THE CLINIC: Too Much, Too Often

Wed, 10 Oct. 2012 - 2:43 a.m. MT
Credit: ARA Staff - American Running Association

QUESTION:

I have begun my 10 day taper for the marathon I’m running in just over a week. My mileage is pretty high: 95 miles a week, now tapered to 60 miles a week. I was doing an easy recovery run when I heard a pop-and-tear as I landed. I had immediate pain in my knee and had to hobble home. I had an ACL repair about 12 years ago but have never had any knee problems since then. The MRI I had done right after the injury showed a “contusion of the posterolateral tibial plateau” along with an effusion, but no torn ligaments or meniscus. I can’t find any information about running causing this type of injury. Besides rest and NSAIDs, how do I treat it and what can I do to prevent it from happening again?

 

Alan Scott

Lewisburg, PA

 

ANSWER:

It sounds like you may have had a microscopic fracture of your plateau. This is a variant of a stress fracture and really is the result of too much, too often, too long, and too hard. If this is in fact what we are dealing with here, you must learn to scale back your training to more moderate levels and incorporate more low-impact crosstraining. Ninety-five miles a week may have been too much. Immediate treatment involves no running for several weeks, followed by one or two days at most, and then working into increased distance and intensity slowly. I had a patient who tried to keep running and had loss of joint surface cartilage in the area, and consequent long-term problems. Swim, row, bike, or use a glider-type crosstraining machine to substitute impact activity. If you are running some in three months, consider that very good progress and don’t become impatient. I am not a great fan of NSAIDs just to keep people going, as inflammation is part of the healing process, so use these with caution.

 

Larry Hull, MD

Centralia, WA

 

ANSWER:

It would certainly be very unusual to suffer a bone contusion in the manner in which you describe. However, it is well known that bone contusions commonly occur at the time of an anterior cruciate ligament tear, and this itself is not uncommon with a simple twisting type injury. In any event, although there are no hard and fast rules, bone contusions typically take four to six months to resolve on MRI, with some most likely never resolving. It is possible that this is residual signal uptake from your original injury 12 years ago. There is really nothing you can do from a treatment standpoint for a bone contusion except time, activity modification, and analgesics. Be as active as comfort allows. However, you must avoid impact activities such as running; substitute with swimming or bicycling. I would also like to note that MRIs are not perfect. It’s been shown that MRIs miss up to 20% of cartilage tears. If your tenderness is not directly over the area of the bone contusion on the MRI, I would question whether the MRI abnormality is in fact causing your pain. Perhaps you have a torn posterolateral meniscus that has gone unidentified on the MRI.

 

G. Klaud Miller, MD

Evanston, IL

DISCLAIMER: The medical information on this site is provided as an information resource only and is not to be used or relied on for any diagnostic or treatment purposes. This information is not intended to be patient education, does not create any patient-physician relationship, and should not be used as a substitute for professional diagnosis and treatment. Please consult your health care provider before making any healthcare decisions or for guidance about a specific medical condition.

The American Running Association (ARA) and its Clinic Advisory Board disclaims responsibility and shall have no liability for any consequences suffered as a result of your reliance on the information contained in this site. ARA does not endorse specifically any test, treatment, or procedure mentioned on this site.

 

(RUNNING & FITNEWS® November / December 2011 • Volume 29, Number 6)



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