Runners knee (Pain under the kneecap)

[George]

Good morning and congratulations for a very useful and interesting site.
My query refers to patella pain, and specifically (I think) to the case mentioned as 'runners knee'.
This occured approx. a month ago, after running as usually ~5 km, quite fast, in approx. 20-21 minutes. I am 47 years old, I play football (soccer - once a week), also run twice a week, and also do a lot of martial arts training (karate - 3 times a week). Unfortunately, during the last four months, just for the experience of it, I tried to do some Iaido training (japanese sword training - once a week), which involves quite a lot of kneeling.
So, a month ago, after running ~5km, I felt some light pain around and sometimes behind the kneecap. Even after resting for a few days, the pain seems to be there, sometimes even intensifying, after the first few miles of the next run. Sometimes I also feel a crunching or clicking sound when I bend or extend the knee.
From what I have read, the test for runner's knee is to sit down and put the leg out on a chair so that it's stretched out straight. Then, squeezing the leg just above the knee while pushing on the kneecap, I push from the outside of the leg toward the center. At the same time, I tighten my thigh muscle, and this is painful (not a lot, but painful).
Having in mind the kneeling involved in my training lately, I think that my knee cap got off track because of the kneeling, rubbing up against its sides. So, I immediately stopped the training which involved kneeling, and also for the last four weeks I have not played football (because it is more demanding on the knees).
Now, after running, I ice the knee with a couple cold packs over a towel for about fifteen minutes to bring down the swelling. So, a month after the injury, my knee has improved very much, but not completely.
I would like to ask fo ryour opinion, on:
(a) Was my diagnosis correct?
(b) Is my training on the right track now?
(c) What is your evaluation for complete recovery from this type of injury?
regards,
George

[Ruth]

Hi George,

I am glad you find the site to be a useful resource.

You may have possibly identified the source of the problem particularly as you can link it in specifically with starting the new training regime you describe. However I would suggest that perhaps it is more likely to be patella-femoral pain syndrome (or chondromalacia patellae) - http://www.sportsinjuryclinic.net/cybertherapist/front/knee/indexcmp.php rather than a problem with the ITB due to the nature of the onset of pain being linked with kneeling.

There is a possibility that there could be some minor element of (natural) wear and tear at the back of the kneecap which could cause the crunching you described, which could perhaps have been "flared up" by the increased contact between the joint surfaces brought about by the kneeling.

It might be worth getting the opinion of a physio just to see if there are any muscular imbalances and to assess whether your problems are due to your aforementioned diagnosis or if something else might be contributing.

Other than that, I would suggest you consider some general strengthening of the knee (you can find these on our site here: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/cmp/strengthening.php and perhaps seeing if taping techniques might help, which you can view here: http://www.sportsinjuryclinic.net/cybertherapist/front/knee/cmp/taping.php

I hope this is of some help, please let us know how it goes!

[George]

Thank you Ruth,
I will follow your advice on knee strengthening, and I will let you know how it goes. However, so far so good, i.e. it is improving at a steady pace!
Thanks,
George