Running killing your knees? Me too. Here’s why and how to fix it

Monday Mug Thoughts #38

Hey Finishers,

Let me just start by saying that it’s good to be back in your inboxes!

If you’re wondering where your favorite email newsletter has been for the past two weeks, I’m here to finally offer you a proper explanation.

Life has had me in a bit of a funk recently. This state of being wasn’t brought on by any one life-altering event, but more the result of a bunch of little crappy things all joining forces to make things a little less fun.

Things at work have really picked up the pace. While I’m grateful for the success of my workplace, it comes with increased expectations, longer workdays, and the placement of other priorities aside like exercise, sleep, and putting out email newsletters 😉

As things continue to get busier at my full-time gig, I’ve really struggled with how to balance my time across all the different commitments I have. Work, My First Finish, a consulting side hustle, being a dog owner, volunteering at church, being a good boyfriend, and being an even better friend are all things that I love doing, but also require my time.

Fueling my anxiety is the fact that I haven’t been able to run much at all.

Now it might seem crazy that I’m complaining about not running. Trust me, it feels crazy to type that sentence out. What I’ve learned about myself over the last few years though is that running is how I escape from anxiety and stress. It has become a staple for who I am as a human being and the glue that holds me together in a trying time. I’m happiest when I’m running. I’m more productive when I’m running. Life just seems to go way better when I’m running.

I’m not me when I’m not running. Whenever I find myself in a season of less running, I think about the Snickers Commercials sponsoring the phrase “You’re not you when you’re hungry.” Remember these?

The reason I’m not running is because of a recent knee injury I’ve sustained. Have you ever heard of the term Runner’s Knee? Well, that’s what I’m dealing with right now, and let me tell it’s frustrating as hell.

I’ve always considered knee pain as something that just comes with running. I’ve experienced discomfort countless times in training but always overcame it by either just taking a few days off, or pushing through it until it just went away. I also rarely stretched, almost never warmed up before a run, and have never utilized tools like massage guns or foam rollers for muscular relief.

Any of this ring a bell? If this is you right now, listen up!

Two weeks ago this all finally caught up to me. I went out for a normal weeknight jog and couldn’t even take a step without feeling discomfort in my knees. Conveniently, there just so happens to be a sports therapy facility 10 steps from my apartment complex. The place is literally in my parking lot so I decided, “Why not give it a shot?”

Within 15 minutes of being there they checked me in, stretched me out on a table, informed me that my knees were trashed, and signed me up for 6 weeks of physical therapy.

Today, I’m about 3 weeks into physical therapy and have learned ALOT about knees. Many of you have reached out sharing similar complaints about knee pain, so for this week of Mug Thoughts, I thought I’d pass along some of this recently acquired knowledge.

So, with all that unnecessary commentary about my life behind us, here is everything I know about knee pain, where it comes from, and how to get rid of it.

First, Knee Anatomy 101

Before we can begin to understand where your knee pain is coming from. We first need to familiarize ourselves with the different parts of the knee, and what it’s SUPPOSED to be doing when it’s injury-free. We’ll start with a picture.

Here are the important parts you need to remember from this graphic:

  • Femur - aka “thigh bone” longest and strongest bone in the human body. Runs from your hip to your knee and provides a “groove” for the kneecap to move in.

  • Tibia - aka “shin bone.” The top of the tibia connects to the knee joint and the bottom connects to the ankle joint.

  • Patella - aka the “kneecap” is a triangular-shaped bone that moves up and down your knee joint where the tibia and femur are connected.

  • Articular Cartilage - For brevity, we are just going to say cartilage, but this smooth substance helps the patella glides across the bone structure when the knee extends.

  • Quadricep - aka “thigh muscle.” It is the large muscle at the front of the thigh, which is divided into four distinct portions and acts to extend the leg.

Did you know that the knee is the largest join in the human body?

Now that you kind of have an idea of what these things are, here is an animation demonstrating how they all interact when the knee extends and abducts.

See how the patella moves up and down in a straight line? Think of it like a train chugging down a track. We’ll come back to this metaphor a little later.

What is Runner’s Knee?

So through this process, I’ve learned that Runner’s knee is more of a broad term to describe knee pain as opposed to one specific injury. From my understanding, there are three main types of Runner’s Knee:

  1. Patellofemoral Pain Syndrome - Pain concentrated right below the kneecap (aka patella) and is a result of abnormal contact and movement patterns of the patella on the femur (thigh bone). Remember the train track analogy I just mentioned? Well, what happens when a train goes off its tracks? Bad things right? The same goes for the knee. When it moves abnormally, it inflames the tendons around your knee causing you to experience pain.

  2. Iliotibial Band Syndrome (IT Bands) - Your IT band is a tendon that runs along the outside of your leg from the hip to the knee and shinbone. It helps to extend, abduct, and rotate your hip. It also helps to stabilize and move the side of your knee while protecting the outer thigh. Here is a picture to help out:

  3. Chondromalacia Patella: Chondromalacia Patella is a softening and breaking down of cartilage in the knee. When this cartilage is broken down, it creates friction when your patella moves, leading to pain.

