They tried to make me go to rehab...

I said, "No, no, no".

And by rehab, I mean physical therapy for my knees.
If they want me to go to drug rehab, I'll go, but only if it's somewhere nice.

Physical Therapy
I had been to physical therapy before for my Runners Knee in 2006. Here is how it went:

Therapist: Lay on this table and do 3 sets of 10 leg lifts.
Me: Ok, done. Now what.
Therapist: Uh, do some more leg lifts. Then come back for 3 days a week for the next 8 weeks.
Me: For more leg lifts?
Therapist: Uh, well... yeah.

Me: So I come here 3 days a week and pay you $300 an hour to tell me to do leg lifts?
Therapist: Yes.
Me: Why don't I just stay home and do leg lifts for free?
Therapist: Because I am a professional.

Go back to start... Do not pass go... Lose $2000 
So after lots of doctors visits I was back to where I started from.
All the way back to 2006, in fact. A case of runners knee and no answers.

"Small Steps" wasn't working.
Hell, even "NO STEPS" wasn't working.

Hmmm. Why did it come back? A better question, why did it go away for a few years?

Fortunately I have kept a detailed running log since 2007 that could answer those questions.

Some people think running logs are useless data.

But back in July, I looked at my log and found something very interesting...

To be continued.

Runner's Knee - part 4 , The Knees Strike Back

My continuing saga with "Runner's Knee"...

In Part #1, I declared myself cured from 20+ years of "Runner's Knee".
In Part #2, I enumerated the my long and painfully stupid search for the cure.
In Part #3, I announced that the cure was "small steps".

Now, in Part #4, I retract all that. I was wrong, I am not cured.

A case of 3rd degree runners knee.
In this stage, the knees begin to bleed.

This year the old Runners Knee came back with a vengeance, but I was in denial.
How could I have it again? I was cured! I had it all figured out with the "small steps"!

It had to be something else.

So back in May I went to the same doctor I went to in 2006, the previous time I had quit running because of knee pain. He gave me the same diagnoses as he did back then: Chondromalacia

He said physical therapy would not help me. Instead his recommended treatments were...

Bullshit, in a pill form

Glucosamine Chondroitin
Here is the conversation I had with the doctor. For the sake of brevity, I am paraphrasing.

Doctor: "I highly recommend you take Glucosamine Chondroitin, it helps people with your condition."
Me: "But from what I have read, all the legitimate studies have concluded it is no better than placebo."
Doctor: "True, but we have the really good stuff that requires a prescription. It must work better because it is way more expensive than the over-the-counter kind. And we sell it here!"

More expensive Bullshit, injected directly into the knee

Hyaluronan Shots 

Doctor: "I highly recommend you also get Hyaluronan Shots, it helps people with your condition."
Me: "But from what I have read, all the legitimate studies have concluded those shots are also no better than placebo."
Doctor: "But we sell the Othovisc brand, which does work, because the drug company says it does. Plus we give it to professional hockey players and they say it works for them.

Knee torture

Arthroscopic Surgery
Doctor: "If those  drugs don't work, then we can do surgery to smooth out the cartilage under your knee cap."



Cortisone Injections
I had not run at all for 3 weeks, yet my knees were still killing me. They did not seem to be getting any better, it still even hurt to walk. Since I am not a fan of placebo treatments, I opted for a drug that actual does something: Cortisone.

Unfortunately it did absolutely nothing for me. A few days after the shots, I tried to run the result was the same. I hobbled home after a half mile.

There just had to be something seriously wrong. So I sought out another doctor.

Getting fitted for skinny jeans

Doctor #2
Again I am paraphrasing, but this is what Doctor #2 told me:

• You have Chondromalacia, which is a fancy name for arthritis. There is really nothing you can do for it.
• If it hurts to run, then don't run.
• Glucosamine Chondroitin is bullshit
• Hyaluronan Shots are even more expensive bullshit
• "Cartilage smoothing" is an absolute last resort, and the success rate is near zero
• Your right quad is like half the size of your left, what the hell did you do to it?
• I am prescribing physical therapy, which we sell right here in the building

To be continued...

Chondromalacia

Blogging Marathon Day #8

OK, so I diagnosed with "Low grade chondromalacia"

Doesn't feel low grade. Ever since the marathon, even walking downhill hurts.

