Patellar Bone Bruise – What I’ve Learned

My training for Boston was going great.  More than great.  Amazing.  The winter months were brutal but didn’t deter me from getting my workouts and long runs done.  I ran on the treadmill more than ever, but made each run count and nailed my paces and mileage despite polar vortexes, icy trails and huge amounts of snow.  I raced a strong half marathon in March at RnR USA and was feeling so good about my fitness and mental strength.  It was all coming together – one day, one step at a time.

Rocking the Rock n Roll USA 13.1

And then, one cold Sunday morning 4 weeks before Boston, I decided to try out the ElliptiGo with my good friends Jeff and Maddie.  Usually on Sunday mornings I take a yoga class but thought why not switch up my cross training and bring it outside with some non-impact running on this super cool bike?!  I still think that in theory this wasn’t a bad idea, the ElliptiGo is an awesome form of cross-training for runners and I look forward to getting better at using it, but looking back it was a little short-sighted of me not to consider the risk I was taking.  I had never done it before and the feeling was totally new to me, and when I went to get off of it I fell into the pavement and banged my knee right into the asphalt.

I got up and assessed the situation – my knee hurt a little but it really wasn’t bad.  I got back on the ElliptiGo and we hit the trail for a few fun and, honestly, exhilarating miles.  We had a blast!

all of these pics were taken after my fall – it was so fun!

It wasn’t until a few hours later when I was home that I noticed my knee was pretty sore and stiff, especially walking down the stairs.  That week was rough.  It was supposed to be my peak mileage week and I ran a total of 31 miles (as opposed to well over 80), ALL of which hurt me — BADLY.  I saw two doctors who I really trust with my whole heart and they both diagnosed me with a patellar bone bruise. An acute injury to the bone, one that would take TIME to heal and a process that I really couldn’t rush.  It would take anywhere from a few weeks to a few months to feel normal again, and that uncertainty was rattling to me.  I really needed to take it one day at at time, to listen to my body and do all that I could do to help myself heal, while also preventing myself from getting another injury as a result of my form changing or muscles tightening or tendons getting grumpy around the kneecap (this was of more concern to me than the actual bruise itself was, to be honest).

As with any injury, recovering from a bone bruise takes time and the healing process is different for everyone and depends on a lot of factors.  A bone bruise is probably not the most common running injury, though I imagine this kind of thing could happen more frequently to trail runners who may fall on rocks and get pretty banged up.  I thought I would share what I’ve learned from my own experience with this injury though, just in case someone might find it helpful.

Running:  In the first few days following my fall, running HURT.  The pain was constant and didn’t seem to get worse as I ran faster or longer, but it did not subside at all.  Despite assurances from my doctors that it was “safe” to run, I hated it.  I was running in pain and in fear and after a few days of that I decided I needed to rest.  I did not run for the remainder of the week.  In retrospect I really think I should have pulled the brakes on my running right away – no matter what anyone advised me of.  If running through pain to you feels wrong then it probably is.  I think I probably slowed the healing process down a little by running through it.  I don’t think I made it worse, but I probably could have, had I continued to not listen to my body.  I gradually started running more and more as the pain lessened and I did not attempt to push my pace until it just naturally came back to me to do so.  It was more than three weeks before I was running my marathon pace again.

Pain Management: LOTS of icing, especially after a run.  I would typically massage the painful spots on my knee cap with ice cubes until they melted, or wrap an ice pack around my knee and elevate it.  I applied Arnica gel to it throughout the day.  After doing some research on anti-inflammatory supplements and foods, I started taking Vitamin D, Bilberry, Bromelain, Glucosamine with MSM (vegan), a vegan Omega (similar to fish oil but I am allergic to shellfish and eat a mostly vegan diet so found one I could take), Calcium and Vitamin C.  I also started taking Arnica homeopathically as well, a spray bottle I squirt into my mouth a few times a day.  I considered taking Aleve for inflammation but I really have mixed feelings about it.  I tried it for one run and I am not really sure how much it helped, and the worry that it might upset my stomach is pretty major for me since I already deal with GI issues.

Exercises and Physical Therapy:  For the first week following my fall, I was pretty much resting the knee and avoiding any activity that hurt.  I got on an elliptical at the end of the first week, pain free.  It was boring but I was happy to be moving without discomfort!  I stuck to my regular routine of core work and Pilates all week though, and modified the exercises that hurt me (shoulder bridges and certain lunges – basically anything that stretched the muscles that inserted at the top of the patella).  After a week or two though once I was beginning to feel better I did these exercises carefully at the guidance of my physical therapist – I needed to retrain the quad muscles to lengthen properly and these exercises were great for that.

Medical Attention:  I went to see my chiropractor, Dr. Wong, right away the day after the injury and have seen him once a week since.  In addition to his excellent chiropractic care, he has done laser treatments, stim, Graston and ART and has helped me with correcting the imbalances that showed up in my body as a result of the injury.  He examined my knee and made sure the injury was not more serious – all ligaments and tendons in tact.  I also saw my physical therapist, Rich.  He confirmed the same diagnosis as Wong and has helped with mobility and strengthening exercises as well as releasing some of the super-tight muscles around the kneecap with dry needling technique.  Rich also taught me to massage the tendon above my kneecap with a cross-frictional technique for 3-5 minutes before I run.  I think that has been really helpful.

