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Injured - help!

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Injured - help!

Post  JohnP on Mon Oct 29, 2012 10:47 am

This is not a post I want to write three weeks out from my goal marathon. But my left knee has really gone bad and it's very frustrating. I think I know what caused this but my main goal is to see how to heal this while not losing fitness. This is not a marathon I wanted to run just to run but to go for a PR. The pain in the knee is all around it, and the calf and ankle were swollen up a bit but there is no pain on any bone so I've ruled out any stress fracture. With ibuprofen, ice, compression, and some rest, I've managed to get it down somewhat.

So my question is are there any other remedies people know of for this, or some advice? I feel I am in really good shape runnnig -wise but am not willing to take three weeks of rest before the marathon. My plan is to do three runs a week - all hard runs like a tempo, interval, and long - and skip all short and recovery runs giving me 3-4 complete rest days a week. SHould this help, and what other advice is there?

My problem is not overtraining - I looked at my logs and while I have 2,170 YTD miles this year, two years ago I had 2,106 at the same time (I don't have last years with me). I haven't had any running injuries in 2.5 years (other than taking a spill last winter in the snow/ice and hurting the same knee).

While I ran Chicago three weeks ago, I have run marathons three times in the past before a goal marathon and never had an issue with it. One difference this time was running the first 16 at pace then taking it easy the rest of the way. One other training change was adding hillwork recently.

I think this is the cause: Normally I replace running shoes every 250 miles or so. After reading "Born to Run" earlier this year, I decided to let my shoes last longer. So most of them had gotten to 300-450 miles without any issues. Mostly I wear neutral shoes (Brooks Ghost, Asics Gel Nimbus) but I also wear a stability shoe (Nike LunarGlide+). Right before Chicago, I ordered new shoes and used the Nike LunarGlide for the marathon. After wearing shoes with 300-450 miles, I think the shock of wearing new shoes (it was also a new model) of the most stable shoes I use did my knee in.

Any thoughts as to what might have caused this, or help to get better quickly? Thanks.
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Re: Injured - help!

Post  mul21 on Mon Oct 29, 2012 11:22 am

I had a minor knee issue early in the training cycle and was able to run through it by wearing a knee sleeve when I wasn't running to give it a little extra support. That and ice/NSAIDs fixed me up after about 2 weeks. Hope you recover!
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Re: Injured - help!

Post  fostever on Mon Oct 29, 2012 11:30 am

I was getting some knee pain during my build up along with my calf and weak ankle on my left side. I used my compression tights for most of my runs when it was cool enough during the taper and it seemed to ease it a bit. I never use Ibuprofen or acetaminophen because from what I've read it can actually slow the healing process. My whole left leg: hip, calf, ankle, and sometimes the knee is a continual problem area. I maintain it with active isolated stretching. I'd say back off even the tempo stuff for 3 days and maybe get on an elliptical or bike to maintain fitness until you resolve the issue since swelling is a sign of some serious issues. You might want to see a sports doc, podiatrist. Hope you get there in one piece, John!
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Re: Injured - help!

Post  KBFitz on Mon Oct 29, 2012 2:56 pm

This is not a post I want to write three weeks out from your goal marathon.

Well, it's not that bad. I just wanted to be cheeky. From where I sit, it appears that your issues may well be coming from the added intensity (added hill repeats) and using new shoes in a long sorta intense effort. The swelling in your ankle & calf do concern me as does the pain all around your knee (sounds fluid build-up as well but may not be).

Rx: do NOT push it. Lose all intensity during your taper. Consider your training complete. You may throw in a few strides during easy runs to keep you sharp if you wish.

Note that I'm not a doctor. Nor do I play one on TV. I have not examined your symptoms. But we're both runners and we're both getting old. I've been there - knee and calf issues not bone related. Mine pains stemmed from intense hill repeats and using shoes well beyond their service life. I changed shoes, used compression sleeves and stepped back. The issues cleared up in less than two weeks.

In addition to compression and icing (knee, ankle and calf), rotate your between ibuprofen and naproxen sodium. Why? They're both NSAIDs but they work through different pathways. So confusing your body by rotating them gives you more anti-inflammatory action than straight ibuprofen or straight naproxen. As an example, I take 400mg ibuprofen (two tablets) on one day and then 220mg naproxen sodium (one tablet) the next day to counter the inflammation in my right ankle.

Good luck in Phila. My best regards to Carol.
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Re: Injured - help!

