I started running @ age 50. I’m lean – 5’8.5″ (used to be 2″ taller)/146#, so excess weight is not an issue. But decades of weight lifting (heavy squats, leg extensions), hard-core skiing (bumps/moguls) and breaststroke swimming (whip kick) took their own toll on the cartilage which lines the inside of the knee joint. 3 years ago @ age 69, after an unnecessarily hard set of squats (450# on the sled), and an excessively long day of powder skiing two months later when I thought I’d healed, I went to see a sports med doc and an orthopod after getting an MRI. They said I had worn my cartilage down to the bone and cut out deep grooves in what little cartilage remained – an “ulcer”. Edema inflamed the femur.I decided to salvage what I could, as I still wanted to do a few more Ironman and other long-distance races, as well as ski and bike for the rest of my life. I began to read everything I could, and saw several physical therapists. The consensus: (1) cartilage will not grow back; (2) You can run as much as you want as long as it doesn’t hurt, (3) Some people use stem cell or platelet injection in an attempt to provide regeneration. I also learned about the three different compartments of the knee. The outer two are where the menisci are, where most of the load-bearing occurs, and mine were (relatively, I am 72) fine. The third, where the knee-cap rubs against the femur, had the damage.. I had pain primarily with things like walking downstairs, squats, and running hard, fast, long or often. I foolishly ignored all that, to the point where I did a 3K/120k/30k triathlon in May 2019, and, while I succeeded in getting 2nd pl in that ITU world championship, ended up literally not being able to walk for several days afterwards, I tried an IM the next month, and walked the last 10-12 miles. Again (like an idiot) I tried an IM in October, and quit after 17 miles of the marathon. I did finish an IM in November of that year. In the summer of 2019, I began doing what I call “gluteal” work, mainly 3-4 x/week exercises to strengthen the small muscles around the hip joint. I also started paying attention to my footfall, and to the ankle/knee/hip angles, the landing points, and the pronation which produced the least pain. I gradually increased my frequency, and added strides judiciously. I also stopped doing long runs, fast runs, and frequent runs. From October 2019 through 2020, things kept improving. I have been pain free for the last five months. I’m grateful for a race-free 2020 (I had been averaging 2 IMs a year since 2000), giving me this chance to heal. The exercises which I found most useful were:
1. “Dipping duck”. Imagine that toy where a duck continually leans forward into a water dish, then leans back up. Standing on one leg, keeping that knee straight, holding the other foot towards my butt, I lean forward close to 90 deg, then straighten up, making sure I feel the effort in the upper outer quad of the glute of the leg I’m standing on.
2. Hip Raises. Again, standing on one straight leg. Again focusing the effort on that same spot. Drop and raise the opposite hip, using the glute muscle of the leg I’m standing on.
3. Clam shells
4. Side leg raises
5. Single leg knee bends
6. Squats, now with lighter weights than I used to use, never going deeper than 90 deg
7. NO LEG EXTENSIONS!!!
I do the exercises 30x on each side, the squats, two sets. I suspect someone who is >;; 40 y/o and wants to have a life-long career in running and/or triathlon, should begin to take preventive measures involving strengthening the quads, hamstrings, and glutes, whether you have pain or not. As well as pay close attention to running technique, especially foot fall. And warming up those glutes before running, either by gradually increasing speed from walking thru jogging to running, vs. specific exercises. The older we get, the more warm-up we need. I also believe the received wisdom is wrong. We can repair cartilage, but it requires (1) stopping the ongoing damage, to allow healing to occur and (2) recognizing that it takes years, not weeks or months, to repair that damage. I also believe that if it doesn’t hurt, it’s okay to run, as long as you pay close attention to frequency, distance, and effort. If it hurts, go back a step. The body will heal, given the space to try.