While it is good that they did not see anything serious in the X-Ray and MRI, I am still left scratching my head with what to do about it.

The explanation they gave me is that I am simply defective. My knee cap does not track properly so when I run it grinds up the cartilage underneath.

This is the same thing they said back in 2006. So they prescribed PT, orthotics, and stretching.
(See runner's knee post). None of that really worked for me back then.

The thing that doesn't make sense is this:

If I am defective and my knee does not track properly, then why did my knee pain decrease from 2007-2010 as  my mileage went up?

Diagnosis

Blogging Marathon Day #7

X-Rays. Cartilage looks OK there. Little bit of a groove worn in on the outside of the kneecap.

MRI from 2006. The neglected to send the me the records from the latest test.

Diagnosis: Low grade chondromalacia.

Hmmm. Sounds right, but why did it come on all of the sudden?

A Knee Recap

Blogging Marathon Day #5

Running mileage and knee craptitude 

Well it's time for me to figure out what the hell happened to my knees, and what I can do about it.

For those of you who are healthy, this will be dull. But runners suffering from knee pain may get something useful from my experience. Der Scott just posted about his triumph over knee failure, which made me hopeful that I can recover from whatever is ailing me.

So let's look back to figure out what happened. Much of this is enumerated in a previous post here.

Before 2000
I ran sporadically. Never more than 3 miles, and never two days in a row. If I tried to run any more than that my knees would hurt like hell. I just assumed that was the way it was.

2000-2003
I found I could run for a longer time if I was out on the single track trails. I just figured because it was a softer surface. Still never two days in a row.

2003-2005
I ran my first race ever in 2003, after my sister talked me into it. I met Shannon and she talked me into running more races, and even a few marathons. I bumped up the mileage and started running more and my knees got correspondingly more painful. After the Salem Lake 30K in 2005 my knees swelled up like balloons, and filled with fluid.

2006
I quit running for about a year, and sought professional help. They diagnosed it as "runner's knee" and recommended stretching,  strengthening, and orthotics. None of which seemed to help.
One doctor recommended lateral release surgery, which I declined.
I went to another doctor at Raleigh Orthopedic. After an MRI, he told me that there was nothing really wrong with my knees, and I could run if I could take the pain.

2007-2010
I started running again while icing my knees all the time and taking a lot Advil.
For some reason, my knees seemed to get better the more I ran. I stopped icing, pill popping and stretching, and ran more than 2000 miles in 2009 and 2010.

In February of 2010 I declared myself cured of "Runner's Knee". I thought I had it solved with "small steps".

Satan makes an appearance
In the fall of 2010, I was running my fastest times ever. I did a 3:02 marathon in Detroit, and followed it up with a surprising 1:23:58 in the City of Oaks half. I was feeling good.

But of course, the following week I had to push it too far.
In a single week, I ran 75 miles which included: a hard race at Raven Rock, some training runs, a PR at the IO Turkey Trot, and finished up with the Faust Marathon, where I had to give a tendon to Satan in order to finish.

I was never the same after that. I hobbled through December, trying to get some miles in for all the big races in 2011.

2011
In January, I finally got over the tendon problem, and tried to cram in an 80 mile training week for Uwharrie, which was a bad idea. I pushed myself as hard as I could in Uwarrie but missed my goal by 5 minutes. Shannon did awesome, of course.

The week after I was battered and broken. Both of my knees were wrecked. Not under the kneecaps like with the "Runner's Knee" before, but instead it seemed to be the tendons in the back, on the insides, and down the shin.

I hobbled through the next months. I did not do much running during the week, but instead rested for the races on the weekends. I had to take Tylenol to get me through the races, and I managed to do pretty good.

However, after every race I felt worse. My right knee was making some horrible crunching and popping sound every time I bent it. Sometimes it would be a stabbing pain behind the knee that left me limping. A couple times it suddenly "gave out" and buckled for a second.

Obviously I needed to take a break. But the strange thing was that when I would take an entire week off, my knees felt worse, not better. It felt like some strange disease radiating and spreading out further from my knees.

Circling the Drain
I went back to the same orthopedic surgeon I had seen in 2006, who had told me to go ahead and run.

I wanted to see if it was something really serious, if I had done some damage or if I just needed to take a break. 

I told him how I was running less and less, but my knees seemed to be getting worse. His reaction was not encouraging: "Wow. You're really circling the drain," he said.

