Knee Injuries identified.

I had a physio session today to work specifically on my problem knee. I explained the pain and he did a few tests to identify the problem.
I'll post a couple of descriptions I've found. Firstly he showed me I had muscle wastage on my right VMO (Medial muscle just above knee cap on the inside. He measured the circumference of both legs above the knee and the right one was 1cm less. It's also really obvious when you look at it. My lef leg has a distinct bump where the muscle is developed, the right one has lost it's bump totally. Apparently this muscle wastes away very quickly when you have a knee injury.

Anyway, after a further test he diagnosed the following.

Runner's Knee
(Chondromalacia of the patella)

Description:
Pain around and sometimes behind the kneecap. One of the most common injuries among runners, runner's knee most often strikes as runners approach forty miles per week for the first time. Even after taking a few days off, the pain seems to come right back, sometimes even intensifying, after the first few miles of the next run. The pain often feels worst when running downhill or walking down stairs, and the knee is often stiff and sore after sitting down for long periods. You might hear a crunching or clicking sound when you bend or extend your knee.

The sure-fire test for runner's knee: sit down and put your leg out on a chair so that it's stretched out straight. Have a friend squeeze your leg just above the knee while pushing on the kneecap. She should push from the outside of the leg toward the center. At the same time, tighten your thigh muscle. If this is painful, you're looking at runner's knee.

Likely causes:
It's actually not your knee's fault at all. Blame your feet and thighs; for one reason or another they aren't doing their jobs properly. Your knee moves up and down in a narrow little groove in your thigh bone. It's a nifty design: when your legs and feet are working efficiently, your knee moves smoothly and comfortably with every step. But trouble appears when your kneecap moves out of its track, or rubs up against its sides. That trouble becomes pain when you factor in nearly 1000 steps per cartilage-grinding mile. Over time the cushioning cartilage around the knee becomes worn. That smarts. And that's runner's knee.

How did your knee get off track? Probably because of relatively weak thigh muscles and a lack of foot support. It's your thigh muscles that hold your kneecap in place, preventing it from trying to jump its track. Running tends to develop the back thigh muscles (hamstrings) more than those in the front (the quadriceps), and the imbalance is sometimes enough to allow the kneecap to pull and twist to the side.

Your foot, meanwhile, may not be giving you the stability you need. It's likely that your feet are making a wrong movement every time they hit the ground, and you're feeling the constant pounding and repetition of this mistake in your knee. Maybe you're overpronating (rolling your foot in) or supinating (turning it out too much) when you run.

Runner's knee is further aggravated by simple overuse. If you have steeply increased your mileage recently, you might consider holding back a bit. Likewise, back off on new hill work or speed work. Runner's knee can also be brought on by running on banked surfaces or a curved track. Running on a road that is banked at the sides, for example, effectively gives you one short leg, causing it to pronate and put pressure on the knee. Try as much as possible to run on a level surface, or at the very least give each leg equal time as "the short leg."

Remedy:
This is an easily treatable injury with a little patience. First, relieve the pain by icing your knees immediately after running. You can use commercially available cold packs or simply put a wet towel in the freezer before you run. Wrap the cold packs around each knee for about fifteen minutes to bring down the swelling. Take an anti-inflammatory like ibuprofen or aspirin after running, too, but only with food and never before running. Before bed, put heating pads or warm wet towels on your knees for half an hour.

Stabilize your feet. Make sure you have the right kind of shoes for your foot type (review our tips on shoe shopping). Consider buying a commercially made foot support in the footcare section of your drug store. If, in combination with thigh-strengthening exercises, the foot supports are not enough to get rid of the injury, see a podiatrist about whether you might need orthotics.

Ok, so I have runners knee. I can't describe how much the test hurt. Pushing down on that kneecap was agony. He worked my knee for a half hour or so, but then identified what he thought was the underlying cause. When I run I have been getting pain in the side of my knee, and also some deep in my hip. When he rubbed over the side of my knee it hurt worse than the kneecap almost. Turns out that this is your ITB (See description). It runs right up your leg, widening, until it reaches your hip. Full description here:

Iliotibial Band Syndrome

Description:
Pain on the outside of your knee (not usually accompanied by swelling or locking). The pain may be sporadic and disappear with rest, only to reoccur suddenly, often at the same point in a run. Depending on the individual, this could happen at four miles, two miles or just 200 yards. The pain often goes away almost immediately after you stop running.

Likely causes:
This is an overuse injury. The iliotibial band is a band of tissue that begins at the outside of the pelvis and extends to the outside part of the knee. The band helps stabilize the knee. If it becomes too short, the band rubs too tightly on the bone of your leg and becomes irritated. The tightness is usually the result of too much strain from overtraining.

Remedy:
Patience. This one takes a while. Give yourself plenty of rest, reduce your miles and ice frequently. You can keep running, but cut your run short as soon as you begin to feel any pain. Cut way back on hill work, and be sure to run on even surfaces. Look into some deep friction massage with a physical therapist.

Try some leg-raise exercises to strengthen your hips and be conscientious about the iliotibial band stretch. You might supplement that stretch with this one, doing it gently but often:

To stretch the IT band of your right leg, stand with your left side facing the wall. Cross your right leg behind your left, while putting your left hand against the wall. Put your weight on the right leg and lean against the wall by pushing your right hip away from the wall. Be sure that your right foot is parallel to the wall during the stretch. You should be able to feel the stretch in your hip and down the IT band (in this case, along the right side of your right leg). Hold for five seconds and do this ten times. For the left leg, do as above, but stand with your right side facing the wall, and put your left leg behind your right.

He finished up with Ultrasound, and I've booked in for next Tuesday.

He has given me all of the strecthes to do every day, several times, and also instruction to ice it 3 times and day, and take Ibuprofen for the next week.

He's pretty hopeful he can get me to the start line if I follow the routine. I can see me downing ibuprofen on the start line to get around.

So, I'm settling for a finish, and not a 4 hour finish. I need to rest my knee as much as possible, and if I do (or can) run, only every other day. He suggested I did nothing until next week though.

I may try and run at the weekend, but at the first sign of pain, stop.