READER RESCUE
RUNNER’S KNEE
QI’ve been suffering with runner’s knee for well over eight months now, despite seeing several private physios. I’m putting in the hours with the rehab and have avoided running and most forms of cardio for several months, but I’m still getting a lot of resting knee pain when I’m sat down. Help! Andy Bennett
a Based on the location that you describe, the fact that the pain initially came on post-run and the more rest you’ve given it the worse it’s become, leads me to think it could be a patella tendinosis over the tibia (shin bone) insertion.
A tendinosis is when there’s some degeneration in the tendon fibres, some fluid sitting between the fibres and an increased vascularisation in the tendon. So in the latter stages this can lead to awareness of pain at rest and, as a non-inflammatory condition, it will be why RICE (rest, ice, compression, elevation) and anti-inflammatories don’t work. The underside of the patella tendon where it attaches on the tibial tuberosity, is an area where it needs to tolerate both compression and frictional forces as you bend your knee.
Tendons are responsive to load, however the balance of loading and then resting is a fine line. So looking back, it may have been a step change in load such as starting sprints or increasing your volume? Or not enough de-load days within your training to allow it time to remodel.
In order to diagnose this correctly, I’d advise seeing a sports physician privately, who is skilled in ultrasound diagnostics and working with tendons. Here are a few that I can highly recommend: Edinburgh, Scotland – Dr. Andrew Murray http://docandrewmurray.com; Manchester – Dr. John Rogers https://www.mihp.co.uk; London – Dr. Lorenzo Masci https://www. iseh.co.uk or Pure Sports Medicine www.puresportsmed.com
Once you’ve a clear diagnosis, then therapy options can be tailored accordingly. If it’s an insertional tendinosis, then you’ll have to build up load tolerance in the tendon, but without any compressive forces, i.e. isometric knee extensions – where you’d hold a high load with the knee completely straight for a set time to get the adaptation required in the tendon. Your programme would then need a progressive plan to tolerate load through different ranges and load forces.
Alongside this, keeping yourself active is key to helping the tendon remodel and reduce the pain. So think of this as an ‘opportunity’ to come back to triathlon stronger in other areas that you haven’t previously addressed, e.g. upper body and trunk focus or getting some cardio hits through pool buoy swimming, deep water running, kayaking or ski ergo. Laura Penhaul
“Think of this as an opportunity to come back to tri stronger”