Random Knee Pain in a Runner

[toolshed]

Dr. Steve,

I have been getting a periodic but random pain on the outside of my knee, or more accurately, at the top of the fibula. It comes from no where, and is a sudden, throbbing pain for about 5 seconds that nearly floors me, then goes away. There doesn't appear to be any rhyme or reason to when it occurs.

I am a fairly avid runner, so I have had the occasional joint pains here and there, but this is different---feels much more like neurological pain than anything orthopedic. I have not been running in a month or two, so it doesn't seem like this is an injury from overuse. And this is not necessarily new, i can remember the feeling at other times, but I was being more consistent with running and just figured it was overdoing it.

Any ideas?

[Thebazile78]

Dr. Steve,

I have been getting a periodic but random pain on the outside of my knee, or more accurately, at the top of the fibula. It comes from no where, and is a sudden, throbbing pain for about 5 seconds that nearly floors me, then goes away. There doesn't appear to be any rhyme or reason to when it occurs.

I am a fairly avid runner, so I have had the occasional joint pains here and there, but this is different---feels much more like neurological pain than anything orthopedic. I have not been running in a month or two, so it doesn't seem like this is an injury from overuse. And this is not necessarily new, i can remember the feeling at other times, but I was being more consistent with running and just figured it was overdoing it.

Any ideas?

I know I'm not Dr. Steve, but may I ask how many miles are on your current pair of shoes?

Running shoes should be replaced roughly every 300-500 miles (http://www.therunnersguide.com/howlongrunningshoeslast/) or approximately every 6 months.

This largely depends on the shoe and whether or not you're what's classified as a "heavy" runner which puts more wear and tear on your shoes.

Also, you may need a different type of shoe to better suit your foot type ... do you know if you're a pronator(flat foot), supinator (lots of arch) or neutral (http://www.runnersworld.ltd.uk/foottype.htm)?

(Me, I'm a pronator and I lean towards shoes rated on Road Runner Sports as for "heavy" runners.)

[toolshed]

I know I'm not Dr. Steve, but may I ask how many miles are on your current pair of shoes?

Running shoes should be replaced roughly every 300-500 miles (http://www.therunnersguide.com/howlongrunningshoeslast/) or approximately every 6 months.

This largely depends on the shoe and whether or not you're what's classified as a "heavy" runner which puts more wear and tear on your shoes.

Also, you may need a different type of shoe to better suit your foot type ... do you know if you're a pronator(flat foot), supinator (lots of arch) or neutral (http://www.runnersworld.ltd.uk/foottype.htm)?

(Me, I'm a pronator and I lean towards shoes rated on Road Runner Sports as for "heavy" runners.)

I thought about that. My shoes are fairly new, definitely not 500 miles on them yet. The newest ones are actually the best I've had i a while.

I'm definitely a pronator, fairly severe actually. I generally feel that in my feet and ankles after a long run or overtraining. What is weird about this particular pain is that it seems to come so randomly but suddenly, and I haven't been able to tie it the exercise. I have been getting it even after taking a month off. I guess it could be latent effects on the patellar tendon from overpronation, but it just felt so different from anything I had felt that I actually felt compelled to ask. Not my actual doctor, mind you, but a complete stranger who has never met me....:bye:

[Dr Steve]

Dr. Steve,

I have been getting a periodic but random pain on the outside of my knee, or more accurately, at the top of the fibula. It comes from no where, and is a sudden, throbbing pain for about 5 seconds that nearly floors me, then goes away. There doesn't appear to be any rhyme or reason to when it occurs.

I am a fairly avid runner, so I have had the occasional joint pains here and there, but this is different---feels much more like neurological pain than anything orthopedic. I have not been running in a month or two, so it doesn't seem like this is an injury from overuse. And this is not necessarily new, i can remember the feeling at other times, but I was being more consistent with running and just figured it was overdoing it.

Any ideas?

TS:

I forwarded your question to PA John, but he has a 1 month old in the house and he's losing his mind. As soon as I get his answer back, I'll let you know.

I am concerned that you may have a knee cartilage issue; since it's over your fibula, it'd be in the lateral cartilage (outside of the knee).

Occasionally, if you get a tear in the cartilage, it'll bunch up or fold over, causing severe pain that will go away quickly if you move in such a way that will smooth out the irregularity.

http://www.kneeguru.co.uk/assets/images/popliteus05.jpg

not impossible that you have a popliteus tendonitis (inflammation of the tendon going to the popliteus muscle (see image above). If you do, you should have tenderness above the lateral knee, though.

