I was running. I was on the Moonee Ponds Creek trail. It travels, unsurprisingly, alongside the Moonee Ponds creek, and runs from the Docklands through the northern suburbs up towards Melbourne International Airport. It also connects to its sister trails; The Broadmeadows Valley Trail, The Western Ring Road Trail, and The Capital City Trail. My intention was to run twenty kilometers. A not undifficult distance, but one I had mandated myself. I had done so for good reason, July 28th was coming. I started strong. I had the day off, a benefit of working part time, and so had prepared well. I had had a sensible breakfast, waited the appropriate time for digestion to take place, and the days weather was cool but fair. Conditions were good.
The first kilometer I was working out the kinks, letting stiffness leave my body. The second kilometer felt good. Very good. My body temperature was low, my breathing was easy, and I was flying over the cement with the easy grace of a gazelle. Then came the twinge. The niggle. The lone forerunner sprinting to the castle to let them know trouble was just over the horizon. I did what anyone with the twin drivers of motivation and denial would do. I kept running.
Throughout the third and fourth kilometers I evaluated and reevaluated the state of my knee. The niggle had grown into something more, discomfort, but only for brief periods. Mostly, when I was going up or down an incline. On those inclines I would worry, questioning if I should stop while not really wanting to, wondering if I was doing more harm than good. Then the flats would come, the niggle would subside, and I would convince myself that everything was fine, it was just my tendons playing funny buggers; a thing they’d never done before.
My watch vibrated, letting me know the fourth kilometer was complete, whilst simultaneously informing how long it took me to run it. It was a good time. I couldn’t stop now. Definitely not. I rounded a bend in the track and headed up a slight hill. The niggle that had become discomfort now became pain. July 28th, I told myself, and pushed through the pain. I pushed through until I got to a flat, where now the discomfort continued. That was worrying. Flats were my reprieve. They were were my optimistic delusion lived. That discomfort chased my optimism away.
My watch vibrated again, telling me I had reached the five kilometer mark. Fifteen more to go. Fifteen more kilometers and who knew what state my knee would be in by then. But, July 28th, I told myself. Won’t be possible if you damage your knee beyond recovery now, a second voice said. That second voice sounded somewhat like my wife, who, when it comes to my limits, is more realistic and knowledgeable than me. It’s a good voice to have in my head beside my own. I let my momentum stop along with my watch. On the five kilometer walk home my knee continued to be uncomfortable and sore. It would prove to remain this way for many days to come.
Runner’s knee is a generic term used to describe a number of overuse injuries that result in pain around the kneecap, also known as the patella. The most common form of runner’s knee is called Patellofemoral Pain Syndrome or PFPS. It’s what I have/had and involves pain around the fat pad beneath the patella, the synovial tissue lining the knee joint, and the surrounding tendons. In other words, pain in front of, around, and beneath the kneecap. You can see why it’s the most common.
As suggested earlier, runner’s knee generally comes from overuse. In my case this is one hundred percent the reason. Just a few days before it’s onset, my wife — the one who’s voice exists not only inside my head but also outside it — had wisely suggested I cool it a bit on the running. I had been going hard. Monday’s involved a ten to fourteen kilometer run. On Wednesdays it was a “gentler” eight kilometers, before the big one on Friday, which would range anywhere between fourteen to twenty kilometers. I was also riding to work throughout that week, as well as going for walks during the day. I had been completing this routine for around a month, building up that longer Friday run until now, when I was set to complete the twenty. I’ve since learned my wife’s advice had already come too late, as runner’s knee presents around two weeks after the initial overuse.
The kneecap is different to a lot of the rest of your body, in that it floats within the knee. When not floating it rests within its home, called the trochlear groove. Then it’s able to slide up and down within the knee as you sit and stand and flex and bend. What helps with all this sliding and floating is articular cartilage, which is a slippery substance. There are also fluids and fat pads that help with the lubricating and cushioning. It’s a fairly robust system — unless you overdo it. Then comes inflammation, soreness, and a certain amount of hobbling when faced with stairs.
There a number of ways to treat runner’s knee. Icing it is an excellent first step, and second, and third, and fourth, and fifth. This is because it’s a good idea to ice the knee up to five times a day, for around fifteen minutes at a time. Compression and elevation also helps, as does taping and bracing the knee. Then there’s the one major treatment that is all but mandatory when faced with runner’s knee. Rest. On one website that I went on in researching this affliction, it asked the question, “Can I run with runner’s knee?” The answer was, “In short, no.”
I kept running.
Well, sort of. I had a week and a half off, and then I was back to running through the pain. That week and a half did do some good, as, even with me still running, the pain was less than it had been, and the recovery the days after a run seemed quicker. I did an eight kilometer run, then a ten a week later, then tried again for the twenty a few more days after that. This was not a good idea but July 28th was coming and I knew without the mental knowledge of doing that twenty I wouldn’t survive. I completed the twenty without too much trouble. It hurt at times, yes, but less so than on that first day. Given everything, it was pretty good. The next morning was a different story. The inflammation was well and truly back, not that it had ever truly left, and the stairs at work proved to be a mighty milestone I was proud to overcome. I iced it and elevated it and the day after that it felt pretty good again.
I did one more six kilometer run before July 28th, and this pattern repeated itself.
July 28th came. The day of Run Melbourne, a half marathon which weaves through the heart of Melbourne CBD, and that I had signed up for nearly six months prior. Twenty one point one kilometers of track that I completed with a persistent discomfort in my knee and began to pay for just over two hours after crossing the finish line. Beyond that the run itself was, surprisingly, rather pleasant.
I don’t usually give ratings when I do reviews but if I did I wouldn’t rate runners knee all that highly; but then I would also have to admit that its onset and continued existence was entirely due to the choices I made.
Choices tell us a lot about the people making them. They tell us about that person’s motivations and their desires. They tell us about that person’s faults and fears. They can, when looked at from a point of distance, tell you things about yourself you might not have known or recognised previously.
Most treatment plans for runners knees suggest four to six weeks of non-aggravating activities, coupled with strength training exercises, and namely, not to ignore the pain. July 28th was five days ago, so now that’s what I’m choosing to do.
I went for a walk today on the Moonee Ponds Creek Trail. I had a sensible breakfast, waited the appropriate time for digestion to take place; the weather was cool but fair.
Conditions were good.
Talk soon,
Damian
