Neil, I ran in the Chicago Marathon in Oct., then ran a month later in
Columbus. I qualified for Boston after the Columbus race. I took a week
off and then began a light running schedule because I knew I would not
begin serious training for Boston until Jan. Unfortunately, I have
developed a pain in both of my knees. I have done RICE, but the
discomfort persists. I have an appointment with sports dr. Dec. 30. What
sort of questions would you recommend I ask in order get a clear picture
of my problem. I hope this is some what clear to you. John
John:
This is a great question because it gives me a chance to speak to the issue in a broader sense. When you visit a physician, I believe that knowledge is power. Physicians are very busy these days, and if you have a list of good specific questions, you are likely to get the best care.
First, you need to understand that generally speaking, dense connective tissues are likely to get injured over muscles. In the knee, this includes the articular cartilage, the knee menisci, the medial collateral ligament, and of course, the ACL and MCL. Also,there are the various tendons about the knee. The Patella tendon, the quadraceps tendon, and the hamstring tendons. The popliteal muscle also lives behind the knee, and is occasionally a culpret, as is the plantaris muscle. One additional structure to be concerned about is the articular capsule.
Second, in order of most common to least common (non-traumatic) injuries, in other words, things that come on with no direct trauma -
1. Chondromalacia patella - or softening of theunderside of the knee cap is probably the most common, and if you have it, then the question to ask relates to the biomechanics of your feet. Pronators and supinators both are likely to develop chondromalacia patella.
2. Meniscus tears - partial thickness bucket handle tears. This is likely to occur in your knee if you had trauma in the past, or if you engage in hi impact loading types of sports - for some, that means running. The question to ask in this instance relates to definitive testing. An arthrogram in some instances, and an MRI in others.
3. Patella tendonitis - sometimes mistakenly called patella bursitis. Again, this tends to be a biomechanical problem, so see number 1.
4. MCL sprain typically comes on over time, mostly in younger (fifteen years old) girls and active women who run a lot. Here the pain is on the medial side of the knee, and point tenderness is evident. Once again, like the others, this tends to be biomechanical (wide hips, large Q-angle, and impact loading).
5. Capsular strain - not as common, but often the culprit when other diagnosis do not check out. Here the biomechanics are at issue, but there are other issues to consider, like the nature of the activity, and habitual postures as a set up for the injury.
Hope this helps!
