Knee Mice + Marathon training. Good idea? Bad Idea?

[channlluv]

Okay, so I visited super chiropractor Dr. Matt (the guy who saved me from shoulder surgery and has me swimming again) about the crackling sound in my knees when I do deep lunges. Actually, kind of shallow lunges, too. He called the noise knee mice and explained that my cartilage is in bad shape. He prescribed glucosamine, and if it doesn't improve, he'll start deep ultrasound and TENS on it in a couple of weeks.

Now, my question here today, because today you can register for the San Diego Rock & Roll Marathon at a discount, today only, is whether or not training for a marathon is just asking for knee-deep disaster down the road.

Literally. I've never been much of a runner, so this is all new to me. I can run, and according to my runner friend, I have a good natural form. I just don't do it. All that pounding just hasn't sounded like fun. But a bunch of my friends are signing up for this marathon and we'd all be training together.

But a Girl Power Goddess Experience isn't worth a lifetime of arthritis or something if all that running is just bad for my knees.

This is the next step on my road to triathlon training, too. If I can't run, I can't do triathlons, so I really want to. I'm just facing down the potential injuries here.

Help, please.

Roxy

[Selkie]

I don't understand. Does it hurt when you run? Or crackle? Why not just stop doing the lunges if the noise bothers you and keep running? If you don't overtrain, are careful to stretch, etc., I don't see why you should continue to run if it doesn't hurt. Particularly if you have good form.

Did the chiropractor x-ray your knees? Did he diagnose this just on the crackling noise when you're doing lunges? I'm sure one of the PTs can weigh in here....

[Trek420]

You can walk a tri depending on the distance. Admittedly probably not an IM distance unless you race-walk faster than some runners (and some race walkers do).

I'm planning a half-mary in March and I don't run at all.

Disclosure: no medical training or experience whatsoever but I do have horrid knees, really bad knees and joints. You might have something kinda floaty bits floating around in there, sometimes lodging where it causes a noise.

You could have arthritis and what you are hearing is bone on bone. Does it hurt?

IM very HO I don't think ultrasound will do much other than make it feel all nice and warm and make your chiro's reimbursement for treatment feel all nice and warm. :rolleyes: OTOH if the ultrasound makes you feel better to the extent that you can do the work to strengthen the joint then it's all good.

Glucosamine may help, so would strengthening and stretching the muscles around the knee. Take the stairs, do some hill work, see a PT not necessarily in that order. :)

Actually .... in reverse order. :cool:

[OakLeaf]

Most marathons will allow you to switch your registration to the half-marathon if it turns out you can't do the full distance.

+1 on seeing a PT. Your chiro should be able to refer you. Ultrasound is great for getting swelling and inflammation out of muscles, but I'm not sure what good it does directly on joints. Make sure you're doing your myofascial release and hip strengthening work - a lot of chronic knee problems can be misalignment caused by trigger points mostly in the lateral muscles, and weakness in the hips.

IANAD, etc., etc... Good luck.

[channlluv]

It hurts when I do lunges, but not always, and sometimes when I climb stairs. I have noticed that I've become cautious when climbing, favoring my left knee, especially. The noise does bother me, but the crackling itself doesn't really hurt, just the ligaments/tendons that move my body up and down in the lunge/stair climb itself.

I'm doing the Core Performance workouts and I'm entering week four. http://www.amazon.com/Core-Performance-Revolutionary-Workout-Transform/dp/1594861684/ref=sr_1_1?ie=UTF8&s=books&qid=1260727508&sr=8-1 DH finished it and it really helped him change his body shape and improve his cycling power.

When Dr. Matt did some manipulation of my knee, he squeezed around my kneecap and that hurt, and he suggested there was some inflammation there. He wants me to ice my knees after every workout.

Trek, it's encouraging that you're running even with bad knees. I'm only 45. I don't want to have long-term knee problems that prohibit my getting around, much less riding or running or swimming. I'm having fun here.

Roxy

[Wahine]

Most marathons will allow you to switch your registration to the half-marathon if it turns out you can't do the full distance.

+1 on seeing a PT. Your chiro should be able to refer you. Ultrasound is great for getting swelling and inflammation out of muscles, but I'm not sure what good it does directly on joints. Make sure you're doing your myofascial release and hip strengthening work - a lot of chronic knee problems can be misalignment caused by trigger points mostly in the lateral muscles, and weakness in the hips.

IANAD, etc., etc... Good luck.

