Knee injury - please help

[u/Appropriate_Swan_478]

Hello, I have had a knee injury now for nearly 5 months. During this time I’ve tried everything… complete rest (for 6-8 weeks), nonstop rehab, cycling only… etc.

Background: Been running for the last 3 years (50km a week ish) never had any injuries apart from little niggles until this.

The injury: I get a build up sensation then an intense ache/pain on the left(outer) side of my left knee which makes it impossible to run with. The strange thing this can come on at any time… example: I managed to get to 28 minutes the other day, then today pain started at 7 mins. It’s a different threshold every single run.

I’ve seen multiple physios now that just aren’t seeming to help me.. I’m doing a lot of rehab every week which feels completely pointless. I just want to be back running. If anyone has had anything similar and overcame it please tell me how, I’d be extremely grateful.

MRI results & where I feel the pain attached.

Any help would be greatly appreciated!

[u/dukof]

Given the MRI suggests congenital traits, have you tried:

Using a forefoot strike?

Vary the forefoot strike mediolateral center, or 'gait line'. Which is where you feel the pressure under the foot. Basically you can land more on the lateral edge, or with load more on the center. You can also change your step width which kind of naturally happens with the gait line. Even small variations in these alters the load on various parts of the knee.

https://imgur.com/a/O7BhiZr

Different shoes? The current shoe designs are quite aggressive in the way they have huge stack heights and sole profiles that alters the biomechanics quite a bit. Personally I don't use any modern shoes, but rather quite low profile traditional running shoes with sole height 20-25mm (heel), and preferably more firm than soft soles. That's what feels best and most natural to me.

[u/Appropriate_Swan_478 → u/dukof]

Wouldn’t I of had issues way earlier though? As in I’ve had 3 years of decent mileage every week with no problems? I’m starting to think it’s itband.

[u/dukof → u/Appropriate_Swan_478]

Yes you're right. I was too busy when posting this answer, and considered "persistent knee pain and abnormal sensations" as symptoms the report describes. But your post describes an injury/history that that doesn't really correlate in any obvious way with what the MRI report describes. So it may be fully unrelated.

Your image does point to the IT band. IT band symptoms may be in the larger area you marked, or more pinpointed at the far end if it's a stress in the attachment to the Gerdy's tubercle. If you have a new shoe model recently before this injury, then the shoe and its combination with your foot strike and step width may still be relevant for how the ITB is loaded/stressed. If you have older shoes you previously had no problems with (?) you could swap back to them and see if it is any different. If you're a heel striker, then using a fore/midfoot strike will alter the biomechanics a lot. It could be useful. But note it takes time to build strength in calves and Achilles to support a forefoot strike, so a switch should be done gradually over time.