCL issue. The doc I saw wouldn't venture any specific diagnosis. If anyone has any other ideas, I'd appreciate hearing them.

So my main concern is to prevent this from happening again, hence my 'constant questioning,' as Nick puts it . One thing I noticed on today's run is that my left foot sometimes makes a little more noise than the right, but as soon as I notice it I can correct it and make the foot land as quietly as the right foot. So there might be a form issue involved, although I'm pretty sure overall my form is decent. I was purposely running a bit slower than normal when I tweaked my knee, and I know my form tends to degrade a bit at slower paces, so I wonder if I landed with the knee less bent than normal.

Besides working a bit more on form and perhaps upping my cadence slightly, to make sure the knee is nicely bent at landing, is there anything else I could be doing? I'm going to be working in more leg stuff into my strength training routine to build up the leg a bit, although I already have relatively strong legs. I'm also going to start doing bounding, skipping, and stairs once a week once my knee feels 100%, to increase overall range of motion, strength, and mobility.

Hi Bare Lee

So looking at the images it does look like it is along the collateral (MCL) ligaments of your knee. Not knowing exactly what movement caused the initial irritation to the soft tissue, I would focus on overall strengthening of your knee, hip and foot mechanics.

Since proprioceptors control the fine movements of all our joints, barefoot training (not just running) is important. You want to train your body how to land and decelerate landing technique. I always recommend walking backward on treadmill, single leg barefoot exercises, jumping rope, step downs and eventually plyometrics barefoot.

I also recommend myofascial release (foam rolling) as the superficial fascia plays a role in proprioception (i.e. joint stability and position awareness).

I hope that this helps. If you experience the TOFP again - please let me know and I will do my best to help you out!

 

[Bare Lee]

Hi Bare Lee

So looking at the images it does look like it is along the collateral (MCL) ligaments of your knee. Not knowing exactly what movement caused the initial irritation to the soft tissue, I would focus on overall strengthening of your knee, hip and foot mechanics.

Since proprioceptors control the fine movements of all our joints, barefoot training (not just running) is important. You want to train your body how to land and decelerate landing technique. I always recommend walking backward on treadmill, single leg barefoot exercises, jumping rope, step downs and eventually plyometrics barefoot.

I also recommend myofascial release (foam rolling) as the superficial fascia plays a role in proprioception (i.e. joint stability and position awareness).

I hope that this helps. If you experience the TOFP again - please let me know and I will do my best to help you out!

Thanks for taking the time to reply! It's nice to have you confirm the MCL diagnosis, one or our fellow BFRers offered the same opinion. Now I have much greater confidence in treating the injury and in taking precautions to prevent it from happening again. It was hard not knowing.

Just a few follow-up questions:

1.) I was wondering if you could be a little more specific about which single leg barefoot exercises and plyometrics you'd recommend.

2.) Also, I don't understand what 'step-downs' means.

3.) I've recently taken up running backwards a bit and doing high skipping. Does that seem like a good idea?

4.) This last week I experienced a little ITBS after running 9.4 miles. This was probably just a case of TMTS after rehabbing the MCL injury, but since that injury is now 95% healed, I'd like to start doing more squats and lunges to help prevent the ITBS from recurring. Does that seem like a good idea to you?

5.) Are there any specific foam rolling movements you'd recommend? I have both a firm, smooth foam roller, a Rumble Roller, and the marathon and sprinter stick.

Thanks again, Bare Lee

 

[Dr Emily Splichal]

Sure Bare Lee -

To answer your questions -

1. As far as barefoot single leg exercises - this is the basis for most (if not all) of my patient rehab programs. I integrated them into a workout which can be found on: http://vcore.myapogee.com/

2. Step-downs means simply stepping off of a step - so just like step ups but the reverse But you want to focus on how you are landing! From foot, knee to hip you should be controlling the stepping down.

3. Yes backward walking & running = good!

4. To prevent ITBS I'd focus more on the TFL. This is a very strong hip flexor and knee stabilizer so tightness is v. common in runners. Foam rolling / trigger point release is great for ITBS - but focus more on the TFL and vastus lateralis (lateral quad) instead of directly on the ITB. Also integrate VMO (vastus medialis) / medial quad strengthening - as this counters the lateral pull on the knee cap. Some great exercises are squats and leg presses with a ball squeezed between the knees.

5. For foam rolling I really like Trigger Point Performance products. www.tptherapy.com Check out their Grid. And you can use "DrEmily" as discount code (15%) off.

Good luck!

 

[Bare Lee]

Sure Bare Lee -

To answer your questions -

1. As far as barefoot single leg exercises - this is the basis for most (if not all) of my patient rehab programs. I integrated them into a workout which can be found on: http://vcore.myapogee.com/

2. Step-downs means simply stepping off of a step - so just like step ups but the reverse But you want to focus on how you are landing! From foot, knee to hip you should be controlling the stepping down.

3. Yes backward walking & running = good!

4. To prevent ITBS I'd focus more on the TFL. This is a very strong hip flexor and knee stabilizer so tightness is v. common in runners. Foam rolling / trigger point release is great for ITBS - but focus more on the TFL and vastus lateralis (lateral quad) instead of directly on the ITB. Also integrate VMO (vastus medialis) / medial quad strengthening - as this counters the lateral pull on the knee cap. Some great exercises are squats and leg presses with a ball squeezed between the knees.

5. For foam rolling I really like Trigger Point Performance products. www.tptherapy.com Check out their Grid. And you can use "DrEmily" as discount code (15%) off.

Good luck!

Thanks for the detailed and timely reply Emily! That was most helpful.