Knee Pain and Running Marathons

This is an inquiry from one runner about a relative (and runner). She wants to run a marathon but each time, her knee acts up and she says it is so painful that she can’t run. She seems to be able to get to around 8-10 miles and her knees stops her in her tracks. The second attempt ended with the pain moving to the opposite knee and the one previously effected is no longer a problem. Now she can only run about 3-5 miles and it still hurts. She’s been told it is her ITB (from a running store) as well as that she doesn’t have the training background to do marathons (by other runners).

Are some people just not made or able to run marathons?
Is it an issue of mental strength to be able to push through the pain?
What does a person do when your knee or IT band acts up every time you hit the 5 mile mark but you want to run 26?
Could it be the shoes?
She will never ask a doctor or a foot doctor. Is this a good idea?

I’m sure every runner knows someone who has similar patterns. Knee/ITB pain or some other pain – it wouldn’t really matter; all can be dealt with similarly. So let’s look at the basics. Anything that has a pattern has to be analyzed.

Training: The fact that she breaks down once she is up around a 10 mile run may indicate that she is simply training incorrectly: that is too much, too soon; wrong workout combinations; poor rest and recovery integration. So, it could be that she is training wrong.

Injury Recurrence: The reason most runners get re-injured is because they don’t remediate the weakness that led them to the injury in the first place. Therefore, the pattern repeats.

Shoes: yes it could be shoes. Not all running stores do this assessment well. Why? Because of the human element. Not all workers at the shoe store are equally trained, astute or insightful to fit the right shoes.

Genetics: It could be that she is not made for long distances and will break down due to her own unique predisposition to injuries. Will power does not override this… without dire consequences.

Biomechanics: If she won’t go to a doctor this is a moot point however, there is no doubt something going on and it may not be as simple as getting a new or different pair of shoes. Leg length discrepancies and muscle imbalances are a couple examples of things that can cause her problems. She’ll take advice from other runners and a shoe store but not a sport medicine specialist? Not a good omen for turning this around. Just because someone runs or sells shoes does NOT mean they know what they are doing. Always consider the source. It is possible that a simple orthotic will solve the problem.

Pain Tolerance: Without a doubt everyone is different in their ability to handle discomfort. Not everyone is cut out for “enduring” long runs or races just like some do not “endure” the pain of an all out one mile time trial. However, it also is not “no pain no gain” approach in succeeding in a marathon. That is a formula for disaster.

The one thing that is definitive: if she continues to do what she has always done, she will continue to get what she always got. If she doesn’t get help and/or do things differently, she is doomed to repeat her failures (pain/injury). What is difficult for me in dealing with these athletes is the continued complaining about the issues yet the lack of action to change it.

So the action items that I would strongly suggest:
1. Back-off on any training to the point that there is no pain. Allow the body to heal. This may mean a few rest days or weeks or just backing off on mileage.
2. Go to a different store and get a footstrike analysis done to be sure she is in the right shoes.
3. Get a full biomechanical assessment from a trained sports medicine specialist (one who knows runners – not someone who specializes in a baseball pitcher’s rotator cuff repair).
4. Get prescribed (by a sports medicine professional) rehab exercises and orthotics (if necessary).
5. Religiously do the prescribed exercises.
6. Get a coach who knows what they are doing and design a training program specifically for her and who will work with her in support of her goals.

Only after all this can the question be answered whether her mind and body are capable of running a marathon.

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About Dean Hebert

I’m a mental game coach, author and speaker. I work with individual athletes, parents, coaches, and teams on sports performance enhancement. Beyond my academic post-graduate work in sports psychology - the psychology behind athlete performance – I am a certified Mental Games Coaching Professional (MGCP) and certified hypnotherapist. I’ve authored several books and hundreds of articles. “Coach, I didn’t run because…” (2008) is a seriously light-hearted look at making excuses not to workout and how to overcome them. “Focus for Fitness” (2009) and “Screw the Goals Give me the Donut” (2010) are two of my eBooks on mental game approaches for the everyday athlete. I wrote these because I believe that everyone can benefit from the powerful mental techniques that the world’s best athletes use. I have been cited in Runners World, Best Health magazine (CN), SWEAT Magazine, and the Washington Examiner amongst many other publications. I have been a featured mental games coach in Runner’s World and for the internationally acclaimed trail running resource - trailrunningclub.com. I also regularly appear on sports and fitness talk shows such as LTKFitness, Runnersroundtable and for more than three years I have co-hosted a weekly video series with Coach Joe English for Running-Advice.com. I specialize in mental toughness training. My clients include tennis, synchronized swimming, golf, race-kart, soccer, motocross, volleyball, MMA, cycling (road, off-road, time-trialist), running, duathlon and triathlon, basketball, football and baseball athletes. I have coached world-class athletes and athletes internationally. I have a passion for working with youth athletes and helping them apply mental game skills and techniques to all areas of life. Most importantly, my aim is to have people enjoy sports and life to their fullest through peak performances.
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6 Responses to Knee Pain and Running Marathons

  1. run4change says:

    Thanks. Great post. And you are so right that there is SERIOUS pain in running a one mile time trial. HAHAHAHA It kills the heck out of me to do one.

  2. bards says:

    perfect timing, thanks for this post. my ITB went on strike yesterday. 😦 we are negotiating today and hopefully we can resolve our issues by Sunday … or maybe tomorrow. *sigh*

  3. Dean Hebert says:

    Total bummer bards… i hope negotiations go well. 🙂

  4. Keryn says:

    I simply had to comment on this because its a very topical issue for me and I agree with the article absolutely. I’ve been running for nearly 28 years and recently my favourite knee (the worker) packed in. As I was in the last week of marathon training, and despite the fact that I knew better, I decided that I didnt run through the winter rain for nothing. I popped nurofen and ran the marathon – not only in new shoes (sold to me by aforementioned running shoe salesman for ‘my problem) but adding my heel wedges as well. Result – disaster. I finished the marathon (about 1.40 slower than my best ) but the damage I did put me into physio for 8 weeks. A sports doctor advised, on seeing my MRI that I have a clean out orthroscopy, but I chose physio instead. There was some improvement and I went back to training. It was less than 2 weeks of almost normal training when the knee packed in again. This time I am waiting patiently for the surgeon and in the meantime I have reached for my water belt – which is how I stumbled on the site in the first place. If there is one thing I have learned, you can’t run through c hronic knee pain and more particularly, not a marathon. Thanks for the great information on this site.

  5. Seoirse says:

    I have problems with my cartilage and use glucosamine sulphate and find that it helps A LOT to eliminate any pain, in fact I would go as far as saying it is 99% effective.

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