Post  Michele "1L" Keane on Mon Oct 29, 2012 3:19 pm

I agree with Kev and I can relate as well. I might also suggest looking into tapping the knee (search on runner's knee) as that may assist along with the compression, ice, ibuprofen/aleve. I know that part of my achilles issue was brought on by trying to see if I could get more mileage out of shoes and orthotics - I paid for it. Rest is better than you think, even at this point, John. You really won't lose as much as you think.

One other thought - are your quads overly tight? This can cause pulling on your knee and it can also be felt in overtight calves. Tight quads could be a result of hill work. One thing that helps me with quads are doing leg raises. If I don't have access to a gym, I actually strap a 5lb weight around my ankle and do lifts off the end of a chair.
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Re: Injured - help!

Post  Chris M on Mon Oct 29, 2012 3:20 pm

I would do COMPLETE off from running for six straight days ending one week out from race day. Do some eliptical or bike to get some exercise in at most but I would go for 0 miles running during those 6 days. Then on the Saturday before the race, I'd do a 4-6 mile run easy and see how I feel the next day. If good, I would do 10 with 4 at GMP one week out from race day and then an every other day schedule into the race itself. Rest is best. Ryan Hall just went 4 weeks without logging a single mile - that's the only way to truly heal.
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Re: Injured - help!

Post  JohnP on Mon Oct 29, 2012 11:37 pm

Hey all, thanks for your comments, you've given me some hope. I did not know about the Naproxen and will pick some up tomorrow to alternate. I wouldn't mind seeing a doc but I think he would do an xray, then want an MRI, then tell me to take a month off and I'm trying to avoid that. I am also concerned about the swelling in the leg and have to hope the extra rest and NSAIDs can take care of that.

Michele - the quads and hammies are not tight. This is all pain around the left kneecap and downwards from there from the calf to the ankle. I hear the message about taking it easier and am going to figure how I can do that.
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Re: Injured - help!

Post  Michele "1L" Keane on Tue Oct 30, 2012 9:03 am

Any pain to the touch in the calf??? I don't want to alarm you, but that can be a sign of a blood clot.
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Re: Injured - help!

Post  JohnP on Tue Oct 30, 2012 9:21 am

Michele "1L" Keane wrote:Any pain to the touch in the calf??? I don't want to alarm you, but that can be a sign of a blood clot.

You know, I've been reading about the fluid build-up and they keep mentioning a blood clot as a reason. I guess because I have no history of them, and this all happened seemingly as a response to either the shoe situation or the increase in training intensity, that I figured it wasn't a clot. There's no pain to the touch in the calf. There is just a lot of tightness in the one calf and when I massage it, it hurts but it feels like it's a large knot working its way out. Today, I'll look up the clot thing a little more, that would certainly be bad news if so but I am thinking not.
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Re: Injured - help!

Post  Dave-O on Tue Oct 30, 2012 11:45 am

Can you get to a doctor and get prescribed a steroidal anti-inflammatory, such as methylprednisolone? I've done the 5-day dose in the past and they work fantastic (not a banned substance under WADA with Dr. prescription).

Other than that, ice the crap out of it. Also, while recent studies haven't find much of a tangible benefit to compression sleeves for recovery, I feel like they work. And they certainly can't hurt.

Good luck and keep us updated!
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Re: Injured - help!

Post  Michele "1L" Keane on Tue Oct 30, 2012 11:52 am

If it is a knot, roll the calf over a foam roller. Stop and apply pressure each time you get to a spot that really hurts and let the knot subside. I get weird notes in my calves all the time, and this works.
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Re: Injured - help!

Post  mountandog on Sun Nov 11, 2012 7:55 am

John - knee issues suck. period. full-stop. I am struggling with one right now as a result of the R2B marathon a couple of weeks ago. Brand new, previously non-experienced pain. My sports ortho (knee specialist by the way) always recommends 1) cut back mileage at least 50% 2) Ibuprofen 3 times per day for a week to 10 days - it takes time to build up in the bloodstream 3) Ice. If after two weeks there is no appreciable improvement, then its time for a more thorough exam - xray, mri, etc. I've had bouts of various tendinitis and this seems to do the trick. Just started this protocol yesterday as my usual post marathon reverse taper has not helped.
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Re: Injured - help!

Post  amyjoann on Mon Nov 12, 2012 7:22 pm

Is pool running an option for you? It's no impact but a great workout,you literally run in the pool in the deep end you may need a float belt but it's just like running. The blood clot mentioned scared me, my husband had one,and it got real bad before we realized it have you had any trauma or procedure done that may cause one ? I hope you recover

Amy
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Re: Injured - help!

