Return to running not quite as smooth as I hoped

I ran cross country in the Ozark mountains of NW Arkansas from 5th grade through high school in the 70s through 85 when I left for college and work.  From 95 to current I have cycled road and MTB competitively.  IN 2008 I was training in Houston for the Houston marathon in 2009 and came back from a week in San Diego running with crazy knee pains.  The ortho said my patella bone was not in the groove.  Now in 2012 I am trying again here in San Antonio.  I really love running even more than cycling.  I ride mostly single speed for its simplicity which is why I like running. 

For the past month I have been running with Merrel trail gloves (Vibram sole with wide open toe box) and Saucony Kinvara 3 minimal shoes and doing okay with minimal knee pain and mostly calf muscle soreness from hills and focus on mid/forefoot strike trying to run soft.  A massage therapist said my patella bone is right where he expects to find it now but I still have quite a bit of knee pain on the right side nearly full circle and on the upper edges of the tibia.  I have been reading and getting ready for a visit to a new ortho this week.  Between a nearly flat foot and longer second toe, I suspect I have a bio-mechanical issue causing my knee some unneeded stress.  I like the minimalist running for the feedback but the concrete running and foot configuration may be working against me and I need more cushion. 

By posting in this blog on Running with Eric I anticipate getting some feedback from more experienced runners to give me more information in next steps and experiments to try.

Jimm

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Comment by Jimm Schroeder on August 30, 2012 at 6:31pm

Thanks Lori and Bobby. 

I go in for a MRI in the morning to confirm what the ortho thinks is going on from physical exam.  The hamstring at the point of connection on the shin just below knee (where it wraps around from behind the leg) is strained.  There is some side to side play in that knee and he is trying to make sure the meniscus isn't damaged as well.  He is just making sure before giving any shots which I appreciate.  I am registered for an 8K in three weeks and a 1/2 in November.  Both he thinks are very realistic.  He did give my patella bone a thumbs up for being in the correct location and no grinding which means my form and strength exercises are working and no surgeries. 

Given where I was two years ago, I am starting to feel more confident about goals for the next year.

Comment by Lori Enlow on August 30, 2012 at 5:29pm
I would suggest looking at the running form videos you can find here and strength exercises for your feet and stabilizing muscles-gluts, hip flexors, adductors... You might check out wwwborn2run..I use the slant board and poles. I am amazed at how much my form and strength have improved. I am also learni g that it takes continual work and attention to maintain it. My overall aches and pains have diminished. I ran a 100 mile race in October...took me 4 weeks to recover and start running again--knee problems. I just ran Leadville 100 and felt like I could run within 2 days. I'll start training again next week.
Comment by Bobby Lewis on August 27, 2012 at 9:36pm

Jimm,

Let me start by saying I feel your pain man, because I've felt it firsthand and it drove me nuts. 

It was 1999, my sophomore year in college. The pain in my knee was making nearly impossible to improve my leg strength or box jumps - therapy did very, very little - I decided to focus on school and frat life and stopped playing football because I couldn't train at the level I needed to because of what I thought was a weakness in my physiology.   I was diagnosed with "patella femoral syndrome," in my "good knee" while I was rehabing what turned out to be a very successful scope on the other knee.  My ortho was great, but the kneecap pain you describe and I experienced baffles teams of sports physicians and pro trainers. I'm a certified personal trainer for what it's it worth and learned everything I could to take care of it.

Today, I'm in law school in Miami and started running to get my normally sharp mind back. I'm 6'4" and 224lbs after losing ten lbs this summer.  I run in the Kinvaras myself that I bought at the start of the summer. I intuitively switched the minimalist shoe when I injured my arch a year ago within a week of buying arch supports (who knew).  The knee that I assumed would be a chronic buzz kill for the rest of my life feels brand new.  

Your physiology is very, very likely NOT the problem. Between all the theories about your patella tracking being out of balance or because of your knee cap shape, or the strength imbalance between your VMO and every other quadriceps muscle...

it's bs.  Syndrome is french for "We have no idea what's going on at this point" 

For what it's worth, my second toe is way longer and my middle toe is at least even with my big toe. My arches had flattened out big time too. My calves feel the same way yours do because I'm running on my toes and my calves are growing rapidly to adjust for the new requirement.  My achilles has loosened up and adjusted and become springy again. My arches are strengthening and feel fantastic and my knees never cross my mind. 

Here's what I'd tell my best friend (and be relentless about it)

If you love running enough to go solo, committing to running.  Stay off the bike and anything else with pedals. The knee bend, shape of pedal orbit, and flexion/extension pressure on your leg is probably what got to you.  Hamstring and lower back tightness played a major role in my case as well so I learned to love the plow in yoga. STOP doing any knee bends or presses at the gym until further notice and go easy on the extensions. You're legs are getting plenty of work.

Here's a way to prove to yourself that your body is as amazing as you used to believe it was --

Go sprint barefoot at the beach on the tight, firm sand near the water. Ease into a 90% sprint (rolling start). Keep your jaw loose.  Whip your loose wrists past your pockets as you accelerate. Any decent fairway at the golf course will do too (around dusk if its busy).  As you reach a near sprint direct your thoughts to your legs and the balls of your feet. Your legs will be under you and your heels way back, you'll be so, so tall...

{Your feet figure it out by the eighth or ninth stride or less.} Get someone to video it if you can. I'll try to do it myself in the next week or so if I can and upload it for the world to see. I'm curious. I'd love to hear what Eric sees.

Jimm, I hope this was of some value to you. When I read your post it really hit home. What you're going through is frustrating and MRI's are silent on the matter. Take my advice on the cycling/knee bend movements for at least a year and run like Eric says.

- Bobby Lewis

Miami, FL

** FYI, your hamstings are the only liability because you'll be running much faster than usual. A great joke in football was when certain guys grabbed the back of their leg after running a deep fade route... "The coaches would howl "You're not fast enough to pull a hamstring Eddie!!!"  -  That's not true on the beach because you're faster.

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