The X-Rays showed no major problems, but we would have to schedule a $2000 MRI for a diagnosis. In the meantime he recommended two expensive placebo treatments, glucosamine and hyaluronan injections.

I declined both of those  (I will do a post explaining why), and opted for sacrificing a chicken. I went over to Bospherous and got the chicken kebab.

How about a Marathon?

So at the end of May, Shannon and I were signed up for the Bayshore Marathon. Shannon was really looking forward it, I was not.

I was unable to even run a mile without either severe pain or taking a handful of Tylenol. In the previous 3 months, the only "long" runs I had done was the Owls Roost Half marathon and the MST 12 Miler.

It seemed insane that I would try to run it. Still, my sister and Shannon would hear none of it.

"Oh, you can do it! You will probably PR!"

Next: The Bayshore Marathon race report.

Runner's Knee Cured - part 3

In Part #1, I declared myself cured from 20+ years of "Runner's Knee".
In Part #2, I enumerated the my long and painfully stupid search for the cure.

Now, I will reveal what the ridiculously simple two word cure is. Drum roll please...

small steps

That's it. I take small steps when I run. In other words, I shortened my stride.

NOT the cause of the problem
Here is a short list of the "sports medicine experts" mis-diagnoses:

• flat feet
• tight hamstrings
• improper tracking kneecaps
• overpronation
• bad "Q-angle"
• weak quads
• tightness of the "lateral retinaculum"

All complete bullshit.

The cause of the problem
The root cause was that I:

• over-strided and landed on my heels when I ran

This is actually a very common mistake, particularly among recreational runners like me who never ran cross-country or track. In retrospect it seems so obvious, and why the "experts" didn't think of it is mind boggling.

Now, I am sure that some smart ass barefoot runner will tell me "if you had ditched your shoes and ran barefoot, you would have solved that problem."
And unfortunately he would be right. The damned cushioned shoes that I thought would alleviate the problem were actually allowing it and even encouraging it.
I wish I would have tried barefoot, a long time ago. Instead...

How I found the solution
By accident.

I had given up searching for a cure to my Runner's Knee, and resigned myself to a lifetime of pain, stretching and ice bags. That is until last month when I realized my Runner's Knee was gone.

I had to look back to figure out what changes I had made to understand the cure:

My accidental cure for Runner's Knee
	Change	Year	Cost	Result
	More Trail Running	2005-	$230,000	Smaller steps
	In 2005, I searched for, and bought a new house. The #1 criteria was that I had to be able to run out my front door and into Umstead park. Since then, I do about half my miles on single track trails. I had thought that trails were easier on my knees because of the softer surface. WRONG. It is because the roots and rocks forced me to take smaller steps. Trying to stay balanced on the uneven trail taught me to land with my foot directly beneath me instead of on my heel in front of me.
	Biking	2006-	$(Embarrassed to admit)	Smaller steps
	I started biking in 2006 when I quit running for a year, and have since been using it to supplement my running. I started to noticing that the more I biked, the more I could run. When running fast down a hill, my feet would spin in small circles instead of bounding down with long strides. The pedaling trained my legs to take smaller steps. The PowerCranks might have had something to do with it (but my experience with PowerCranks requires it's own epic blog post, complete with tragedy, humiliation, and the triumph of human will).
	No stretching	2009-	$0	Smaller steps
	I used to stretch my hamstrings before, after, and sometimes in the middle of a run. Everyone told me that tight hamstrings were bad, and that I had to stretch. But over the last few years I have stretched less and less, and my knees and hamstrings felt better and better. I now do zero stretching and can run more miles, at a faster pace, than I ever have before. My hamstrings are very tight now, and I can barely touch my knees let alone my toes. The result is a much shorter, quicker stride... smaller steps.
	Less shoe	2009-	$89	Smaller steps
	While my Red Shoes are far from minimalist, they are much less than what I had been wearing. These are quite different than the orthotics and motion control shoes that the "experts" had prescribed. They are light weight and very flexible. There is no stiff "support" or "motion control" features, and I can easily fold them in half. After I took out the cushioned insert, it feels like I am standing flat on the ground instead of on a wedge like all my other shoes. It feels much easier to move my feet fast, and they seem to encourage smaller steps. My next pair of shoes will be even less, and maybe barefoot soon.