A sports-oriented orthopedist can really help you with this. After a quick physical exam, they can usually tell if an MRI will help. If the MRI shows a tear (or other problem), it can usually be fixed with a little arthroscopic surgery. This is a simple procedure and is essentially painless (thanks to good anesthesia!)

http://www.yorkshirekneeclinic.co.uk/images/G1.jpg

I could be way off on this as well. Let a sports medicine person check it out and let me know what they say.

hope it gets better!


your pal,


steve

[CofyCrakCocaine]

what's the difference between an arthroscopy and aspiration?

[Dr Steve]

what's the difference between an arthroscopy and aspiration?

excellent question!

Aspiration is when you stick a needle in something and suck whatever is in there out. We'll aspirate cysts, aspirate boils, or aspirate joints that have fluid in them.

Arthroscopy (arthro=joint, scopy=scopy) is when you actually stick a fiberoptic scope into a joint (in this case, the knee) along with a couple of tools to grind, cut, sew and even aspirate.

here's what the knee joint looks like through the arthroscope:

http://1.bp.blogspot.com/_qvEQNNHCYjM/R4_WntmNFPI/AAAAAAAAAGc/a5RgltiXRb4/s320/knee+surgery+arthroscopic+photo2.jpg

it's amazing they can accomplish anything with that limited crap-ass view they get. :smile:

[toolshed]

Thanks Dr. Steve.

I have given it some rest and done some knee stability stretches and excercises for a couple weeks, with no recurrence of the pain so far. Seeing as it has been fairly random, if/when it pops up again, I think I'll schedule a doctor's visit and have some sort of imaging done. I'll let you know the outcome of that, for posterity's sake. I have a marathon scheduled in May, so I should probably get an all-clear before doing that, I suppose.

Thanks for the input and advice! You do a great job here (and on the show).

[Dr Steve]

Thanks Dr. Steve.

I have given it some rest and done some knee stability stretches and excercises for a couple weeks, with no recurrence of the pain so far. Seeing as it has been fairly random, if/when it pops up again, I think I'll schedule a doctor's visit and have some sort of imaging done. I'll let you know the outcome of that, for posterity's sake. I have a marathon scheduled in May, so I should probably get an all-clear before doing that, I suppose.

Thanks for the input and advice! You do a great job here (and on the show).

thanks man!

if the pain's gone so fast, it's less likely to be a cartilage issue. Just take it easy and see how it goes; if it comes back it's worth a look by a good sports med person.

Good luck and good luck in the marathon!

your pal,


steve

[hammersavage]

I had pain in the same area last year. Directly on the outside of the knee. My knee doctor told me to stretch it well. I found it didn't work, rested for a month and it was gone.

Now my knee pain is different and if I had to guess, I'd say I have a microfracture at the top of my fibula where it meets the kneecap. But I've had some knee pain for 10 years since my ACL surgery. I'll get it looked at when I get health coverage.

[Dr Steve]

I had pain in the same area last year. Directly on the outside of the knee. My knee doctor told me to stretch it well. I found it didn't work, rested for a month and it was gone.

Now my knee pain is different and if I had to guess, I'd say I have a microfracture at the top of my fibula where it meets the kneecap. But I've had some knee pain for 10 years since my ACL surgery. I'll get it looked at when I get health coverage.



the lateral collateral ligament is in that area, too...a little strain of it can cause irritating pain that eventually goes away with rest.

[Ritalin]

I know I'm not Dr. Steve, but may I ask how many miles are on your current pair of shoes?

Running shoes should be replaced roughly every 300-500 miles (http://www.therunnersguide.com/howlongrunningshoeslast/) or approximately every 6 months.

This largely depends on the shoe and whether or not you're what's classified as a "heavy" runner which puts more wear and tear on your shoes.

Also, you may need a different type of shoe to better suit your foot type ... do you know if you're a pronator(flat foot), supinator (lots of arch) or neutral (http://www.runnersworld.ltd.uk/foottype.htm)?

(Me, I'm a pronator and I lean towards shoes rated on Road Runner Sports as for "heavy" runners.)

Just read the last sentence out loud as this guy:

http://1.bp.blogspot.com/_sHOk7rRp150/SQqhLzhh9mI/AAAAAAAAASw/Ocbe-Wg95gQ/s400/ratzenbergergx7.jpg

(Me, I'm a pronator and I lean towards shoes rated on Road Runner Sports as for "heavy" runners.)

[hammersavage]

the lateral collateral ligament is in that area, too...a little strain of it can cause irritating pain that eventually goes away with rest.

It's on the front of my knee. It's there too? And I can't rest until after April 18th.

[Freakshow]

don't run on sidewalks--asphalt is softer.