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

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 .

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?

floridatennisdude said:

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?

Click to expand...

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" .

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.

floridatennisdude said:

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. ............................

Click to expand...

Do you have any references for these points?

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.

Click to expand...

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.

Chas Tennis said:

Do you have any references for these points?

Click to expand...

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/538234-running-after-a-minor-sprain/
- 1-3 weeks for low grade ankle, 2-4 for low grade knee

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"

floridatennisdude said:

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.

Click to expand...

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.

r2473 said:

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.

Click to expand...

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's-Ravenous™-Lite/BM3736,default,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.

Chas Tennis said:

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
....

Click to expand...

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/sport-injuries/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.

Chas Tennis said:

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"

Click to expand...

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

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's-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.

Click to expand...

I never had my gait analyzed either. Just learned what I need by trial and error. During this period (which is long ago for me), I suffered the knee pain you speak of, until I "hit on" the right type of shoes (neutral).

As a road runner, I also get that pain if I run on the side of the road instead of the sidewalk. This is because the side of the road is sloped so the water will drain into the sewer. So maybe its just because you were doing a lot of running on uneven, sloped surfaces.

r2473 said:

I never had my gait analyzed either. Just learned what I need by trial and error. During this period (which is long ago for me), I suffered the knee pain you speak of, until I "hit on" the right type of shoes (neutral).

As a road runner, I also get that pain if I run on the side of the road instead of the sidewalk. This is because the side of the road is sloped so the water will drain into the sewer. So maybe its just because you were doing a lot of running on uneven, sloped surfaces.

Click to expand...

Me too RE the shoes. I'm a supinator and even the slightest amount of stability/control in a shoe kills my inner knee.

How's the rehab, r2? Still weak as a kitten? If I came to your house and slapped you right know, could you defend yourself?

r2473 said:

I never had my gait analyzed either. Just learned what I need by trial and error. During this period (which is long ago for me), I suffered the knee pain you speak of, until I "hit on" the right type of shoes (neutral).

As a road runner, I also get that pain if I run on the side of the road instead of the sidewalk. This is because the side of the road is sloped so the water will drain into the sewer. So maybe its just because you were doing a lot of running on uneven, sloped surfaces.

Click to expand...

Understood. Well ... the uneven, sloped surfaces are unavoidable when running on that sort of stuff . It's kind of the point of it I guess.
I don't even know what category these shoes I linked (and bought) go into...but "stability" doesn't sound like it...I suppose those are more "bulky". These things are extremely minimal, light and don't seem to have any "stability features"...well not the way tennis shoes have anyway...I guess I don't have enough experience when it comes to running shoes to see the differences.
I've read a bit about that "barefoot running movement" and frankly I'm tempted to try some of those shoes to see how I do in them.
The logic behind their ideas seems to make sense at first sight. Maybe I'll get some of those Vibram shoes with fingers or some competing product if I find something "better" .


Edit.

Hmmmm...these look nice : http://www.merrell.com/US/en-us/Product.mvc.aspx/22875M/50390/Mens/Barefoot-Run-Trail-Glove . And they don't make you look like a freak (the way those shoes with fingers do )

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.

0d1n said:

I guess I don't have enough experience when it comes to running shoes to see the differences.

Click to expand...

Sometimes trial and error is best.

You might want to read up on a few general things and just take it easy when you try something new.

r2473 said:

Sometimes trial and error is best.

You might want to read up on a few general things and just take it easy when you try something new.

Click to expand...

That seems like the gist of it...yes.
Too much too soon...

I suffered from ITBS and lateral trekking which would only aggravate whenever I ran long distance outdoor (anything over a mile). But, it never flared out playing tennis or basketball. Outside of my left knee would hurt so bad that I couldn't run any more. Not sure if YOU have it or not...

Anyway, my left outer leg stiffened and tighten up so bad that it was pulling down my hip, which started to cause lower back problem...So I suffered from pretty bad lower back for about 2 years before I saw a chiropractor. About a year later, I saw him again for my knee problem. My lower back problem almost disappeared when he took care of it. He thought the scar tissue on my knee had been there for at least a few years.....

junbumkim said:

I suffered from ITBS and lateral trekking which would only aggravate whenever I ran long distance outdoor (anything over a mile). But, it never flared out playing tennis or basketball. Outside of my left knee would hurt so bad that I couldn't run any more.
..........................

Click to expand...

I had medial collateral ligament pain from surprisingly light forces on my lower leg. Only certain force directions caused my MCL pain.

The knee also has the lateral collateral ligament on the outside. I would assume that forces that push the lower leg or knee outward from the center can stress the lateral collateral ligament. ??

Do you have an idea as to how the pain and location from ITBS might compare to that of an injured lateral collateral ligament?

I am not familiar with the differences. Apart from the locations of the pain, the type of activities that cause the pain can help diagnose the problem. For me, ITBS never caused pain during tennis or basketball. It was only the outdoor running. So, I suggest you go see a doctor, PT, or chiropractor. Treatment for ITBS is quite simple; get a roller foam or even a round bottle and roll it along the outside of the leg.

Hmmm although tennis didn't seem to bother the knee anymore...some bicycle riding seems to have done it.
Took a longer ride with a few buddies yesterday...just over 90 km (about 60 miles) for the day combined road with trail/woods and some light downhills.
Got to our destination one route, rested for a few hours...had a few beers...etc and then came back another way (mostly roads on the comeback). About half way through the comeback I started feeling it pretty badly.
Iced it last night...and today it's much better (much better than it felt the following day after the run as well), but it seems like I'm not quite over the hill yet.
Might have to take it easier with the physical activity for a few days. Have a tournament next weekend and I don't want to risk having pain for those matches.

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.

floridatennisdude said:

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.

Click to expand...

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 ).
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.

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.

0d1n said:

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 ).
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.

Click to expand...

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.

floridatennisdude said:

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.

Click to expand...

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" .