Sports Medicine/Knee Pain- Do I Have An Injury?
QUESTION: Hello! I'm a 15 year old endurance athlete that competes in XC and runs all year round. I put in about 55-60 miles a week, and 70% is easy mileage. Since yesterday I've had an annoying ache/pain, mainly in my left knee, that hurts most when my knee bends, for example, when my running stride is long, or when my knees lift high when I run sprints. I'm just wondering what this could be. I have attached a picture showing where the pain is coming from. Thanks in advance!!
ANSWER: Hello Dustin!
Thank you for your question relevant to your left knee pain. To be able to run 55-60 miles a week is a great achievement! Because this activity is not a new program for you, I have to wonder if you might have momentarily twisted your left leg, causing the hips to turn one way slightly, and the lower leg to turn the opposing way.
Now, realize that this movement was not even a conscious incident, but something that slightly altered the mechanics of the left knee. If both legs were affected causing pain in both knees, then I would suggest your shoes are not a proper fit, or you are over- training, or some other phenomenon. When we are standing, walking, running.......we use two legs............with a single leg pain, there is always some kind of incident that occurred to alter the mechanics of the leg.
In lieu of the pain in your left knee, I feel you have a lateral ligament attachment tear or a tendon tear. This is not a complete tear, but a slight separation of the soft tissue from, or around the bone.
My suggestion would be to ask your physician to refer you to a good orthopedic physician, who specializes in knees, to check your knee. Sometimes the patella (knee cap), will move slightly out of the ridge where the knee fits to move the leg straight or bent with out pain. In order to diagnose your situation, part of the examination would include a Range-Of-Motion for your knee, tendon reflex test, and possibly a MRI of the knee. An X-ray would not show the spacing of the patella, and/or the attachment areas in the knee.
Until you can see see your physician, I would suggest stopping any type of athletic activity where there is direct weight-stress on the leg. I hope you will write back to let me know what is happening with your knee. As a XC athlete, you are an elite athlete, and I don't want you to do anything to ruin your future. Thank you again for writing, and I will look forward to hearing about your follow-up.
Dr. Patricia Arthur
---------- FOLLOW-UP ----------
QUESTION: Thank you for you time! So since I wrote the question, I took two days off (running), two days training, two days off (running, two days training. Always on the end of the second day's training it comes back. I think it's still Grade One, but I'm not an expert. I'm comtemplating taking a whole week off of running and doing cycling to keep my fitness instead, since I am 3 weeks from the start of XC and I can not afford any loss of fitness and speed whatsoever. Anyways, I'll try my best to discribe how my knee feels. So now when I bend it I still have the pain when it makes that light popping feel. For example, If I'm sitting upright in a chair and I straighten my knee out, the pain is only sort of slight. When I bend my knee back to the position it was (floor), the pain is slightly worse when it "pops" midway back. Sorry, I have to say "pops" because I don't know what else to call it. The area is not painful to touch unless I dig my finger a little in there to feel the area. I also can feel some tenderness or pain when I tap the area with some forse with my hand. I wear knee braces now, they seem to help it. What are things I can do to speed the recovery? Thank you so much for everything you have done already.
We are getting pretty close to the XC competition, and there has been no MRI to facilitate this injury! In order to "see" what has happened internally, or within the knee, we MUST be able to analyze the tissues you cannot feel with your fingers, but to see the hidden tissues causing the pain. Obviously, pain is a sign there is something inherently wrong. As I mentioned before, around the kneecap there is a tough, tendonous tissue called the Patellar Tendon. This tendon is the attachment of the quadricep muscle to the knee, via the tendon. Inside the knee is a pad-like material so the femur bone does not physically touch the lower leg bone, the Fibula. If there is a small tear in this pad, and when movement is initiated with the knee and leg, there is an audible "pop" noise. In order to know exactly where this is occurring, an MRI is indicated.
If you were to race with this injury, more than likely you would only get a few yards.........at the most........until you fall down with a locked knee. The Menisci. ( the name of the pad), must be visualized, and surgery is the name of the game! Not all knee surgery is bad. For an injury such as yours, more than likely, it would be a type of non-invasive exposure where the surgeon can repair the pad, and the recovery is fast with a good Physical Therapist'.
I would suggest you find, through recommendations, a very good, conservative knee Orthopedist, and make an appointment as soon as an opening is available. Make sure you emphasize to the receptionist that this injury is an emergency, and you need to be seen ASAP. One thing, don't try to train or run until you have seen the doctor. All that will happen is to fuel the injury into a major problem. Fixing it before it becomes worse will make it heal better, faster, and back to normal. Otherwise, there could be a chance, with further injury, that you will not be able to run again! I don't want that to happen to you, Dustin, so please do what I have suggested. There is no quick "cure" for this injury, so try very hard to have this seen as fast as you can.
I'm not a wealth of good news for you today, and I am sorry, but just know I appreciate your intensity at being the best, but you will be, someday soon, if you can take care of this now.
Thank you again for writing me, and I would like you to drop me a note to let me know what is found, how it was taken care of, and most important, how you are feeling. Take care, and I hope to hear from you soon, as I care how you are doing.
Dr. Patricia Arthur