Bingo. You can always switch to a half and hip work, strengthening, stretching and myofascial release with a foam roller at home can do absolute wonders for this sort of thing. Orthotics are sometimes helpful too if you have badly fallen arches.

So I'd say sign up for the mary if it's what you want.

Personally, I would go with some shorter races first. You don't have to run a marathon to do Triathlon. Training for a marathon eats up a lot of time and if what you want to do is a Tri, it'll limit you're ability to put time into that. And, tri training is usually better for your joints overall due to the cross training involved.

Hope that helps.

[KnottedYet]

Please no ultrasound to the joint. Ultrasound is worse than useless to joints. It causes cavitation in the synovial fluid. Little explosions that damage your cartilage. Also the US waves are reflected off the surface of the bone and cause superheating of the first thing they encounter next: the periosteum or the cartilage.

Please no TENS. TENS is for nerve pain, it gives the nerves electrical signals that flood out the pain signals they transmit. It is useless for a noisy joint.

Please give the glucosamine 3 months to take effect. Expecting it to make a difference in "a couple weeks" is premature. Glucosamine gives the body the raw materials it needs to fix cartilage, which is helpful if you don't have enough raw material in your system already. If you have an adequate diet, and the cartilage is normal (but noisy, like normal cartilage gets over the years) glucosamine won't change anything, even after 3 months.

Knees are noisy. It is their nature. They self-repair damage, but they remain noisy. They are especially noisy if you deep lunge or squat improperly (which most women do).

Knees are constantly repairing themselves. Retraining your muscles to keep the knee alignment and forces through the knees optimal at all times helps the knee repair keep up with the wear they experience. Knees are noisy. Even young folks have noisy knees. Knees constantly clean themselves, they "squeegee" out the fragments and cooties that float in the synovial fluid. It's normal.

Please see a PT to get your muscles and leg posture trained. Please see a PT to learn how to help the "squeegee" effect (usually knee extension with patient-applied overpressure either saggitally or with internal or external rotation does the trick, your PT can help you narrow it down) if you do have some large chunkie-bits adding to the noise.

If your knee isn't locking or collapsing or causing severe pain, then you just have normal noisy knees. But it wouldn't hurt to have a PT get your posture and muscle control up to snuff before your marathon. Irritation and occaisional twinges often come from poor posture and muscle control.

[channlluv]

Wow, Knot, thank you.

I've got an appointment with my GP in early January to follow-up on my blood pressure and general well-being. I'll talk with her about getting a PT for my knees. Are there videos online of the proper lunge technique?

No TENS, no ultrasound on the knee. Gotcha.

I think I will stick to shorter distances for now. Let the goddesses run their goddess hearts out. I'm going to find my happy pace and stick to it.

Thank you!
Roxy

[Zen]

The crackling sounds are known as crepitus (http://en.wikipedia.org/wiki/Crepitus)
I'd avoid lunges altogether.

here are some alternatives (http://www.prevention.com/cda/article/best-and-worst-exercises-for-bad-knees/ff53323b0b803110VgnVCM20000012281eac____/fitness/fitness.for.your.health/exercises.for.specific.conditions/arthritis/)

[Wahine]

Please no ultrasound to the joint. Ultrasound is worse than useless to joints. It causes cavitation in the synovial fluid. Little explosions that damage your cartilage. Also the US waves are reflected off the surface of the bone and cause superheating of the first thing they encounter next: the periosteum or the cartilage.

I knew there was a reason why I never use ultrasound!!

Seriously Knot, I hadn't heard about damage to cartilage or periosteal effects when ultrasound was applied properly. I don't pay attention to US research, because I don't really use it but I'd be interested in a reference if you've got one. I'm probably pretty out of date in this realm.

TIA.

[channlluv]

The crackling sounds are known as crepitus (http://en.wikipedia.org/wiki/Crepitus)
I'd avoid lunges altogether.

here are some alternatives (http://www.prevention.com/cda/article/best-and-worst-exercises-for-bad-knees/ff53323b0b803110VgnVCM20000012281eac____/fitness/fitness.for.your.health/exercises.for.specific.conditions/arthritis/)

Yay, Zen, yes, crepitus, that's what he called it, too, but "knee mice" stuck in my head, go figure. Thank you for the link to the alternative exercises.

