Chronic knee injury (33m) - running out of ideas

Question: Do you land on your heel or midfoot/forefoot when you run? If you land on your midfoot/forefoot, do you tend to switch more to heel strike when you get tired?

I had a similar problem and treated it successfully with a slight change in running form, hamstring exercises, and a single hyaluronic acid injection.

I'm on my phone and can't thumb type so I'll have to wait until I have a laptop, but if you can expand on my questions, I'll explain what I did and maybe it would help you.

What are your arches like? Do you roll inwards?

I had some tests for my biomechanics at the back end of last year that showed that I was a mid foot striker. I believe I do tend towards heel striking when tired yes.

In answer to the other reply, I have quite high arches.

Dome other things that test revealed which differ between my two legs, which I suspect are contributing to knee issues:

- Poor ankle doesiflexion / knee to wall

- Poor hip internal rotation

- Foot points outwards

- Ankle pronates / rolls inwards - contributes to post tibial issues I have always suffered from

- Hip collapses on that side when running

- Inability to put much "force" through my big toe, which results in poor balance and drive on that leg.

I have been working on a number of these with my physio, but soI had some tests for my biomechanics at the back end of last year that showed that I was a mid foot striker. I believe I do tend towards heel striking when tired yes.

I had a similar injury 5 years ago, but now it's under control. My x-ray showed that the cartilage where was on the underside of the lower kneecap and the lower leg bone, but i think maybe what I did will help you as well.

I have numbered some key points in your previous post. Points 2 and 3 cause the kneecap to track improperly, which in turn causes excessive wear on the cartilage. Point 4 is caused by 2 and 3. Fix 2 and 3 and point 4 will be less of an issue. Heel striking when you're tired can exacerbate 3, which makes the problem worse when you're tired or you inadvertently heel strike.

A hyaluronic acid injection will provide some temporary relief for a few months but it doesn't address the underlying problem, which is the kneecap pushing against the leg bone because it's not tracking properly. That's the problem you need to fix. ( of course, I could be wrong, but this at least gives you a place you can start.)

If I were you, i would try arch supports because on these problems can originate from the arches collapsing. You could try an off the shelf orthotic, like superfeet, to see if it provides some relief but I would guess that you may have to see a podiatrist who works with runners because your foot also points out. That can be addressed by tilting the insert in that shoe slightly. I can do it with my own homemade orthotics but I'm not sure I can describe to you how to do it.

Once your foot is tracking properly, the kneecap will move back and forth in the proper plane and won't put undue pressure on one side of the kneecap. That won't replace the cartilage you've already worn off, but it might be enough to allow you to return to running for many more years.

I've made my own orthotics for many years. I've even posted a video on how to do it a year or so ago on let'srun. You should be able to find it if this interests you.

Look up the Knees Over Toes Guy on Youtube. He has lots of great exercises like split squats and walking backwards on a treadmill. I hurt my knee last year, went to the ortho, MRI showed nothing. But a few weeks of the Knees Over Toes stuff and I was fine.

Knees over toes guy has good stuff.

Also, has your PT checked recently for tightness/knots in quads? Tight back? And Thomas test? I would address that, and then try to correct the collapsing hip and feet. Maybe you need a different PT to help with all this.

I'm a PT from Bellingham, Wa and what I see that can happen is your body is protecting something and it's showing up as pain. Bone Bruises are often a source of knee pain. There is an IMT technique to clear up bone bruising. Let me know where you live and I can see if there is someone in your area who can fix it up. The key is to find out why your body has this issue. It could be various reasons. I can also send some self treatment videos over if you like. Keep us posted. Hope you get out running soon. Ralph Havens PT

Check out kneesovertoes guy on youtube. stretch/loading quads/hamstrings with nordic/hamstring/quad exercises. glute strengthening also can help. think about how muscles interact with the knee - if some are tight or weak - they may pull asymmetrically on the knee.

Knees over toes is very good. The motor blew up on my treadmill and I use the natural resistance on it now doing 2x8mins front /backwards power walking. I always do slow motion bodyweight squats as a warmup. Slo motion allows you to activate the glutes and use your hips to lessen tendon overuse.

*I did the above with a measured difference but patella medial&lateral would always twinge a few times a month on stairs.

I did a Blood test and it showed a slightly high Ca and Vit D and elevated liver enzymes(inflammation). I basically bought into the hype of Vitamin D(multiple having 2kIU) After this got on 400mg of Magnesium Malate(vitamin d depletes), trace mineral liquid, beef liver(useable vitamin a- vitamin d depletes Retinols) Zinc, Niacinamide&lower dose b complex and fish oil. After 4 weeks of this I felt looser then at 6weeks began to feel a symmetry of both legs. This regimen really seemed to turn the corner.

Holistic health, diet, and objective blood markers do make a difference in my case the patellas were whispers then barking that PT could not solve.

Thanks for the advice. You're correct in that I have some clear associated biomechanical deficiencies in this leg - there must be a correlation between these and the reason that literally all of my historical running injuries occur on this side. I own a couple pairs of off the shelf orthotics which I have used in my running shoes, but as you say they might not exactly fit the bill with regards to the tilt. I've gone and ordered some additional inserts which can be used tilt the orthotic for pronation/suprination, so I'll give those a go. I'm also concious that I spend time on my feet for work, and I've never used an orthotic in those - so that would probably be sensible to remedy too.

The results from the MRI did show some "discoloration" (I think that was how he phrased it) around both the cartilage and the bone in the area of pain, so its entirely possible that the problem has extended to bruising of the bone as well. Unfortunately I'm on a different side of the world to you, however I am seeing my PT next week and will raise this (and the orthotics mentioned above) as a avenue to explore. Appreciate the advice.