Hi Neil. I am a 27-year-old female, weigh 125 lbs., and have been having knee
pain for approximately 7 years now. I have recently started running again for
about the fourth time. Unfortunately, I have had to give up running in the past
because of my knees. I am determined not to give it up this time for several
reasons, one of which is that I am pursuing a career in federal law enforcement
and must pass a timed, two-mile running exam (I also have a longer-term goal of
running a marathon).
I am in good shape and workout 3-6 times a week, usually on a stationary bike,
elliptical trainer, stair climber or treadmill (walking at a steep incline). I
haven't had too much pain in my knees until I started running again about three
weeks ago. I feel some pain and aches during the run, with sharp pains under the
inner, upper portion of my kneecap. When I'm not exercising, I usually feel a
general achiness in my knees and thighs but cannot pinpoint the exact location
of the pain. I also experience some sharp pains and aches in my left hip and the
inside of my left ankle.
Over the years, I have done research and determined that I may have
chondromalacia or something similar. I have also seen an orthopedic surgeon,
physical therapist and general practitioner, all of whom agreed with me after a
cursory exam (so I'm not too sure how accurate the diagnosis was). I have the
usual symptoms -- pain behind the kneecap when decending stairs, stiffness after
sitting, etc. My problem is that I do not feel that I have been completely
diagnosed nor do I feel that I have been given any adequate advice for treatment
and prevention. The various doctors and physical therapists I have seen have
given me stretches -- although I am already very flexible. They have also given
me strength training exercises -- most of which I had already been doing for
years. I have also been given orthotics to wear, which seem to help some
(although they are not custom fitted).
After reading some of your responses to other people's questions, I am thinking
that I need to get a biomechanical evaluation and custom-made orthotics. But I
still have some questions:
a.. Where do I get a biomechanical evaluation? And can the evaluation
pinpoint the problem so that I can find a solution? For example, if there a
problem with my running stride, etc.
b.. If I do have chondromalacia or something similiar, will I have this for
the rest of my life? Is this a debilitating problem?
c.. If I ignore the pain and run anyway, am I causing permanent damage to my
d.. Is there a reliable book or source that I can refer to for more
information on treatment and prevention?
Basically, my fear is that I will always have to limit my physical activity for
fear of damaging my knees and that I will never be able to run consistently.
Although the pain does not bother me too much, the thought that I may have to
one day completely give up physical activity does.
Some other information about me that may be helpful -- I have never had an acute
injury to my knee; however, the knee pain started after I sprained my left ankle
7 years ago (minor sprain) and did not allow enough recovery time before I went
back to exercising. The knee pain began about three months later, first in my
left knee, then in my right. Eventually, my left ankle and hip began hurting,
too. I have had my knee x-rayed; there was no structural problem, although the
doctor said my kneecaps were tilted out more than normal. Running by far causes
the most pain of any type of exercise.
I appreciate any advice you can give me and apologize for the very long email!
Dena - You describe the natural history of over pronation of the lower extremity
biomechanical chain. Knee pain usually preceeds hip pain, and more so in females
due to the increased q-angle at the knee (after the fact of a wider pelvis). The
problem is amplified by your feet - if you are a pronator or a supinator at teh
foot and ankle, you can increase the forces that the knee and hip are required
to decelerate at impact. It sounds like you have been struggling with this for a
whil, and that you have not found relief so far. It occurs to me that you must
get a biomechanical eval. Find a specialist who can do so for you by calling the
outpatient physical therapy providers in your phone book, and ask the following
1. Do you do video gait analysis.
2. Do you cast for and prescribe custom orthotics.
3. Do you use a orthotist to make the device, or do you use a computer generated
device based on a force platform readout?
4. Can you make adjustments to the device in your clinic?
5. Do you use a functional biomechanical lower extremity profile as part of your
The answers to these questions should be 1. Yes, 2. Yes, 3. An orthotist, not a
computer generated device., 4. Yes, and 5. Yes.
This way, you are bound to get a better assessment and device, and one that is
more likely to correct your allignment, improve your hip and knee pain, and
reduce your long term damage.
As far as the long term is concerned - start taking glucose amine sulfates now,
and gve your cartilage a lift, and getyour hands on Juice Plus as a superior
anti-oxidant to minimize oxidative stress to your joints and connective tissue.
Finally, use ice daily as long as you have pain,