If it’s persisting this long, go see a Physical therapist or other healthcare professional with a running specialization or practice.
Looks like rest and ice aren’t working too well at this point so continuing to do the same thing probably won’t make any improvement
The OP of this threa wrote:
So I can keep running? I was afraid running through the pain would slow the healing process. I’ve been icing more lately. Heat seems to aggravate it. I didn’t develop a bruise until recently. The bruise is on the upper left corner but I feel pain a little more towards the center of the knee cap.
I’ve been keeping up my stretching routine. I do the Wharton rope stretching at least one a day, sometimes twice.
Icing & movement are the best, as much as you can do of icing, walking and running.
Use your results as a guide.
Definitely avoid heat, and probably stretching too. If you're going to stretch, then pay attention what results you're getting from it, i.e. does your knee hurt more after stretching. I see no upside to doing it.
I saw a PT a few weeks ago. He didn't do much. Some light massage on my quads and said it would take anywhere from 4 weeks to 6 months to heal. It was a pretty disappointing visit. No recommendations in terms of ice, heat, running or cross training. Just to go by how it feels.
Probably see a different PT as it sounds like that one didn’t know much. Ice doesn’t do much to help things heal, particularly at this long of time since the injury.
Philh wrote:
If it’s persisting this long, go see a Physical therapist or other healthcare professional with a running specialization or practice.
Looks like rest and ice aren’t working too well at this point so continuing to do the same thing probably won’t make any improvement
I think that it just takes months to heal, like what many who have had this happen have already said. No amount of PT or icing/heat will help. It's only 1.5 months for the OP. Probably will be fine 6 months from now or sooner. Patience.
Philh wrote:
Ice doesn’t do much to help things heal, particularly at this long of time since the injury.
Ice calms the nerves, reduces inflammation, reduces pain, drives blood deep into the tissues for healing, strengthens the muscles, nerves and tendons, and promotes faster healing.
The biggest thing for me is whether or not I should continue running. If the injury will just take time, and running won’t slow the healing process, then I can tough it out.
Should I continue to run?
How much longer will the pain continue? Shouldn’t I start to be feeling a bit better soon?
This is an interesting thread because there is so much conflicting advice. Here's my take.
Icing is only useful in two situations. 1. Immediately after the injury and in the first 24 hours to reduce swelling. 2. After attempting to do too much movement, which results in reinjuring the tissue and subsequent swelling. If you avoid reinjuring the area, icing is not necessary after 24 hours.
Are you using any liniment on the area? A heating liniment will help blood flow to the injury to remove damaged cells. When I have an acute injury, I apply my favorite liniment 2-3 times a day.
Are you avoiding all movement that irritates the knee? Walking up stairs? Squatting down. Getting up from a chair? Running? You need to limit the range of motion of the area for the first few days so you aren't constantly reinjuring the tissue. Failure to limit range of motion in the initial healing stage of rehab is a common problem among runners.
Are you taking supplements to speed healing? Bromelain? Chondroitin/MSM/Glutamine tabs? Tart cherry extract?
Epsom salts soaks? This is awesome for foot and ankle injuries, but I don't know about knees. It's easy enough to try it to find out.
Water running or spinning might be okay in the interim, but you'd have to test it to find out.
I've written a book with a chapter on treating running injuries, but the section on this injury is too long to post. The book is in pre-publication now, but it won't be out until March.
I tried heat for a little while but it did not seem to help. I’ve been cycling on the stationary bike without pain. It’s usually worst in the morning, quite stiff. By lunch time I can do squats or lunges without pain or only minimal discomfort. Running seems to be the only thing that really makes the knee hurt.
I’m wondering if maybe it’s tendon related but I’m fairly strong. I don’t think it’s a weakness or deficiency. I had very consistent training for months before this injury. The PT that I saw has helped me develop a strength and conditioning routine for the past year and half that has kept me healthy outside of this injury. Prior to the injury I consistently did gym work 2-3 times a week and other glute and hip strengthening exercises 5-7 days a week via Jay Johnson’s routines among additional exercises.
Pain is at the top of the knee cap but sometimes it feels that the pain is more towards the very bottom of the quad. If I’m sitting for too long and I straighten out my knee I feel pain as well.