Well, that's my Runner's Knee story. The whole thing has left me disillusioned and even angry with the whole "Sports medicine" and running shoe establishment.

The fact that an orthopedic surgeon was ready to cut ligaments in my knee to solve my poor running form sounds like something straight out of the dark ages of medicine.
And the only thing hamstring stretching ever did was give me horrible hamstring pain.

In any case, I am now enjoying running a lot more than I ever have. I only wish I could go back 20 years, slap myself up the side of the head and say:

Small steps.

Runner's Knee Cured - part 2

As I was saying in Part #1, my 20 year bout of "Runner's Knee" has been cured by a simple and obvious two-word solution.

But in order to fully appreciate the two word punchline, I must tell the joke first.

Below is a recounting of my 20+ year epic quest, enumerating the time, pain and money I have spent searching for a cure.

In search of a cure for Runner's Knee... All the things I tried that did NOT work
	Treatment	Year	Cost	Result
	Low mileage	1988-2001	$0	Pain and sadness
	Most of my life I was limited to running 3 miles, about 3 times a week. Any more than that hurt my knees too much, and never could I run two days in a row.
	Cushioned shoes	1991-2009	$1500+	More pain
	"Running causes impact forces of 1000 times your body weight with each step! Equivalent to a Hummer falling from outer space!". I was convinced that my knee problems were due to this unavoidable pounding that running puts on your legs. So I kept searching for ever softer, thicker shoes to cushion the blow. Didn't help.
	TRUE Treadmill with S.O.F.T. suspension	2001	$4000	Crippled
	Based on the price only, this just had to work! Plus it said "SOFT" right on it, it couldn't possibly hurt my knees! After it was delivered I ran 6 miles on it, 3 days in a row. After the 3rd day, my knees had swollen up and I could barely walk.
	CHO straps	2002	$50	Cursing
	This supposedly stabilizes the kneecap and keeps it tracking "correctly" These things would fall down every every two minutes, and i would have to stop running and readjust them. So I guess they way they worked was by keeping you from running very far.
	Motion Control Shoes	2003	$120	OW!
	I have flat feet. The "wet paper bag test" revealed two amorphous round blobs for my foot prints. "You are an overpronater. That causes Runner's Knee", said the running store salesman as he sold me "motion control" shoes. When I tried to run in them, they felt like bricks strapped to my feet. Clunk, "OW!", Clunk, "OW!" Instead of my usual delayed, obtuse knee pain, this was sharp and immediate. I put these on the shelf after 5 miles.
	Magnets	2005	$25	Secured shopping list to fridge
	OK, I didn't actually try magnets. But Shannon had a knee wrap that had an ice bag and magnets in it, and she said I should try it. "Magnets? To cure knee pain? How stupid and unscientific that is!", I scoffed, reaching down to pull up my CHO straps.
	POSE method	2005	$0	Confusion
	I had heard that this "POSE method" was a running cure-all. Makes you injury free, faster, smarter, better looking, etc. Something about landing on your forefoot instead of your heel, which no one on earth had ever done until this"Dr. Nicholas Romanov" discovered it in his crazy running lab. Landing on my forefoot seemed simple enough, and I didn't understand why I would need to pay for books, videos, and classes to do it. So I tried it on my own for a few days. Unfortunately, the result was that I was sprinting down the street and never made more than 100 yards. So I gave up. I figured if "POSE" really was a panacea then wouldn't more people be doing it?
	Stretching	2005	Intense pain	Stopped running for a year
	I was next told that my runner's knee was caused by my tight hamstrings, so I stretched my them constantly and forcefully. Eventually I was flexible enough to put my palms on the floor. Convinced that this meant I was cured, I ran the Salem Lake 30K, bounding along with my new elongated stride. Afterwards, however, both my knees filled with fluid, swelling like balloons. My hamstrings were so painfully inflamed I could not sit down. Thinking that I had done some permanent damage, I quit running, and sought medical attention...
	Sports Medicine	2005-2006	$1000	More pain and suffering
	Went into Cary Orthopedic "sports medicine specialists". Surely, they would have the answers. The orthopedic surgeon evaluated me, and I swear, laughed out-loud when he saw how inflexible my hamstrings still were. I was diagnosed with "Bilateral Patellofemoral Syndrome"(or "Knee pain"), caused by weak quads and tight hamstrings. Prescribed physical therapy guided by a trained professional, I did copious amounts of leg strengthening and stretching exercises.
	Resting	2005-2006	Incalculable	Got worse
	I quit running for an entire year while doing physical therapy. Despite all the stretching and strengthening, my knees never got any better and in fact seemed to get worse. And so did my hamstring pain. Both ached horribly just from sitting in chair. I was now convinced there was something horribly wrong with my knees, and I went back to the professionals...
	Custom made orthotics	2006	$400	Anger
	The wizards at Cary Orthopedic made me some orthotics, custom molded to my feet. I was so happy, and couldn't wait for a run. I slapped them in and took off down the street... and stopped after 100 yards. "The orthotics are so thick that my heels are coming out of my shoes. What do I do?", I asked the therapist. He scratched his head, "Gee, I never heard that before." I had to buy yet another pair of shoes that would fit the orthotics. I tried again. It was bizarre to run in the orthotics. They immobilized my feet, preventing any motion, like running with my feet in casts. Clunk, "OW!", Clunk, "OW!" After 5 runs in them I put them with the motion control shoes, cho straps, and "body ball" which were piled on top of the treadmill.
	Lateral release surgery	2006	$?	Very close call
	Desperate to start running again, I went back to the orthopedic surgeon. He said my "Q-angle" was off, and that my kneecap did not track properly. There was a surgery called "lateral release" which would cut a ligament to fix the problem. I went home to think about it, then came back a few days later to start the process. After stuck in the waiting room for 2 hours I got pissed and left. What a lucky break that turned out to be!
	Second opinion	2006	$500	Hallelujah
	Went to another orthopedic surgeon to get a second opinion on the surgery, and he took an MRI of both knees. "There is nothing wrong with your knees. If you can stand the pain, go ahead and run."
	Ice Bags	2007	$300	Cold knees
	I started running again, more than ever before. I still didn't know why my knees hurt, but if it wasn't causing permanent damage, I didn't really care. So I bought about a dozen fancy expensive cold packs and iced my knees all day, everyday. I even had some at work and wore them in my cubicle. I resigned myself to doing this for the rest of my life.
	Bulk Ibuprofen	2007	$15	Horrible Auto-immune disease?
	I also took handfuls of "Vitamin I" to keep the swelling down. Around this time I starting having some other strange, unexplained health problems (I won't bore you with details), which might have been due to long term use of the little brown pills. I don't touch this stuff anymore.

