Pain on the outside of knees after running unusually long distances (for me)

[0d1n]

Here it goes. I don't usually run for the sake of running, my running is usually pretty much limited to the multi-sprint sports I enjoy (tennis and football...the European kind), but I'm a 32 yo in very good cardiovascular shape and athletic.
Some of my friends invited me to run with them in a mountain running race. There were 2 categories, "pro" who ran over a semi-maraton distance (21 km) and "amateur" who ran over a distance of just over 7 km (about 4.5 miles). We participated in the "amateur" race.
Given the fact that I had a holiday scheduled and other commitments I only "trained" twice for this race, the target being to see how I do in running uphill/downhill...etc, both times we did some trail/woods running with something like 1/3 of the distance of road running.
First time we did about 10-11 km, and the second time about 14 km. The first run was a couple of weeks before the race, then I went on holiday for a week and the second run was a few days before the race. At the end of the first run I felt slight discomfort on the outside of my left knee, but it went away totally in a couple of days.
At the end of the second run (the 14 km one), which was on a Wednesday I felt serious discomfort (pain) in the same location. I iced it, did some stretches, applied some local anti-inflammatory creams and took some Ibuprofen as the race was going to be on Saturday.
I ran the Saturday race with some elastic bandage on my left knee and finished in a very respectable 3rd place in my age bracket and 5th overall for that amateur section.
However...although the distance of the race was shorter than my training runs...the uphill/downhill sectors were much more aggressive, there were some sectors with climbing that involved rope/chains, a couple of small mountain river crossings and there was a long and aggressive/rocky downhill at the end of it. By the time I got to that downhill sector I was feeling the same pain on the outside of my knee (this time it was worse in my right one...presumably because I've been "saving" the left one during the race) and I frankly couldn't run that part of the race the way I know I could have done with "healthy" knees...I lost a lot of time there, but running that downhill quickly was just too painful.
During the following 2-3 days I felt pain when walking uphill/downhill and when going up and especially down some stairs. Walking on "straight" floor wasn't as big of a problem. About a week later I was able to play some tennis but felt slight discomfort (not too painful) during longer/more demanding rallies.
I only consulted "Doctor Google" about this and I'm pretty sure it's the so called "ITBS" or a problem with inflammation of the Iliotibial Band...most likely caused by my poor running form.
I'm looking for second opinions from more experienced runners and recommendations of strengthening exercises and/or stretches that help prevent this issue for the future. If this issue comes up again I'm going to have to talk about it with some physio/doctor but for now I think some "on my own" work might be enough as a preventive measure.
Thanks in advance .

[floridatennisdude]

Rest it til the pain is all gone and take 2 Alleve per day. Then try to play tennis. If it hurts still, might be an issue. If not, just don't do the mountain runs anymore. That is seriously about all you'll learn from a 1st doctor appt.

Quick question...does it hurt when you stand on one leg and do trunk twists?

[0d1n]

Originally Posted by floridatennisdude

Rest it til the pain is all gone and take 2 Alleve per day. Then try to play tennis. If it hurts still, might be an issue. If not, just don't do the mountain runs anymore. That is seriously about all you'll learn from a 1st doctor appt.

Quick question...does it hurt when you stand on one leg and do trunk twists?

Nope, it doesn't hurt when doing the twists. I have some tennis scheduled in about 3 hours...I guess I'll know more after that session. Last time I played (4 days ago), I felt some discomfort and "insecurity" which might have been mental more than anything but no "real pain".
With regards to not doing those mountain runs...I don't expect those to be "regular" but I don't like to be physically limited like that either.
If possible I would rather put in the work that allows me to do them rather than "not doing them" .

[floridatennisdude]

Ok, if you can twist on the knee without pain it shouldn't be your meniscus.

Probably over did the intensity of your three runs. Also could be a form issue with your stride. Or just onset muscle soreness. Multitude of options really.

If you're fine after tonight, doubtful that you have a structural issue. If there is soreness, the general recommendation is no high impact activities for 2 weeks. That's generally how long minor pulls and tears need to heal them self. Still in pain after a two week rest and you have something to worry about.

