Running and knee problems

[Tobes]

In the past two years, I have lost approximately 80-85 pounds, going from 299 to 210-220. My weight has been stable since last June though people tell me I still look like I'm losing, which I guess is a good thing.
The problem that I have been having lately is that with my cardio workouts, every time I have tried to mix even a moderate amount of running into some run/walk workouts, I develop some pain in my knees (usually under the kneecap, but sometimes in the bone on either side of the kneecap. I don't feel it so much when I'm running as during everyday activities, especially driving). I've tried different shoes, different surfaces, different run/walk progressions, etc. and I still have that problem.
I suppose I could still stick to walking, but I've found when I wear a heart rate monitor that I can't walk fast enough to get my heart rate to a level where I can get any training effect out of it. Walking just doesn't seem to do it for me anymore.
For that reason, I do most of my cardio work on an eliptical machine (though the trainer who helped me with the weight loss feels that I'd be better off learning how to use a treadmill properly than using an eliptical machine or running/walking outdoors. I think experience has taught her that people tend to work harder on treadmills). Still, I'd like to be able to run because it's a convenient form of exercise and on days when the weather is nice, I'd like to have the option of doing cardio outside and I can't afford a bike. I'd also like to be able to play sports that require a good amount of running.
Despite my weight loss is it possible that I'm still too heavy to run or could there be other reasons I'm having these problems? I'm seeing an orthopedic specialist next week. I'm hoping the knee problems could be corrected with therapy and that surgery won't be necessary, but if that's what has to be done, so be it.

[Tom]

First, congrats on the weight loss.

I've had a lot of the same problems with running. I'm OK with it in small doses, but when I increase the volume past a couple miles a week, I start getting the kind of things that you're dealing with.

Some alternate ideas:
- Swimming can be great cardio, if you have access to a pool.

- Take a look at the want-ads, or a swap meet like http://www.craigslist.org/ to see if you can find a cheap bike. You don't necessarily need a good one, and having some kind of bike gives you a great low-impact cardio option.

- If there are hills in your area, walk up them in order to boost your heart rate. Or jog up, then walk back down.

- Calisthenics and weights can also be used for a cardio workout. Check out Mike Mahler's "High Octane Cardio" or some of the workouts on www.crossfit.com for ideas.

- Try to mix things up. You might be able to run a day or two with no ill effects. So run one day, do elliptical the next, bike another day, do some intense calisthenics another day, etc.

What I do: I mostly do the crossfit workouts. Now that I'm focusing on weight loss, I'm going to add some extra elliptical work or biking on.

Just from my own experience, when I'm doing a lot of intensive lifting, I can't handle high-intensity cardio on top of that. I just never feel all-the-way recovered.

I hope something in here is helpful.

[edited to add:]
Also, if the elliptical is working for you, keep at it. I find that ellipticals elevate my heart rate more, with less percieved exertion, than anything else I do. They're a great low-impact cardio alternative.

[moonlady]

Unfortunately I don't have any advice on the knee itself, but I do have an idea to add to Tom's list.

On the treadmill you can increase the incline to get your HR up. I've been doing that -- I find my HR goes up too much too fast when I run, so I've been walking fast, and I found increasing the incline gives me more control and lets me work harder too. I guess that's analogous to walking in the hills.

[asteroid]

I'm an avid runner, been running for over twenty-five years and still learn new things all the time.

First I would ask how tall are you, what your dress pants waist sise is, and what size dress and running shoe you wear?

At a lot of running shoe stores, they will look at your old shoe soles and view your gait. But I find it best to go to different running shoe company WEBSITES and read their methods for determining foot shape (wet paper imprint, old shoe wear patterns) forget about that and and buy a pure neutral running shoe. After a few months try a shoe that conforms to the degree of pronation the (wet paper, shoe pattern test ) confrim. Then compare shoes and alternate shoes on different runs.

Also nice synthetic fiber, padded socks are a great help for foot comfort.

Also analyse your running, are you striking your heal hard or landing flat and hard on each strike? Learn how to glide when running - go to www.runnersworld.com and search gliding, and their many other tips and advice.

Never have surgery in-order to be able to run.

[Tobes]

I saw the doctor today. He took x-rays and said it looked like a simple case of runner's knee. No arthritis.
He prescribed physcial therapy and maybe wearing a sleeve on my knees when I run.

[moonlady]

Great! I love fixable problems.

[Tobes]

I saw the physical therapist today. He said I have patellar tendonosis (sp?). There are small holes in my patellar tendons, like Swiss cheese. There might also be a torn meniscus, but he's not sure.
He told me to ice it for 10 minutes every two hours and to avoid doing anything that causes more pain than a 3 on a scale of 0-10.
I rode a recumbent stationary bike last night for 45 minutes and that hurt a lot more than I thought it would.

[moonlady]

Ow. OK, maybe not so fixable. Sorry.

In looking up what this thing you have is, I found a good website: http://www.tendinosis.org/

Sounds like biking is out for you, for now. How about swimming?

[Tobes]

If only I had access to a pool.

[Tobes]

After a month and a half of physical therapy, my knees seem to be getting better (I still have my shoulder to worry about, but one thing at a time). The therapist has had me stretching, doing a balance exercise and doing step downs (lowering myself off the side of a 4-inch step, touching my foot lightly to the floor, then pressing back up, sort of like a 1-legged squat with a limited range of motion). Once it gets easy, I add 2 inches to the step.
I asked the therapist about resuming squats and what he suggested was sticking to leg presses for a while. Once I can do my bodyweight on the leg press in proper form, do bodyweight squats, then do weighted squats.
Does that make sense?
By the way, one of the problems I had was that my quads were very, very tight, almost knotted into one big ball that never loosened up. After regular stretching and some soft tissue message, that situation has improved.

[Tom]

In light of the fact that you're rehabbing an injury, I think the recommendation is a good one. Really, doing your own bodyweight on the leg press isn't all that much. Think of it as proof positive that your legs are ready for better things. :)

Once you're ready to move on to bodyweight squats, don't skimp on that step. Marty likes for his trainees to become bodyweight squat artistes before moving on to weights. He's stated a couple times that he wants to see 100 non-stop reps with body weight only before moving on to weights.

[Marty]

this is why we need an entire arsenal of cardio alternatives - too much of any one cardio activity risks 'repetitive motion' injury - thousands of weekly reps (each stride-step is a rep) done for years can simply wear down the human body parts used...drummers are often afflicted with carpal tunnel syndrome hitting the skins over and over and over using the same technique - swim, jog, powerwalk, raquetball, B-Ball, tennis, use of weighted implements, jump rope, wrestle, karate - variety of MODE spreads out cardio-inflicted body stress

[tyciol]

- If there are hills in your area, walk up them in order to boost your heart rate. Or jog up, then walk back down.

Totally this! This is like those limited range step-ups except that you can instinctively moderate the height as is comfortable. Climbing a hill is much more predominantly concentric in nature than traversing level terrain.

This is of course, countered by descending the hill being predominantly eccentric, but you can lean back and do that as slowly as possible. Heck, one can even drop to one's side roll down it if nobody's watching or you can bear the stares.

If you have a pair of hiking or nordic walking poles, these can be used going up hill just as on level terrain. One can of course also use one's hands (this is easier on very steep hills) so long as one can stand the dirty, the forward bending can be a little uncomfortable if it's not steep enough that's why the poles are good if you have abdominal problems until one works up to it. Easier on the hands if there are wrist problems as well and potentially better leverege once one learns to stabilize the poles.