Runners knee?, IT-Band Syndrome! New measure for getting injury free

This afternoon I made a visit to a manual therapist in order to start working serious with getting injury free. After a short examination the therapist reached a somewhat different conclusion than I had. It appeared that the cause of my injury is not in the knecap, but rather a condition referred to as the Iliotibial Band Friction Syndrome. The iliotial band is a tendon that extends from the hip to the outside of the knee and is attached tot he shin bone, just below the knee. When the kne is bended about 30 degrees the tendon makes contact with a part of the knee causing the pain when this is done extensively over a lengthy period of time. The good new is that this condition is curable. A combination of stretching, icing and spesific strength training towards strengthening the gluteus medius muscle, should work wonders-and a few visits to my manual therapist as well to work on loosing up the tension. In this period I've decided to not schedule any running-workouts. Initially I plan for this period to last 8 weeks-that is both January and February. I'll start schedule running again in the beginning of March, but build up the volume gradually. First from one to thre weekly sessions and later on to a volume that adds up to 300 km each quarter-this will take place in March. From that point I can start training normally again.
That means not more than 300 km each quarter and increasing the volume with no more than 10 % from quarter to quarter. That means that I'll use ten quarters(2,5 years) to reach 800 km a quarter which was my volume in the third quarter-Talk about reality check!
That means I'll use my efforts in the terrain mostly this year and the next two years. In addition I'll prioritize XC-Skiing, cycling and swimming.
I'll schedule to A-races this year-Kristins Runde and UltraBirken. In addition I'll run one or two marathons and a terrain-race leadin' up to UltraBirken, and finally-Sentrumsløpet in Oslo(10 km). Not more than that. In km that will be around 800 in 2011-down from 2.200 in 2010.
I'm convinced that this is the right decision.

Helsfyr course-endurance run: Recovering from my knee-injury?

Nedre Blanksjø-Nordmarka

Bitterly cold tonight. It was right at the level of getting to cold, but it was allright to run when I got started. I was eager to learn if my measures since last session at 23th of December had paid off. Since then I've been stretching regularly. In addition I've carried out a session with cross-country skiing and cycling. Tonights session was slightly promising. I ran for more than half the distance before noticing any pain in my left knee. The right knee is not in perfect condition, but it's far better than it's neighbour. Afterwards the condition of my knee was better than after the session at 23th of December. That's promising. Anyway, I have scheduled an appointment with a physiotherapist the 3th of January. I need an independent evaluation of my condition and a training programme for the knee.
Next time I'm running under similar conditions I'll use some knee-warmers. I noticed discomfort due to the cold tonight and the knees are particularly vulnerable.

Technicals:

-Distance: 6,1 km

-Time: 37m 47s

-Average pace: 6:12 min/km
-Average moving pace: 5:59 min/km
-Elevation gained: 56 m( 9,2m/km).
-Calories: 424 kcal.

-Average heart rate(max): Not measured

-Shoes: Mizuno Wave Inspire

-Weather: Partly clouded, -10 degrees celsius, quiet, low humidity in the air, overall very cold

Running: still a long way to go

Sandnes-Christmas eve

Yesterday I had my first running session since my last race-Bislett 24h race at 27th of Nov. I ran at a very moderate pace and the distance was very short. Naturally I was very eager to learn if I still suffered from any pain because of my knee-injuries. I headed out in the early evening, temperature just below zero, light winds and a bit of snow. After just one km I noticed pain in my knees-especially my left kne(particularly the back of the kne). I got a bit worse and stabilized at a nmoderate level, but I was in no condition to push on towards higher pace. Clearly I have a long way to go in order to recover from my injury. First thing next week I'll schedule an appointment with a fysiotherapist in order to establish a training programme to strengthen what muscles that need strengthening in conection with my knees. I addition I will carry out a stretching programme and use ice extensively for the next two weeks.

Technicals:

-Distance: 6 km

-Time: 37m 0s

-Average pace: 6:10 min/km
-Average moving pace:  min/km
-Elevation gained:  m( m/km). 10-ok
-Calories:  kcal.