So as I mentioned earlier, I'm in the same boat, and here's my experience. I fell a few days before Christmas Superman style onto the concrete sidewalk. The first 2.5 weeks, the ribs were the main problem. Almost impossible to run. I had also hit my knee, but didn't notice too many problems with it during those few weeks on the few runs I did. I don't know if that's because it was overshadowed by the rib pain or if it took a few weeks for the knee pain to surface. Once the ribs were better, I realized the knee was much worse than I thought. In hindsight, I wish I had done more for the knee in those first few weeks.
When I first fell, I immediately got a small goose egg about the size of a marble on the top lateral corner of my knee. It's still there today, but not as big. When I noticed the knee was worse a few weeks later, I was feeling the pain about an inch below that bump on the outside of the kneecap.
So for the past month, I've done the whole take a week off, try to run a few days, take more time off, try again deal. I can get it feeling to almost 100% with time off. Been working on rolling out the quads too. For a while, going down steps was bad, but not as much now. But after a few days of running again, it gradually starts to return. For me anyway, it doesn't seem like time off is the answer, unless it's a whole month or something. And I'm not willing to do that if it's just going to start back up again within a few days of running.
Right now I'm under the assumption that it's either a bone bruise, tendonitis from compensation, or possibly a tracking issue and the outside of the kneecap is rubbing on the cartilage. I've had some adjustments, and I've been told everything seems to be in place. I've had x-rays (which were normal), but no MRI. That might be the next step. At this point, the only thing I haven't really tried is just jumping back into full training and see what happens. If it doesn't get much worse, then it's probably just a bone bruise that's going to take time to heal completely. That's kind of where I'm at right now. It's very aggravating because it will feel great with a few days off, so I'll feel like I'm ready to go and wasting time just sitting around. But as soon as I start back...same old story.
And I'm still icing every day. No heat. Did do a few epsom salt baths in those first few weeks, but none now. Been using arnica gel also. And doing a little KT tape when I do run.
I’ve also been using Arnica gel in addition to tart cherry extract and keeping my diet really clean.
Unless and until the injury is completely healed, then keep using ice.
If the injury is completely healed in 24 hours, then feel free to stop using ice.
Never stretch the site of an injury, as that always makes it worse.
The idea is to stretch adjacent tissue to take pressure off the injury without making it worse.
Delayed healing is usually caused by overuse of heat, stretching, and inactivity.
Active healing is much better than trying to heal with inactivity.
Complete healing is only possible with activity.
The OP of this Thread wrote:
I tried heat for a little while but it did not seem to help. I’ve been cycling on the stationary bike without pain. It’s usually worst in the morning, quite stiff. By lunch time I can do squats or lunges without pain or only minimal discomfort. Running seems to be the only thing that really makes the knee hurt.
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Pain is at the top of the knee cap but sometimes it feels that the pain is more towards the very bottom of the quad. If I’m sitting for too long and I straighten out my knee I feel pain as well.
If you can spin and do squats without pain, that implies that your problem is not range of motion but impact related. Running puts a very fast, hard impact on the joints. As I suggested earlier, spinning and water running might be the way to go until you are pain free. If you start running too soon, you reinjure the area and healing must start over. This is really, REALLY hard for runners to understand.
I had an MCL strain a few months back. I took all the steps I suggested to you -- liniment, supplements, restricting range of motion, Epsom salts soaks, and an inferential TENS unit that I used every day. I did not attempt to run until I was completely pain free for a whole day. That includes getting up and walking down the stairs first thing in the morning. That took a long time. On my first run, I ran about a mile and did two strides. The next day, I warmed up and ran one interval. Since there was no pain, I continued to ramp up my workouts on the next week. In all, I was able to reduce my downtime from the typical 6 weeks to only three weeks, but I hit the healing steps with diligence.
Almost 7 weeks out now. I don't think it's a bone bruise. I feel like it's lower quad/tendon. The pain is right above my knee. I was biking but stopped all activity. The pain is mostly when I bend the knee or extend my leg. But it's inconsistent. Sometimes I can squat or extend my leg without pain, other times I can't. It's felt better over the last week of inactivity. If I stretch my quad I feel pain in that area as well, not down in the knee. I started doing some isometric quad exercises and I’m no longer icing.
