1. I go out running.
2. My legs feel great. I feel great. I love running.
3. After 4 or 5 miles my knee starts to become uncomfortable.
4. After 7 miles I start to worry and fret that the pain is constantly getting worse.
5. I think about stopping and seeking alternative transport or shorter routes home.
6. I realise that I’m running in the middle of nowhere. There is no escape route.
7. After 10 miles the pain is particular acute on any ascent and I am reduced to walking on even the slightest up hill.
8. After 12 miles the pain is so constant that I am reduced to hobbling along paths and pavements, being overtaken by pensioners and small children.
9. I stop running. Eat. Work. Rest. Sleep.
10. I wake up the next morning feeling refreshed with no pain in my knee.
11. I go out running. See point 2 and repeat.
This is the process which I go through almost daily depending on the mileage and the amount of hills. I have been running mainly on the flat and as a consequence most of it has been on roads and pavements. This is pleasant but boring. I would much prefer to be up a mountain or lost in some maze of valleys somewhere. What’s even more annoying is that (apart from the knee) I feel fitter than ever. It is just this one problem that needs sorting out. This is me, sorting it out.
OK. PFPS (patellofemoral pain syndrome or runner’s knee) is characterised by discomfort seemingly originating from the contact of the posterior surface of the patella (back of the kneecap) with the femur (thigh bone). The prolonged, repetitive compression on the joint causes pain and will eventually lead to the thinning and softening of the cartilage beneath the patella (I looked that up on Wikipedia to sound ‘knowledgeable’). Here are some of the problems and their possible solutions.
Problem: Overtraining or overreaching.
Solution: Physically and mentally I feel great so I don’t think I’m overreaching. It is only the left knee that is a problem and my legs feel pretty fresh even after a long run. However, the knee is clearly getting a lot of use and since PFPS is an overuse injury the obvious solution would be to use it less. Since I am training for a marathon this is not really an option. And besides, this would only be treating the symptom rather than the cause. As soon as I would increase the mileage the problem would arise again. However, I have been putting in some high mileage runs recently so it might be wise to do low mileage for a week or so to see if I can shrug this off.
Problem: Weak quadriceps.
Solution: I favour my right foot and as a result the muscles on my left leg (which is where the trouble is) are less strong. The quadriceps which hold the patella in place are responsible for making sure that it is aligned correctly during the bending and straightening of the leg. As the quadriceps muscles tire through distance or hills the alignment of the patella becomes squiffy and pain is felt. The obvious solution is to isolate and strengthen the quadriceps muscles on the left leg to correct this imbalance. It would also be a good idea to strengthen the core muscles to assist the quadriceps during running.
Problem: Tight hamstring and calf muscles.
Solution: I often find that the pain follows a tightening of my left calf muscle and that during the pain all the muscles on the back of my leg feel very tight. Now, I am rubbish at stretching. I don’t stretch for long enough or often enough. I am hoping that proper stretching will aid in this recovery.
Problem: Too much force on the knee as a result of being overweight and having a lack of cushioning on my shoes.
Solution: I am slightly too fat to be running. I could do with losing another stone. My weight is slowly coming down as I increase the mileage. I just have to be patient and eat less cake.
My shoes are about 450 miles old and I have just checked them over to find that they have almost no cushioning left in them. It’s a bit silly of me not to check these sooner. The same problem occurred at the end of my last pair of shoes (same brand). So I have changed to my other pair of running shoes which are pretty much unused. I stopped using them ages ago because, like a lot of Asics shoes, there’s this little ridge on the insole that always causes me blisters after about 4 miles (something you can never find out in the shop just before letting go of £80). This annoyed me because, other than that, they are a very comfortable shoe. I suddenly had a brain wave (should of thought of this sooner!) and decided to cut out the offending ridge. This has left the shoes a little airy and not very waterproof but should stop any offending blistering. We shall see. If it doesn’t work then I’ll just have to shell out for a new set of Brooks.
Problem: Overpronation.
Solution: I overpronate quite badly and rely on shoes to correct this. The observations made in the previous section hold true here as well. My old shoes were not giving me the correct level of anti pronation. New shoes will hopefully correct this.
Going through all these points has been a bit of a wakeup call to me. As ever, injuries are not ‘acts of God’ and there is always a reason or reasons as to why. Unfortunately, it takes me a while to suss out the reasons because I am stubborn and occasionally moronic when it comes to these matters. I have been running by feel, doing as much or as little as I want day by day. In terms of mileage and the quality of my running this has worked pretty well. However, as a consequence, I have been stupidly neglecting the basics. I forgot that I need to “understand the holistic nature of being a runner” (Lore of Running, Noakes). This means that in training to run one needs to train the whole system in every aspect of one’s life. Now, I’m not going to become totally obsessed but approaching more aspects of the whole system will help me here.
On the plus side I am really enjoying my running, especially the long runs. Despite the knee, I am getting fitter and stronger. If I can get rid of this injury then I feel confident in my ability to run much further. So, in conclusion, the following steps should lead to recovery:
1. Lower mileage for 7-10 days. Nothing over ten miles.
2. Change to new shoes with better cushioning.
3. Strengthen core and left quadriceps.
4. Stretch the left hamstring and calf muscles properly and regularly.
5. Wear my knee support whilst recovering.
I am sorry that this post has been boring and if you’ve stuck with it this far then you have too much time on your hands. I like to make lists when I problem solve. I think it’s a blokey thing. Incidentally, I am designing a cake holder for running. It’s like one of those funny little gel holders but for cake. Iced buns and scones seem to work well but jam donuts are a definite no-no for obvious reasons. I think I might actually be gaining weight during my long runs.