Post  Julie on Mon Nov 12, 2012 10:55 pm

My knees get injured whenever I let my shoes go too long, too. Ice, ibu like already mentioned, also maybe look into Kinesio taping or some other form of support. It did help mine and I've worn the K tape for long runs and my last 2 marathons since my PT showed me how. Also, some stretches, I can look mine up if you want (their official names) but the one where you lie on your back and have your ankle over your opposite knee and pull forward is an awesome one for me...I really hope it heals soon and you can run a good marathon. I would take at least 3-4 days completely off.
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Re: Injured - help!

Post  JohnP on Wed Nov 14, 2012 3:16 pm

I thought I'd give an update, thanks for all the thoughts and ideas. I'm still not sure what caused this, it could have been the shoes as I thought, or the hill work I added. Looking back at the training guide, I didn't rest up enough after Chicago even though it was a training run. I've got to respect the marathon distance.

Anyway, the swelling has gradually gone down over the past two weeks and I saw a doctor last Friday. After an xray and MRI , he gave options of no running for a while, a cortizone shot, or scope on the knee. He recommended the first option. In the end after talking it through, I chose the shot. I've never had one before. He also withdrew a bunch of remaining fluid from the knee before the shot. Hopefully this will help a lot now. So assuming all goes well in the next few days, I'll plan on running Philly this weekend.
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Re: Injured - help!

Post  Julie on Wed Nov 14, 2012 3:34 pm

I hope that's what you needed and you can have a good race at Philly this weekend.
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Re: Injured - help!

Post  dot520 on Wed Nov 14, 2012 4:49 pm

Sounds like a plan. Don't go all crazy now!
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Re: Injured - help!

Post  ounce on Wed Nov 14, 2012 4:53 pm

Meloxicam 7.5 mg helps reduce swelling. It's a NSAID.
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Re: Injured - help!

Post  Kenny B. on Wed Nov 14, 2012 7:13 pm

seems like you got a hold of the situation. Now let go and run your race! See at dinner!
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Re: Injured - help!

Post  JohnP on Wed Nov 14, 2012 11:45 pm

Kenny B. wrote:seems like you got a hold of the situation. Now let go and run your race! See at dinner!

I hope I do. I was thinking a shot was like a dose of magic but I can tell it is not. We'll see how it goes, I am trying to keep the big picture in mind of wanting to run for many years to come. In any event, see you at dinner!
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Re: Injured - help!

Post  T Miller on Thu Nov 15, 2012 7:16 am

JohnP wrote:
Kenny B. wrote:seems like you got a hold of the situation. Now let go and run your race! See at dinner!

I hope I do. I was thinking a shot was like a dose of magic but I can tell it is not. We'll see how it goes, I am trying to keep the big picture in mind of wanting to run for many years to come. In any event, see you at dinner!

Well, it is kinda like a dose of magic. There's still hope since it takes several days for the full effect to set in. I hope it does you well for your marathon.
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Re: Injured - help!

Post  JohnP on Thu Nov 15, 2012 10:22 am

Tim, you are absolutely right. Last night I think the swelling and pain was from the extraction of the fluid and the injection but today, I can tell the pain is down dramatically and I can bend the knee almost normally. I'm hoping it keeps getting better and it just needed the help getting rid of the last stubborn fluid.
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Re: Injured - help!

Post  T Miller on Thu Nov 15, 2012 10:26 am

JohnP wrote:Tim, you are absolutely right. Last night I think the swelling and pain was from the extraction of the fluid and the injection but today, I can tell the pain is down dramatically and I can bend the knee almost normally. I'm hoping it keeps getting better and it just needed the help getting rid of the last stubborn fluid.

I would expect maximum benefit to be realized about 3 - 4 days after your injection. It should be perfect timing for you. Best of luck!
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Re: Injured - help!

Post  Kenny B. on Thu Nov 15, 2012 11:11 am

T Miller wrote:
JohnP wrote:Tim, you are absolutely right. Last night I think the swelling and pain was from the extraction of the fluid and the injection but today, I can tell the pain is down dramatically and I can bend the knee almost normally. I'm hoping it keeps getting better and it just needed the help getting rid of the last stubborn fluid.

I would expect maximum benefit to be realized about 3 - 4 days after your injection. It should be perfect timing for you. Best of luck!

Here Here!
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Re: Injured - help!

Post  Michele "1L" Keane on Fri Nov 16, 2012 3:11 pm

Hope the knee is good today. Good luck, John.
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