Unknown Ending Part 2: You got Jumper’s Knee training for an ultramarathon?

It’s official, Patellar Tendinopathy is the culprit. Patellar tendinopathy, also known as Jumper’s knee, is an overuse injury where pain is centralized below the knee cap. Since I’m just about 2 weeks out from the race, I’m learning to manage the pain the best I can, but it has obviously not been ideal. However, there is good news in all of this, I’m learning A LOT! And if you, or someone you know, are dealing with similar knee pain, I hope this helps you. 

The Journal of Orthopaedic & Sports Physical Therapy had this to say about an in-season patellar tendinopathy diagnosis, “(it) can be difficult to manage, primarily because energy-storage loading may be difficult to modify sufficiently to allow symptoms to settle.” There’s a lot to unpack in that statement, but for the sake of brevity, I’ll pull out one interesting nugget. It’s not ideal nor usually advised to modify your normal running gait (unless maybe to correct previous issues that got you injured in the first place). But since modifying movement allows for the symptoms to settle, there may be enough variation I can play with to make these last two weeks a success.

To cut right to the chase, this is what I’m learning about my case and stage of Patellar Tendinopathy.

• The pain I have at the start of the run seems to be the consistent pain I have the entire run
• Back to back full body weight run days are painful and not currently possible
• 0-4 on the pain score means I can continue running, a score of 5-10 is when I stop the run almost immediately
• Running at an incline feels great, but body weight supported incline running feels the best
• My knee likes at least one day off between runs, however, it’s manageable to run back to back if the first day is a run at ~85% body weight and the second run is outdoors
• Find yourself a good PT that can do dry needling with e-stim, laser therapy, and provides specific strength exercises (more to come on this next week)

My week in review:

• Friday 6/16: 9 mile LEVER run @ 85% body weight and 1% incline (7 min/mi). Pain score 3/10
• Saturday 6/17: 30 mile hilly trail run. ~4.5 hours, ~6k vert. Pain score 1/10
• Sunday 6/18: Run attempt. Tenth of a mile. 6/10 pain, called it quits and enjoyed Father’s Day. Weekly run total 72 miles (17 LEVER miles)
• Monday 6/19: ~33 mile gravel ride. 2hr 7min. Pain score 1/10.
• Tuesday 6/20: 8 mile LEVER run @ 85% body weight and 1% incline. Pain score 3/10.
• 10 mile bike commute to LEVER run
• Wednesday 6/21: 8 mile trail run. Pain score 4/10. Not comfortable, but manageable.
• Thursday 6/22: 1 mile run attempt. Pain score 5/10. Called it off.
• Afternoon: 4 mile LEVER run @ 85% body weight and 4% incline. Pain score 1/10!!

To summarize this week… I’m finding it super helpful to modify training, incline, and body weight support. If I were to be able to do this week all over, knowing what I know now from talking to my PT, I would do the following:

• Increase the incline of all my LEVER run days to 3-4% incline because inclines naturally;
• Get the quads engaged right from the beginning of the run, taking stress off the knee
• Shorten the stride to run uphill (overstriding on flat surfaces can affect patellar tendinopathy pain. This is why I still had some pain on my flat LEVER runs)
• Bike or LEVER run at incline after trail run
• I had to call off two runs this week.

Calling off a run is never a good feeling, especially so close to a race. But it’s in those failed run attempts where I’m learning the most. For example, before a Saturday race, I take off on Thursday and then do a shake out run on Friday. However, understanding now that the day after an outdoor run is usually the most uncomfortable day for my knee, my pre-race strategy is shifting. I don’t have the pre-race plan nailed down just yet, but I will most likely take the Friday off before the race or get a bike ride in.

As I’m learning more about Patellar Tendinopathy, I’m gaining confidence in these training weeks leading up to the 50 miler. It feels so satisfying knowing that I’m learning a lot about my body and that I have the right tools to keep the legs strong and turning over before the race. The little to no confidence I had 3-4 weeks ago, has now been replaced with hope and excitement. Two weeks feels like a long time to continue managing pain, but this week was a great step in the right direction.