[Chas Tennis]

Originally Posted by floridatennisdude

Ok, if you can twist on the knee without pain it shouldn't be your meniscus.
.................................................. .................................................. ........
If you're fine after tonight, doubtful that you have a structural issue. ?
If there is soreness, the general recommendation is no high impact activities for 2 weeks. That's generally how long minor pulls and tears need to heal them self. ............................

Do you have any references for these points?

[floridatennisdude]

Originally Posted by Chas Tennis

Do you have any references for these points?

My doctor. Was a test he did on my knee that ended up just being arthritis.

As for no pain after playing tonight...that's just common sense. No one goes to a doctor and says "I think there's something wrong with my knee because it doesn't hurt anymore"

But, for those that believe in only trusting Internet sources...

http://www.livestrong.com/article/53...-minor-sprain/
- 1-3 weeks for low grade ankle, 2-4 for low grade knee

[Chas Tennis]

I guess that link might be relevant after a Dr had diagnosed a low grade knee sprain. What's sprained? ............

I don't have a list for pain causes for the side of the knee but to me the following list illustrates that these things are complicated and require a Dr. Here's a list for pain on the front of the knee (21 listed causes) -

http://www.aafp.org/afp/2007/0115/p194.html

"TABLE 2
Causes of Anterior Knee Pain
Cause Comment

Articular cartilage injury
May describe history of trauma; mechanical symptoms may occur if loose body present; may have effusion; may have tenderness of involved structure (e.g., femoral condyles, patella)

Bone tumors
Pain may be insidious; may have tenderness of bony structures

Chondromalacia patellae
Retropatellar pain; may have history of trauma; may have effusion on examination

Hoffa's disease
Pain and tenderness localized to infrapatellar fat pad

Iliotibial band syndrome
Typically presents with lateral pain and tenderness over lateral femoral epicondyle

Loose bodies
Symptoms variable; may have intermittent sharp pain, locking, or effusion

Osgood-Schlatter disease
Tenderness and swelling at insertion of patellar tendon at tibial tubercle in an adolescent

Osteochondritis dissecans
Symptoms variable; may have intermittent pain, swelling, or locking

Patellar instability/subluxation
Intermittent pain with sensation of instability or movement of patella; may have swelling; locking can occur with loose body formation; may have tenderness over medial retinaculum

Patellar stress fracture
May have tenderness directly over patella

Patellar tendinopathy
Tenderness of tendon; tendon may be thickened if chronic

Patellofemoral osteoarthritis
May have crepitus or effusion; characteristic radiographic findings

Patellofemoral pain syndrome
Anterior knee pain “behind” or around patella; usually no effusion; may have findings of patellar maltracking

Pes anserine bursitis
Pain usually described as medial rather than anterior; tenderness over pes anserine bursa

Plica synovialis
May be medial or lateral to patella; if symptomatic, tenderness can be demonstrated on examination

Prepatellar bursitis
Characteristic swelling anterior to patella following trauma

Quadriceps tendinopathy
Tenderness over tendon

Referred pain from the lumbar spine or hip joint pathology
Symptoms depend on origin of pain; knee examination usually normal

Saphenous neuritis
Pain usually medial but poorly localized; may have history of surgery

Sinding-Larsen-Johansson syndrome
Tenderness at patellar tendon insertion at inferior pole of patella in an adolescent

Symptomatic bipartite patella
May have tenderness directly over patella with characteristic radiographic findings"

[0d1n]

Originally Posted by floridatennisdude

Ok, if you can twist on the knee without pain it shouldn't be your meniscus.

Probably over did the intensity of your three runs. Also could be a form issue with your stride. Or just onset muscle soreness. Multitude of options really.

If you're fine after tonight, doubtful that you have a structural issue. If there is soreness, the general recommendation is no high impact activities for 2 weeks. That's generally how long minor pulls and tears need to heal them self. Still in pain after a two week rest and you have something to worry about.

Didn't have any problems with muscle soreness that I could feel, the muscles were fine after all 3 runs.
Anyway, played for two hours last night...was OK...no pain.

Originally Posted by r2473

In my experience, knee pain was the result of using shoes that didn't match my stride (or were worn out).