While these injuries have unique characteristics, it’s highly likely that you might be experiencing varying degrees of each. In my case, my IT bands are incredibly tight and inflamed while my patella is also out of place when it moves. I haven’t received an X-Ray to diagnose the state of my cartilage, but I’m sure that’s pretty messed up too.

What Causes Runner’s Knee?

The better question to ask is what DOESN’T cause runner’s knee? The unfortunate reality for our knees is that they absorb most of the force, or what is called “load,” when our feet slam against the ground. If pretty much any part of your leg is injured or misaligned, your knees are going to feel it. That being said, there is a laundry list of common factors that lead to pain in your knees.

  • Overtraining - If you run 10 miles one week, and try to hit 20 the next, you’re going to be at risk of knee pain. Your knees have to build up a “load tolerance” or comfortability with absorbing the force of impact with the ground. Your body endures 2.5 to 3 times its body weight with every stride and so it’s critical that you take things slowly and work your way up in mileage over time.

  • Lack of Recovery - Adequate recovery time is essential to avoid developing knee pain. How would you feel if you were getting smashed into the ground all the time without any rest? That’s why our training plans always involve 3 weeks of buildup and 1 week of rest each month.

  • Another Injury - An injury to the ankle, hip, or knee can change the knee’s biomechanics, eventually leading to runner’s knee symptoms.

  • Muscular Imbalance - Weak or underdeveloped thigh or hip muscles can cause the knees to take on more of the burden when running. This is where your cross-training comes in handy. Building muscles in your quads, hamstrings, and hips can take some of the load off of your knees and allow you to displace the impact across more of your muscles.

  • Excessive body weight. Being overweight can cause unwanted stress on the knees. If you didn’t catch it above, your knees take on 2.5 to 3 times your bodyweight of force with each running stride. Just walking puts 1.5 times the pressure on your knees.

  • Flexibility: Particularly tight quadriceps (thigh), gastrocnemius (calf), iliotibial band (IT bands), or hamstrings, may predispose to runner’s knee.

How to overcome Runner’s Knee

Now for the good stuff. How do you make the pain go away so you can get back to running?

The unfortunate answer is that it’s not a one size fits all approach. Since your knee pain could be a result of so many different things, the road to recovery is going to look different from person to person.

The first step on that journey though is to STOP RUNNING! As endurance athletes, we are accustomed to overcoming pain in pursuit of our goals. While you might be able to push through your knee pain, you shouldn’t, as your only going to make things worse and shorten the lifespan of your running career. Don’t be a hero, it’s not worth it. This has been really tough advice to follow for me, but the time off I have taken over the last few weeks has really helped.

While it may be a big piece of the puzzle, rest alone isn’t going to heal you. Whether you leverage the help of a physical therapist or choose to go it alone, recovering from knee pain, and preventing future knee pain, takes a good amount of work. Here’s what I’ve learned through my time in physical therapy.

  • Don’t Run - Give your body the time it needs to rest and recover. I know how frustrating it can be to sit on the sidelines, but pushing yourself at this point is just going to do more harm than good.

  • Cross Train Instead - Since I’ve been doing nothing but running for so long, my quads and hamstrings are really muscular, but my glutes (butt) and hips are incredibly weak. Much of my physical therapy has been focused on strengthening these parts of the body to help with some of the muscular imbalance that’s been forcing my knee to move off its train tracks.

  • Stretch - Much of my knee pain is from my hip flexors, hamstrings, and IT bands being really tight. So, every single time I go to physical therapy, I stretch. When I wake up, I have to stretch. Before I go to bed, I have to stretch. The more flexible these muscles are the better the less pressure is put on the knees when I move around so stretching is an incredibly important part of both the recovery and prevention process.

As part of Mug Thoughts next week I’ll send over a full list of stretches and workouts I’ve been doing in physical therapy. Stay tuned!

  • Wear a brace - A brace like the one pictured below will help hold your knee in place and train your patella to track correctly when you walk.

  • RICE - Remember this old acronym? Rest, Ice, Compression, and Elevation This process can help reduce any inflammation and ease the pain you’re experiencing.

  • Consider Physical Therapy - If you want to fast-track your recovery process, I would highly advise considering physical therapy. As much as I hate to fork out the money for it, PT has taught me so much about how to properly take care of my knees as a runner. They massage my legs every time I go, teach me new workouts to strengthen my hips, and have even shown me healing methods like dry needling and cupping (more on these later). The most helpful thing though is that they keep you accountable to doing the work required to get you better. I am very grateful for the help I’ve received so far and look forward to continuing the process with my therapists on my way to a full recovery.

To be continued…

We’ve got the fundamentals of knee pain down, but I really want to make sure you all are fully equipped with everything you need to solve this problem should you ever face it (don’t worry, you will). Next week, I’ll include a full list of ALL the workouts I’ve learned during my time in PT with video demonstrations on how to do each and every one. I’ll also include a brief description of what the focus is for that stretch / exercise and how to make sure you’re doing it correctly.

In the meantime, I want you all to know how much I’ve appreciated the love and encouragement you’ve shown to me as I’m undergoing this healing process. I very much look forward to being done and getting back out there with you all. Until then, feel free to reach out with any questions/concerns you might have about knee pain and check out the Mug Thoughts next week!

Cheers,

Zack


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