Image: https://www.flickr.com/photos/thomasrousing/
I have been running for 37 years. I have been doing it wrong. That didn’t matter until last year. Last December I ran a trail race in Marin and afterward my knees hurt. Both knees now creak even when I walk down stairs. Any amount of running has become a pain. I thought that time and rest would heal my knees, but they didn’t. Before the race, I had been running at least twice a week. Now, I’m lucky to run twice a month. Not being able to run has diminished my fitness. I had also been commuting by bicycle 15 miles a day. Due to some job transitions, I cut out that commute. The sudden reduction in exercise lead to a 10-pound gain in body weight. Being heavier meant more pressure on my aching knees. Running became even more painful. I picked up swimming to get some exercise. Swimming is tough. Lap sessions are open early in the morning. Swimming is also not as aerobic as running. Unless you are training to compete, swimming doesn’t get my heart rate up. Also, my lane partners don’t appreciate my swimming up on them every lap. It looked like things would just continue in this vein, if I didn’t get proactive. So, I did. The first step was identifying the problem.
The knee pain could be correlated with several things.
- I could have an injury. The steep downhill of the trail race and training and the tough training for it may have caused a tear in the meniscus. I could have arthritis of the joint. Having recently turned 50, these kinds of ailments get more and more likely.
- I’m fat. I was posting a body weight of 30 BMI, which is about 35 lbs. overweight. I didn’t think it was a big deal. A little extra weight didn’t keep me from posting run times that were above average for my age. All that extra weight had to be putting some hurt on my joints, though.
- Weakness in my core. Although I was aerobically fit, my core was not especially strong. Flexibility was terrible. I hadn’t touched my toes but once in the last year but that was after literally an hour of stretching. I have not been able to repeat the feat. Lack of flexibility and a weak core could be forcing me to put undue pressure on my knee and back joints when I run.
- Trails themselves. Maybe I am just not cut out to run on trails anymore. If I just keep to the flats or even run on the track I may not put myself in situations where I’m likely to encounter a lot of knee pain. With this idea, I tried ramping up my running just on flats and tracks. Pain was less but not by a whole lot.
- Many people have remarked on my running technique. Not favorably. Back in high school my sister used to tease me about my loping gait. Training for trail run last year, one of my colleagues tried to give me some pointers on how to run uphill. I paid attention but it didn’t all connect. I have never been very confident of my form, but as long as my split times were getting lower, I figured I was improving. With the knee pain, however, I found it impossible to find a comfortable gait which I could just groove on and forget. Perhaps, a more economical and correct form would help with the pain.
- I have been running in the same shoes for the last 25 years. Asics GT-2000. They had another name in earlier year models, but it is the same shoe. It’s the only one that fits and feels comfortable. Maybe my latest pair were worn out and new pair might make running easier.
I didn’t know which if any of these factors was causing the knee pain. So, I dealt with all of them. I went to the doctor and had x-rays of both knees. No cartilage tears or arthritis. The diagnosis was “runner’s knee”. Inflammation because the patella was not riding in the groove of the shin and thigh bone joint. Finding out there was no trauma gave me hope that physical therapy might relieve the problem. The first and easiest thing to attack was weight. I adopted every other day fasting for weight loss. Over August and September, I dropped 20 lbs. In the last month, I am losing another 5. This has been great for more than just my knee pain. I feel better and my clothes fit better.
The second thing was starting a consistent weightlifting routine. I have been a member of 24 hour fitness for three years, but have basically just mailed my monthly membership fee to the company because I only used the gym to take showers downtown. Now, I started the Stronglifts 5x program and have been going to the gym and lifting heavy weights for the last twelve weeks. This has undoubtedly helped with the weight loss. More importantly, I have been focusing on full body compound movements like the squat, deadlift, bent over row, overhead press and bench press. These movements strengthen the core as well as the muscles around the knee joint from the hips all the way down to the calves. When I first started, I was feeling a bit of pain on the squat. Digging deep puts some pressure on the knee. After several weeks of very slow progression in weight, the pain has subsided. Along with the weights, I have more consistently practiced yoga. Focusing my poses on flexibility in the hips, legs and feet. Lastly, I got the physical therapy protocol for “runner’s knee from my doctor. I have added the specific stretches and exercises to the yoga and weightlifting. All of these together promise to help my form in running.
After 8 weeks of this, I decided to test if running were any less painful. I invited my son to run the course he runs at school in PE. The class circles the Sunset reservoir. This .86 mile routes has a pretty steep downhill, a quarter mile flat, then a gradual uphill. We set off. The downhill was not fun. I felt I had to lean back and stutter shuffle all the way down to avoid putting too much force on my knees. The flat was okay, but still plenty painful. The uphill was fine and I got a chance to get my heart up and to pour on some speed. The final analysis of this run was that I had a long way to go before I was putting in any 15 mile weeks.
Having dealt with the more obvious things, I now turned my focus to technique. I ran across an article in the New York Times about the 100-up. The 100-up was a running technique invented in the 19th century by a chemist’s assistant who went on to set world records that stood for almost two decades. It is incredibly simple but according to the journalist offered dramatic benefits to speed and resistance injury running. I took this to heart. I won’t go into the details here, but basically the technique focuses on landing on the midfoot directly below your center of gravity so that the muscles of the leg absorb the shock of the stride. The journalist wore sandals to run in. Using the 100-Up technique there is so little impact on the feet, that the cushioning and support of a modern running shoe is unnecessary. I had to try this.
I figured I would need to be going barefoot or wearing a minimalist shoe if I was going to try this technique because otherwise my very cushiony Asics would lull me back into my heavy heel strike. I went online to Amazon found the Merrel minimalist shoe. Not wanting to venture so much money on an experiment, I found a knockoff from some non-name only on Amazon company and ordered it. When they came, I biked over to Kezar stadium to try them out on the track.
These shoes are barely there. They have a 4-mm thick sole that is wrapped to your foot by mesh. Peddling on a bicycle felt weird. With no support of your arch, one must hold one’s feet rigid to get the force to the pedal. At the track, I ran through the 100 repetitions of the hop and started out on a nice leisurely mile. One foot in front of the other with no heel strikes. Heel strikes would clearly have hurt with no padding on the shoes. I started slow, each lap speeding up a little until I was at my half marathon pace. Nice. Weird thing, my calves burned. Really burned. I then ran some easy 200 M intervals trying out some faster paces. All smooth. I found that as I got tired, I started getting closer and closer to striking with my heel, but my feet were sensitized and I could feel when my gait was breaking down and correct it. Two and a half miles and I was done. The longest I had run in over two months. Three days later I tried again. When I got to the stadium, however, I found that it was closed for a football game and I couldn’t access the track. I guessed it was a good time for a road run. I biked back to Golden Gate Park and ran through the panhandle on the asphalt path. This was more uneven and rougher than the rubber crumble of the track, but I was doing just fine.
For my third run I returned to Kezar stadium and timed intervals. 30 seconds of sprint and two and half minutes of rest. Again, relatively pain free. During the sprints, my form running on the balls of my feet felt very natural. I have to pay close attention to form all the time though. Every stride, I note exactly how my foot is striking. I pay attention to my posture, the angle of my lean, the height of my knees. It is going to take a while to ingrain my new form. I am very excited about learning this new form. It may not be as fast as my old technique, but the gentleness on my knees mean I can do a lot more running.