By wrong shoes I mean, have someone analyze if you are a pronaotor, supinator, or neutral runner and buy shoes accordingly.

I used to get knee pain when I didn't toss out my old shoes when they were worn down and replace them. But once I replaced my shoes (and stopped running for a few days to let the pain go away), I was fine.

That's the best I've got.

Got it. I thought about that as well. The first run was done in some old Adidas Climacool shoes, which were not specifically for trail running. I thought I better buy something more appropriate and the following training run + the race were done in these Columbia Ravenous Lite:

http://www.columbia.com/Men%27s-Rave...efault,pd.html

Different color than the ones in the link, but the shoes are the same.
No...nobody analyzed the way I run, and I doubt such service is common around here. My girlfriend is a much more frequent runner than myself (she ran a marathon this year) so she buys running shoes much more often than I do and she never had such service when buying shoes so...I think she just knows what works by now. I run so rarely "just for running" that I usually just grab what lies around...or run in my old tennis shoes. Until now...that is...when I bought these "trail running" things...
Guess I could film myself though...just to find out.

Originally Posted by Chas Tennis

I guess that link might be relevant after a Dr had diagnosed a low grade knee sprain. What's sprained? ............

I don't have a list for pain causes for the side of the knee but to me the following list illustrates that these things are complicated and require a Dr. Here's a list for pain on the front of the knee (21 listed causes) -

http://www.aafp.org/afp/2007/0115/p194.html

"TABLE 2
Causes of Anterior Knee Pain
Cause Comment
....

Thanks for the link, I understand that the knee joint is complex
My pain was located on the outside of the knee (on the right side of the right leg and left side of left leg, but in the knee joint area). The best...clearest reference I found for this "knee pain" problem was this : http://www.sportsinjuryclinic.net/sp...ries/knee-pain
Detailed enough...there are some pictures...and they have a so called "symptom checker" where you can give details about your specific issue to narrow down the possibilities. Obviously, this can't really replace a qualified specialist, but I don't feel that my issue is bad enough to be in that "zone" just yet. It's gone now a week and a half later (played tennis last nigh), but I'm just trying to better understand what happened so that I can avoid it in the future...with specific exercises or whatever.

[floridatennisdude]

Originally Posted by Chas Tennis

I guess that link might be relevant after a Dr had diagnosed a low grade knee sprain. What's sprained? ............

I don't have a list for pain causes for the side of the knee but to me the following list illustrates that these things are complicated and require a Dr. Here's a list for pain on the front of the knee (21 listed causes) -

http://www.aafp.org/afp/2007/0115/p194.html

"TABLE 2
Causes of Anterior Knee Pain
Cause Comment

Articular cartilage injury
May describe history of trauma; mechanical symptoms may occur if loose body present; may have effusion; may have tenderness of involved structure (e.g., femoral condyles, patella)

Bone tumors
Pain may be insidious; may have tenderness of bony structures

Chondromalacia patellae
Retropatellar pain; may have history of trauma; may have effusion on examination

Hoffa's disease
Pain and tenderness localized to infrapatellar fat pad

Iliotibial band syndrome
Typically presents with lateral pain and tenderness over lateral femoral epicondyle

Loose bodies
Symptoms variable; may have intermittent sharp pain, locking, or effusion

Osgood-Schlatter disease
Tenderness and swelling at insertion of patellar tendon at tibial tubercle in an adolescent

Osteochondritis dissecans
Symptoms variable; may have intermittent pain, swelling, or locking

Patellar instability/subluxation
Intermittent pain with sensation of instability or movement of patella; may have swelling; locking can occur with loose body formation; may have tenderness over medial retinaculum

Patellar stress fracture
May have tenderness directly over patella

Patellar tendinopathy
Tenderness of tendon; tendon may be thickened if chronic

Patellofemoral osteoarthritis
May have crepitus or effusion; characteristic radiographic findings

Patellofemoral pain syndrome
Anterior knee pain “behind” or around patella; usually no effusion; may have findings of patellar maltracking

Pes anserine bursitis
Pain usually described as medial rather than anterior; tenderness over pes anserine bursa

Plica synovialis
May be medial or lateral to patella; if symptomatic, tenderness can be demonstrated on examination

Prepatellar bursitis
Characteristic swelling anterior to patella following trauma

Quadriceps tendinopathy
Tenderness over tendon

Referred pain from the lumbar spine or hip joint pathology
Symptoms depend on origin of pain; knee examination usually normal

Saphenous neuritis
Pain usually medial but poorly localized; may have history of surgery

Sinding-Larsen-Johansson syndrome
Tenderness at patellar tendon insertion at inferior pole of patella in an adolescent

Symptomatic bipartite patella
May have tenderness directly over patella with characteristic radiographic findings"

Way to research it! The kid is fine after a week.

