Good Preparation Can Stop Jogging Pain, But Not Always
Dear Dr. Roach: In preparation for jogging, I built up to power walking 4 miles a day over a three-week period, in addition to 20 minutes a day of full-body stretching. After jogging only twice (with proper instruction), I have developed swelling under the inside of my kneecap. In addition to the swelling, it is painful to walk (more so toward the end of the day). The pain seems to be more toward the front of the knee.
My personal goals for jogging began four weeks ago, when I committed to being in better physical condition. I have always enjoyed walking and wanted to pursue running. I have lost 16 pounds in the past four weeks due to my daily exercise and diet. I have been able to come off of my cholesterol medication, as well as my blood pressure medication (all under the supervision of my doctor). I felt confident that I was progressing at a safe rate, then all of a sudden my knees started having the pain and swelling. — W.I.
Answer: You must be frustrated by developing this complication when you have taken great care to prepare your body so as to avoid it.
There are a few possibilities for the cause of the pain. One is that, despite your properly getting your body ready by your power walking, the structures in your knee just aren’t yet up to the task of jogging, which puts more stress on your bones, joints, ligaments and tendons. This goes into the general category of overuse injuries.
The second possibility is that you have a little osteoarthritis in the knees that is acting up with the increased activity. However, I think what you may have is a condition called patello-femoral syndrome, which is the most common cause of anterior knee pain in young athletes. In patello-femoral syndrome, which is more common in women, there is some laxity in the patellar and femoral tendons (which attach to your kneecap above and below, respectively). The thigh muscle (actually four muscles, the quadriceps) sometimes gets imbalanced and doesn’t pull straight up. In your case, the inner thigh muscles might be stronger, pulling your kneecap toward the inside (i.e., your other knee). Diagnosis is important, because if left untreated, it can permanently damage the cartilage under the knee, a condition called osteomalacia. Treatment is with physical therapy, retraining the muscle to lift straight up.
A physical exam and possibly an X-ray should sort out these possibilities. Many general doctors are familiar with this syndrome, but a sports-medicine doctor or orthopedic surgeon would be the expert. Please let me know. For right now, I would recommend going back to just walking. An anti-inflammatory such as ibuprofen would be a good idea if you continue to have pain and swelling just with walking.
Finally, walking is nearly as good as jogging in terms of overall health, blood pressure, cholesterol and weight control, though I still recommend getting your knee checked out.
Dr. Roach Writes: In August, I answered a question about floaters, and said as long as they weren’t affecting vision and that a thorough exam had been done, the treatment might be worse than the disease. Several readers took the time to tell me of their good experiences getting rid of floaters through vitrectomy or with laser treatment. Another wrote to warn me of a rare disease, birdshot retinochoroidopathy, which can present with floaters and might be missed by ophthalmologists not familiar with this condition.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or rwrite to P.O. Box 536475, Orlando, FL 32853-6475.