Roxy

[channlluv]

The crackling sounds are known as crepitus (http://en.wikipedia.org/wiki/Crepitus)
I'd avoid lunges altogether.

here are some alternatives (http://www.prevention.com/cda/article/best-and-worst-exercises-for-bad-knees/ff53323b0b803110VgnVCM20000012281eac____/fitness/fitness.for.your.health/exercises.for.specific.conditions/arthritis/)

Yay, Zen, yes, crepitus, that's what he called it, too, but "knee mice" stuck in my head, go figure. Thank you for the link to the alternative exercises.

Roxy

[KnottedYet]

I knew there was a reason why I never use ultrasound!!

Seriously Knot, I hadn't heard about damage to cartilage or periosteal effects when ultrasound was applied properly. I don't pay attention to US research, because I don't really use it but I'd be interested in a reference if you've got one. I'm probably pretty out of date in this realm.

TIA.

We had it DRILLED into our heads in school: no US over joints, no US over the spinal cord. (cavitation in the cerebrospinal fluid, just like in synovial fluid). US only over muscle, never over bone less than 1/2 inch deep to the skin.

Of course, US is only recognized as a heat modality at 8x the cost of a hot water bottle... but because of the increased transport over the cell membrane it causes we also had it drilled into our heads that we could cause tumor formation if we used US over questionable tissue.

The periosteal heating is one way you can find stress fractures, and I watched a PT use US once to cause extraordinary pain in a young man's shin: "Yup, there's a fracture there!" and send the kid back to his orthopod.

US is scarey stuff, and I only use it if directly ordered by an MD. Otherwise I tell folks to get a hot pack. The effect is the same and the risks are so much less.

"Manual for Physical Agents" by Karen Hayes talks about the cavitation and periosteal heating. This book is from 2000, so not quite up to date.

"Physical Agents; Theory and Practice" by Behrens and Michlovitz (1996) gets more into the physics of cavitation and reflection, and into some of the other nasties US can do, like degranulating mast cells, producing excess histamine (which isn't always a bad thing) and such. Also out of date, but the physics is nice.

I don't have current research, just anecdotes from other clinicians who read current research and told me about it. I pretty much gave up US a few years ago.

I used to love US, it made me feel so sexy and powerful "oooh, look at me wielding this magic wand, and I get to bill $60 for it!"

Now I see it as a waste of my time, my patients' time, their money, their insurance company's money; and unnecessarily creating dependence on me when all I'm providing is warmth (with added risks) that the patient could achieve for free on their own.

[Wahine]

Knot - I graduated from PT school in 1995 and took my physical agents class in 1993. So that's more current than what I've got. I've just never liked modalities in general and tend to stick to manual and therapeutic exercise stuff, so I never really bothered to try to stay current on US. I do use it occasionally to help diagnose fractures, especially stress fractures. Thanks for the info.

[KnottedYet]

Knot - I graduated from PT school in 1995 and took my physical agents class in 1993. So that's more current than what I've got. I've just never liked modalities in general and tend to stick to manual and therapeutic exercise stuff, so I never really bothered to try to stay current on US. I do use it occasionally to help diagnose fractures, especially stress fractures. Thanks for the info.

I can photocopy and mail the textbook pages if you want them, but they are out of date. We make a point of avoiding modalities at our clinic, so I really haven't kept up on recent stuff.

We did have a minor group heart attack when we heard that diathermy is coming back into vogue. WTF!?!?! DIATHERMY!?!?!

[Trek420]

Speak English you PT's :p :rolleyes: :cool: What's diathermy? :confused:

[KnottedYet]

Speak English you PT's :p :rolleyes: :cool: What's diathermy? :confused:

Essentially sticking body parts into a microwave to warm them up.

Insanely stupid and dangerous and was disproved and discarded decades ago.

Trust me, go buy a hot water bottle instead.

[Trek420]

Why not bring back leeches? I hear letting out blood is good. :rolleyes:

[Zen]

diathermy (http://www.britannica.com/EBchecked/topic/161815/diathermy)
Sure, and after that how about some nice soothing electroshock therapy?
I like getting US, it feels so good:o

[Trek420]

I like getting US, it feels so good:o

That's the idea I think. It feels good, so your PT is doing a good job for you because you feel goooood. As opposed to in agony but actually putting the injury back in place.

[Crankin]

Actually, (totally off topic) ECT is being used again, quite successfully to patients who have severe mental illnesses that have not been helped by medication. It's changed a lot since it was used in the '50s and '60s. I have a client that underwent it in September and is doing well, with no side effects.

[OakLeaf]

And so are leeches.

Want some (http://www.leeches.biz/)?

