I’m in the countdown phase of my marathon training and am now experiencing pain in the outer part of my knee—likely an IT Band problem. I’ve had to lay off several days after long runs (latest was 22 miles) and I’m concerned I may be losing fitness and making myself more prone to pain/injury in future runs. I have two more long runs before the marathon in Feb. but am highly concerned that I may not be able to do them. Any advice is greatly appreciated!
—Rachel
Fitness is a bit like money; difficult to accumulate and easy to lose. You do lose some fitness on the cardiovascular and muscle level when you are not active. Substituting an alternate activity will help curb that loss, but you lose sport specificity training with activities that are not like running. I think deep water running in a life jacket or similar flotation device would be the closest activity to maintain your cardiovascular and muscle fitness.
I think of the victim-culprit paradox when assessing injuries like ITB syndrome, which are often the victim of altered kinetic chain mechanics somewhere between the foot and low back. The usual suspects are in the foot-ankle joint complex or in the pelvis. If the pelvis is rotated, the normal downstream motion is altered and the ITB can be tight on one side and loose on the other putting pressure on the underlying tissues and leaving you with pain in the lateral knee. A loss of motion through the foot and ankle can result in the same tissue stresses upstream in the knee. A manual therapist (PT, chiropractor, or DO) should be able to assess your mechanics and correct any problems. Sometimes the pain resolves rapidly once the joint motion is normal along the entire kinetic chain.
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You should also address your training log. Did you advance your training too quickly for your running history? A longer running history toughens the tissues and reduces your risk of injury from doing too much, too soon. If you have over done your training, you will need to let the tissues heal before you try to progress. From the information you have given above, you probably have the base to complete a February marathon and your chances of finishing pain-free will go up if your mechanics are correct.
Hope this helps and good luck.
Cheers, Bill
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