High Peak Marathon induced knee pain

Since finishing the High Peak Marathon a couple of weeks ago, I (Tim) have been having issues with my knees.

Actually, let me clarify that, I have been having an issue with my left knee. The right one is fine and dandy, I could hop about on that all day not really be all that bothered. It’s the left one that is causing the issues.

I could be a classic runner/lifter/cyclist and just ignore the pain, think, oh, it’ll get better over time, I’ll just ignore it and train through it. But I’m not that kind of person, and I’ve seen any number of people who have tried to do this, and have ended up sidelined and frustrated for weeks, if not months because they have not heeded what their bodies have been saying to them.

So looking at knees, why does my knee hurt?

The offending knee. It's all about mobility in the ankles and hips. Looks like I'd better get working.

Well, the first thing I can rule out is actually an injury to the knee. I know that I ran a 42 mile race a couple of weeks ago, and I am absolutely certain that I didn’t smack it against anything or crock it in any way, so mechanical damage to the knee did not happen. By this theory, although there is pain in and around my knee, it’s NOT actually the knee that is the issue. As is very often the case with knee injuries, something else outside of that realm is causing the pain.

What is it then?

Well, the knee, being a hinge in the middle of the leg is mainly affected by two structures in particular, the joint below it, the ankle, and the joint above it, the hip. Any imbalance that starts in either of these places can have a massive impact upon the knee, and over 42 miles of bog trotting, any small issue which you don’t really notice on a day-to-day basis is magnified and intensified, and ends up becoming an issue, generally at the weak point of the chain, which, as you may have guessed, is the knee.

A quick soft tissue assessment (for that read “poking the muscles in my leg to work out which ones hurt the most”) revealed that the lateral muscles in my quads (outer side of upper leg) hurt like hell, as do the medial proximal part of my gastrocnemius (inner upper part of my calf). Also my hamstrings, again on the lateral – outside really do smart quite a lot when prodded. This is after a good few days when the Delayed Onset Muscle Soreness has faded, so there must be something going on here. It’s all in the left leg, and its all the muscles that surround the knee and provide support for it.

So all these muscles hurt – why? What is causing the muscles to pull on my knee and make it the weak spot? I start looking at mobility of my legs, ankles and hips. Ankles, not too bad, though a little stiff. Hips, yikes. I have, and indeed have had hips that are so immobile its quite embarrassing. In the past I have laughed it off saying, yes well, nevermind, it doesn’t affect me badly on a day-to-day basis, so there isn’t problem.

I am now beginning to suspect there might be more of an issue in the future if I carry on in the way I am at the moment.

My knees and hips on last years Shelf Moor race

Low mobility in the hips means that every time I take a stride, be it walking or running, the body is trying to move optimally. If there is not optimal range in one particular joint, it will try to gain the rest of the movement pattern in another joint – which is NOT a good thing. So it would seem that as I run, the hips aren’t moving properly and the body is trying to gain more movement in certain directions by getting that movement in my knee – which isn’t meant to move that way. In doing this, the muscles around my knee are having to work extra hard to keep the knee stable as the body tries to move it – which means the soft tissue is getting tighter, and causing pain to the area which shouldn’t be moving.

At the same time, the muscles around my hip aren’t working correctly BECAUSE my hips don’t move correctly, and that has an effect upon the muscles in my legs. The leg muscles are trying to compensate upward into my hips AS WELL as downward into my knee.

No wonder my knee hurts.

What is the answer?

  1. soft tissue work – foam rollering and a fair bit of quite painful myofascial mobility work in the form of deep sports massage with soft tissue release work
  2. hip mobility work
  3. ankle mobility work
  4. strengthening and mobilising the muscles around my hips – that’s the glutes and the hip flexors
  5. keep moving, but not running excessive amounts, I may have to pull out of a couple of races, but in the long-term, I don’t mind about that. Better to not run a race this time than screw my knees up in the long-term.

Best get to it then.

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