OK. That's about everything I tried that didn't work.
I'll finish up with what did work in the third and final installment
(Most of the photos above were stolen from the Internet, without permission from anyone. Sorry.)

Runner's Knee Cured - part 1

I have been running for over 20 years, during which I have suffered from a chronic case of Chondromalacia patella, or "Runner's knee"
That is until today, because I am declaring myself cured.

Symptoms of "Runner's knee":
1. Aching, throbbing pain directly underneath the kneecap
2. Hurts when you first start running, then goes away somewhat as you warm up
3. Painful when sitting for long periods.
4. Never seems to go away, no mater what you do

Here is the basis for declaring myself cured:

• Just a couple years ago it would take lot of ice bags, stretching and ibuprofen to run 100 miles in a month.
• Last month I ran over 200 miles, followed by a 37 mile trail race, without any knee pain, ice bags, stretching or ibuprofen.
  

If you suffer from this, you may be asking "HOW?! What did you do? What's the secret?"
The answer for me was so utterly simple that I am embarrassed to admit it. The amount of time, money and pain that I have squandered seeking such a simple answer qualifies me as a moron of the highest (or lowest) degree. But I am not alone in my stupidity, as I join the ranks of:

• podiatrists
  
• physical therapists
• "sports medicine" specialists
• orthopedic surgeons
  

All of whom have attempted and failed to cure my knee pain. And lets not forget the source of the bad advice and wrong information that I blindly followed:

• Runner's World
• Shoe companies
  
• Running store "experts"

Before I reveal the simple, two word answer of what worked for me I must make the standard disclaimer: accept this "cure" as anecdotal evidence only.

I am only making claims about my case of "Runner's Knee". Maybe the above "experts" are right about everybody else, and you should follow their 15th century torturous treatment plans that are backed by the same amount of scientific evidence as blood-letting, fire cupping, and drilling holes in people heads to let the daemons out...

Oops. Have to go to work. Continued in part #2