[katluvr]

yes, as a nurse I HAVE done leech therapy. It works for "reattachment" of fingers, etc. They keep the blood "flowing". Of course when they get full and fall off you have to find them. When I did it w/ kids, they thought it was gross and cool.
OK, we have digressed from the knees.....

I say take it slow. Do all thing things they said. Many studies have stated that people at run do NOT get osteoarthritis at a higher percentage rate than the other population that does not run. In fact it may be higher in non-runners. I don't have the study, but life in general can be hard on the knees...not just running.

K

[KnottedYet]

I say take it slow. Do all thing things they said. Many studies have stated that people at run do NOT get osteoarthritis at a higher percentage rate than the other population that does not run. In fact it may be higher in non-runners. I don't have the study, but life in general can be hard on the knees...not just running.

K

I have that study somewhere at work. The upshot was that running cues the knees to repair at a higher rate and keeps arthritis down. By the late 70s and 80s the regular runners had fewer joint issues (even if they only ran a couple miles).

"Use it or lose it"

[Selkie]

Not to bash chiropractors because I think there are some good ones out there, but I had a very, very bad experience w/one. In addition to pushing to sign me up for series of appointments, he used US on my knee and kept BURNING me --- Knott's comments about US use on joints confirm my opinion of him.

I have had good luck with an Osteopath, though. And of course, PTs.

[KnottedYet]

DOs (osteopaths) go through med school. DCs (chiropractors) do not.

When I was in school a chiropractic school was trying to seduce us away from PT by telling us that if we went to their school after only 2 years we'd be DOCTORS, instead of all the work we were doing just to be allied health.

I like being allied health, and after 9 years of college and 3 degrees I'm quite aware that there is no way in heck I could learn enough in 2 years to justify calling myself "Doctor."

[Wahine]

Thanks for the offer on the text book pages but I shall decline. If I get the urge strongly enough I'll see if I can pull up some more recent research. But like you, I don't use modalities much at all which makes my motivation to look into this pretty weak.

[KnottedYet]

A little light reading:
(actually, it is light if you read the abstracts instead of the papers!)

10 years worth of knee goodies:

Changes on magnetic resonance tomography in the knee joints of marathon runners: a 10 year longitudial study. Wolfgang Krampla. Skeletal Radiology v 37 n7. July 2008.

18 years worth of knee goodies:

Long distance running and knee osteoarthritis: a prospective study. Eliza Chakravarty. American J of Preventative Medicine v25 n2. August 2008.

There's another one I haven't been able to get (but really want) from Journal of Bone and Joint Surgery on the physics of cartilage loading and the reinforcement response in the knee. (Feb 2009) Gotta toodle on over to the Health Science library one of these days... cuz I'm not paying online for it.

[Wahine]

Thanks Knott!!

[SadieKate]

DOs (osteopaths) go through med school. DCs (chiropractors) do not.

When I was in school a chiropractic school was trying to seduce us away from PT by telling us that if we went to their school after only 2 years we'd be DOCTORS, instead of all the work we were doing just to be allied health.

I like being allied health, and after 9 years of college and 3 degrees I'm quite aware that there is no way in heck I could learn enough in 2 years to justify calling myself "Doctor."Can I print this out and hand it to everyone who recommends chiros? I can't imagine handing over my spine to someone with so little training.

[KnottedYet]

Can I print this out and hand it to everyone who recommends chiros? I can't imagine handing over my spine to someone with so little training.

Go ahead. There are a variety of schools and requirements. Some are pretty high level, some are not. Just scrolling through a google search during my lunch break I found one that would give both a BS and a DC in 3 years. Niiiiice.

There are no chiro schools in Washington. General opinion when I brought that up to my coworkers is that WA's requirements are just too high for a chiro school to make it here.

Nearest one to me is Western States in Portland. http://www.wschiro.edu/index.php They require at least 3 years of college before admission, and their DC program is 4 years. (so their graduates have 7 years at least) I would probably feel ok going to someone from that program. They also have a sports MS, which requires additional classes to those already required by the DC. So the more degrees someone has from Western States, the more work they actually did.

With DC, it really is "buyer beware." The chiros are working hard to get some standards set, but check each one out carefully before you go.

[Trek420]

Can I print this out and hand it to everyone who recommends chiros? I can't imagine handing over my spine to someone with so little training.

Sure, as long as Knott doesn't get sued by some International Global Chiro Association. :D :p "someone on the internet said you should check our credentials :mad:"