-Average heart rate(max): Not measured

-Shoes: Mizuno Wave Inspire

-Weather: Clouded, -5 degrees celsius, light wind, high humidity in the air, overall cold

Recovering from injury II

Minor pain in my knees nowadays. I guess thats good. I went to see my orthopedic technican tonight. My aim with this process is to produce orthotics. It was a pretty straight-forward visit and I'll receive my orthotics the 21th of January next year. I'll start running before then, but not untill next week. I'll stick my programme as planned. The first quarter in 2011 I've only scheduled just over 300 km of running, but there's a lot of other training-among that over 300 km of skiing.

Recovering from injury

Porsanger fjord

It appears that I have a challenge to overcome that needs some time and dedication. The challenge is referred to as "Runners knee". You can read more about it here:



http://jannicke-athletics.blogspot.com/2010/10/suffering-from-runners-knee-part-1.html

My initial measures were:

1) Anti-pronation shoes
2) Orthotics

I've tried out the former. It seems that it isn't adequate enough. In addition I may have pushed my luck participating in Bislett 24h race at 27th of Nov-just 4 weeks after I had to DNF in Copenhagen. I should have backed off and started my recovery then, but that's history. I will have to deal with it now.
First priority is to get well from the kne-injury. Next in line is to take necesssary measures to prevent this from happen again.
Well, then, how do I get well from the injury?
First, no training this week and the next week except for swimming.
Second, running is off for the time being. That'll be easy. I get nauseated just by thinking of running.
Third, I'll get some orthotics. I have an appointment on 16th of Dec and will receive my orthotics two weeks after that-the first week in January. I will start my running after that.
Fourth, I'll start training gradually. Starting with strength-training the week after next week(51-2010), supplementing with cross-country skiing the week after that(52-2010). Further on cycling and running from the first week in 2011 and swimming from the second week in January-2011. I January I'll have one running-session a week the first three weeks, two running-sessions the next three weeks and three running-sessions the following three weeks. All sessions will be with low intensity(endurance in zone 2).
From week 10 in 2011 I'll start with base-training. That will last 9 weeks, finishing at the beginning of May.
All scheduled races in the first quarter is cancelled. I'm considering to cancel scheduled competitions in April and May as well, but I'll conclude on that some during the first quarter.
The first period is this and next week. My measures here will be use of ice(twice a day) and stretching(three times a day).

Suffering from Runner's knee-Part 1: intital measures

It appears that I suffer from what's referred to as "Runners knee". A condition of which the pain is localised around the knecap, becomes gradually worse over time and is exacerbated by running long distances. Walking steps causes discomformt as well as squatting and sitting with the knee bent for longer times. The condition of ligament and bones in this condition is abnormal, causing the pain.
Runner's knee, also known as patellofemoral stress syndrome, is a condition characterized by the kneecap rubbing against the thighbone (femur) when moving.

There may be different causes to this injury such as:

1. Running shoes: 
does not limit ankle-pronation

2. Training errors
training too hard, too far, too soon, always running on the same side of the road, interval training and racing too often

3. Training surfaces:
too much running on hard surfaces

4. Biomechanics:
flat feet, high-arched feet, increased quadriceps(q).angle at the knee, redusced ankle-flexibility, 


Measures to correct this injury are:

1. Anti-pronation shoes

2. Orthotics

Both measures are directed towards correcting biomechanical abnormality that causes the injury.

The advice is to try out these measures in prioritised order.


Well, that is as far as the general theory goes.

Facts about my situation is this:
1. Running shoes:
I've used 5-6 different shoes, but gravitated towards lighter shoes(competition shoes) of around 0,2 kg.
The first time I noticed pain in my knees was during Thueringen Ultra in the beginning of July. At the beginning of the third quarter I made more use of Mizuno Wave Ronin and the pain disappeared. Before that I'd been using Puma Concinnity extensively. After making that change I didn't notice any pain again before week 42.
The change when it comes to shoes is Saucony Kinvara which I bought 9.9.10 and have runned approximately 150 km since then. They may be the cause for this injury

2. Training errors:
I've been increasing my amount of training substancially from the first to second and third quarter. In addition I have done very long training session. This may have caused some of this, but I since the symptoms have occurred after changes of shoes I don't think that can be the cause of this injury. It doesn't reduce the injury to run long runs, but it's not the cause of it.

Initial measure:
I need to try out using a different shoe again that reduces pronation. I'll buy a pair of shoes first thing tomorrow and try out this approach during the next month. In addition I'll run shorter runs the next weeks and make use of ice the coming week to cool down the injured area which is mostly the right knee.
If this doesn't to work out I'll try orthotics as my next measure.