FYI, since we seem to be in a similar situation (location of pain, how it behaves, and I'm at 8 weeks since falling), I finally gave in and got an MRI scheduled for this Tuesday. I'll find out results on Friday. I'll try to remember to post what they find. I'm also like you in that I keep going back and forth between bone bruise and quad tendon, but I'm leaning towards bone at this point. The bump I got on the top lateral corner of the kneecap after the fall was more swollen after a harder run a few days ago.
MRI results are in, which I said I would post. For me...bone bruise of the femur with mild soft tissue swelling. No meniscus issues. Official report is:
1. Focal bone marrow edema within anterior aspect of lateral femoral condyle at the level of the lateral aspect of the trochlear groove, compatible with bone contusion without discrete fracture. No evidence of acute fracture, subluxation or osteonecrosis. Mild prepatellar soft tissue swelling, most prominent laterally, compatible with prepatellar bursitis, subcutaneous edema, or hemorrhage.
2. Intact medial meniscus. Intact lateral meniscus.
3. No significant tibiofemoral arthropathy. No significant patellofemoral arthropathy.
4. No significant knee joint effusion. No significant popliteal cyst.
So...there you have it. Basically the patella rammed the front of the femur during the fall and bruised it. Hard to say if you have the same issue OP, but that's what mine is. Doctor said I shouldn't make it worse by continuing to run. It's just gonna take time to heal completely. Wouldn't be surprised if there is also a little tendonitis going on.
I've actually had a significant improvement over the last week or so. I just jumped back into full training 2 weeks ago and hoped it would work itself out. I'm still icing at times. But other things I've done include better foam rolling of the quads and wall sits...which probably had no effect since it's a bone bruise. But I also spent about a full week with KT tape on 24/7, put down in a way to try and pull the kneecap more toward the medial side. Maybe that helped take some pressure off the lateral side and let things setting down a bit...but that's just a guess.
I have also been confirmed of a bone bruise. I have been advised not to run but to swim and bike instead because running will make it worse. Been working with a PT on isometric quad exercises and massage/dry needling of the quad. My last week or so has been pretty bad. The beginning of the week was the worst it’s felt so far, even worse when I was trying to run through the pain. I asked about icing/heating/stretching but was told none of those would make any difference. Timeline is unknown. Apparently some heal in 6 weeks others 6 months.
Surprised they said no running. I was told running wouldn't do anymore damage. I personally think biking made things way worse for me than running did. Maybe you just hit harder than me. I'd be interested to hear what type of isometric quad exercises you're doing.
I’m surprised you were told to run. Running was a big off-limits because of the impact. It will only slow the healing process. Cycling and swimming, even aqua jogging, are all no impact but get the blood flowing. The pain that I felt when running was an 8/10. Some days I would have to stop and walk home.
The exercises I was prescribed were different variations of isometric straight leg holds with ankle weights, extending the leg, holding for a few seconds and slowly lowering the leg back down. I do these 2-3 times a day and will gradually increase the weight.
Did you receive any advise on when the injury would clear-up or anything that can increase healing?
No...no timetable or advice on stuff to speed things along. Just that it should gradually improve with time.
I guess I am also a little surprised about the running, but it's been very strange. Since December I've only been able to manage about 20 mpw. Maybe a few in the 30's. But then 2 weeks ago, it didn't seem like time off was really helping, so I said screw it, put my head down and powered through. Got in 54 last week, somewhat worse at times, but nothing out of the ordinary. I'm on pace for 60 this week. Even did 2 harder workouts and I'd say it's oddly back to about 90-95%. Still aches at times, but I'm not limping around all day afterwards. When I told the doc that this morning, he just said be cautious and use my judgement, but I'm probably over the hump at this point and didn't have to go cold turkey. Even though they saw the bone bruise on the MRI, it does make me wonder if a lot of the pain was actually from tendon and muscle tightness that finally loosened up once I got going again. Guess time will tell. Of course maybe I'm wrong and 2 weeks from now I could be laid up with a stress fracture or something, but for the time being, I'm moving ahead as much as I can.