[r2473]

I only consulted "Doctor Google" about this and I'm pretty sure it's the so called "ITBS" or a problem with inflammation of the Iliotibial Band...most likely caused by my poor running form.

In my experience, knee pain was the result of using shoes that didn't match my stride (or were worn out).

By wrong shoes I mean, have someone analyze if you are a pronaotor, supinator, or neutral runner and buy shoes accordingly.

I used to get knee pain when I didn't toss out my old shoes when they were worn down and replace them. But once I replaced my shoes (and stopped running for a few days to let the pain go away), I was fine.

That's the best I've got.

[r2473]

I'm doing fine. Doing high rep exercises with the right arm. I can do most normal, everyday stuff without a problem. In theory, the doc will clear me to play tennis in about a month (I think he's crazy).

Well, if you came to the house and slapped me, I'd have to let my wife defend me. Trust me, you don't want to risk it.

[floridatennisdude]

You seem to like to jump into things at extraordinary levels of intensity. I think your body is just telling you to try to ease into things. I'm sore just thinking about a 90k bike ride.

Try training for things instead of just jumping into it full force. It's just disaster waiting to happen.

[0d1n]

Originally Posted by floridatennisdude

You seem to like to jump into things at extraordinary levels of intensity. I think your body is just telling you to try to ease into things. I'm sore just thinking about a 90k bike ride.

Try training for things instead of just jumping into it full force. It's just disaster waiting to happen.

I'm a bit more used to biking than I am to mountain running . If my knee was intact to begin with this would not have been a problem.
My only sore parts were my knee and my arse (didn't use cycling specific shorts :P).
You do have a point though...I do tend to trust my general fitness level and believe that it's OK to jump into anything (sports related) due to it, but rationally I do realize there are other adaptations that the body needs to go through in a new sporting activity even if one's cardiovascular fitness and most muscles can take the beating.
Joints are the most obvious examples...for these needed adaptations. Food for thought.

[maggmaster]

Yea that is pretty nuts without training. I have done my fair share of endurance work over the years and I am pretty sure that I could crank out a marathon right now if the urge struck me. If I did so without any pre work I would definitely collect some injuries.

[floridatennisdude]

Originally Posted by 0d1n

I'm a bit more used to biking than I am to mountain running . If my knee was intact to begin with this would not have been a problem.
My only sore parts were my knee and my arse (didn't use cycling specific shorts :P).
You do have a point though...I do tend to trust my general fitness level and believe that it's OK to jump into anything (sports related) due to it, but rationally I do realize there are other adaptations that the body needs to go through in a new sporting activity even if one's cardiovascular fitness and most muscles can take the beating.
Joints are the most obvious examples...for these needed adaptations. Food for thought.

It's just insane to assume the body can take this type of work without building up to it. I bike a few days per week as cross training for tennis. 90k in a week would be a lot for me on top of 3-4 tennis matches per week.

I have a feeling you'll be seeking a lot of advice on injury treatments in the future. You just don't pace yourself and it's a risk.

[0d1n]

Originally Posted by floridatennisdude

It's just insane to assume the body can take this type of work without building up to it. I bike a few days per week as cross training for tennis. 90k in a week would be a lot for me on top of 3-4 tennis matches per week.

I have a feeling you'll be seeking a lot of advice on injury treatments in the future. You just don't pace yourself and it's a risk.

Hmmm, I get your point and appreciate your concern, but somehow you are making it sound like I'm a couch potato trying to climb the Everest...and that's not exactly the case.
I sure hope I won't be spending much time injured and asking for treatment as per "your feeling" .