Emotional/Mental State:  An acute injury really knocks you down – literally and figuratively.  I felt like I was on top of the world with my running and then in an instant I was trying to climb up out of a major slump physically and emotionally.  The thing is though, I believe that everything happens for a reason and that our biggest struggles are truly our greatest opportunities for growth and strengthening.  My injury has been no fun on a lot of levels, but at the same time I think it has been an essential part of my story and it is building me up in so many ways.  I have learned how to trust my body in new ways, and I have discovered a determination and strength in my heart that is so unwavering and comforting.  I feel like this experience is making me a stronger runner overall and is also going to enable me help others who I know love, teach and coach.  The road to recovery is a bit of a roller coaster ride emotionally and that is all part of the process.  There will be downs and ups, just like there are in running and like there are in LIFE.  You just have to hang on, listen to your heart and to your body, and BELIEVE that you will get better.  Because you will.

I leave for Boston tomorrow and I am so excited to run on Monday.  With each day I can literally feel myself healing and getting stronger.  I will lace up my shoes on Monday morning, proudly pin my bib to my shirt and run with my HEART.  I feel pretty sure that my legs will come along with me for the ride now!

Have you ever had a patellar bone bruise or a bone bruise of any kind?  Do you have anything to share or add about your experience with the healing process?

Are you running Boston on Monday or will you be there?  My bib number is 9465 and I’m in Wave 2, Corral 1.  You can track me by texting 9465 to 345678!  

32 thoughts on “Patellar Bone Bruise – What I’ve Learned

  1. I'm not sure if I had the same thing, but years ago I fell hard ice skating with my kids, but then put it out of my mind. My knee started bothering me and when a few weeks of PT didn't help, I got an MRI and the technician jokingly asked if I played ice hockey — it was at that moment I remember the fall and put 2 + 2 together. Once we figured that out, some time off from running did the trick. I hope you heal quickly and enjoy Boston!

  2. Love your mindset that our biggest struggles are our best opportunities for growth and strengthening! I agree 100%. As frustrating as injuries can be, they are good learning experiences that make us better runners in the end.
    Good luck at Boston! I'm so excited to read the recap when you get to it 🙂

  3. Our stories are amazingly similar. I too was training for Boston, had a great training season, and on my last 20-miler, tripped and landed hard on my right kneecap. Able to finish my run, but by that evening, my kneecap was swelled and unbendable. Had to take 6 days fully off running, which thankfully came during a taper week, but still, I haven't been off running for 6 days in almost 2 years. Very painful injury and threw me off mentally. I was able to run Boston, but it stiffened up on me afterwards. I will have to try the cross-friction. Thanks for posting your experience. Hope you are doing better, this injury stinks. Congrats on Boston, it was an epic run (I was behind you in Wave 2, Corral 2). 🙂 Take care, Kate

  4. I had 1/2 my foot bruise when something heavy fell on it, x-rays showed no broken bones, then I treated it as a sprain with ice and crutches … 20 years later, I've tripped, bruised my knee, and am now letting it heal; ouch, but each takes time to heal

  5. Still don't know what my injury is 18 months later but it sounds I may have had the same thing, none of the 'professionals' I've seen has even mentioned this. You were right to stop when you did and get medical advice and not start again until healed. In summary I carried on running / exercising (perhaps 30k run / 30k cycle per week) after a short rest, the patella area is still not healed and believe this led to achilles issues as a result. Currently doing nothing at all bar a bit of swimming.

    It all started whilst stretching on a machine (one of these things: Flexability Anterior by Technogym) 18 months ago, the knee slipped off and like an elastic band (and with the help of gravity) released itself like a coiled spring onto a thin metal strip beneath (bad design, should be recessed), it hit a narrow metal rail underneath very hard, it hurt a lot. Impact was top end of the patella / quadriceps tendon.

    For anyone reading, if you use mechanical stretching equipment yourself ask if it is really necessary (there are usually alternatives). I had been trained on using it, but my leg was damp due to returning from a run, and it slipped.

    I did the RICE thing for two weeks and at the end of it, although the top of the patella area was sensitive I found I could run OK without discomfort. However over the next five months the achilles tendon on the affected leg became very painful, forcing me to stop everything (this pain creeps up on you slowly, the tendons are never the same). After physio the achilles tendon is no longer painful. Physio on the knee did improve things slightly, it also highlighted how weak that leg was compared to the other either as a result of the injury or naturally. A cortisone injection to the quadriceps tendon was also applied, it did nothing much (except some short term relief of a matter of weeks).

    The patella area of my knee is perhaps 40% better than 18 months ago, the quadriceps tendon is still tender, the patella still sensitive and has a long thin raised bump running from the top down the centre to about half way where the rail hit it. I had an MRI last week and awaiting the results.

    If at the end of all this I can jog (not run) a few kilometres three times a week for fitness levels for the rest of my life I will be satisfied. I will no longer be pursuing any competitive aspects in terms of fitness / exercise, I know how debilitating these injuries can become. I had planned to train for a duathlon the year this happened but no more.

    Cannot stress enough to take injury seriously when it occurs, and as part of the physio rehab I learnt the value and purpose of strengthening exercises – which may also help ward off injury.

  6. HI, I found this just now. I fell this morning while running. A dog who lives down the street who is friends with my dog decided to be friendly. Too friendly! I am not usually knocked over by dogs but I was caught off guard. I fell hard. Thank goodness I was wearing padded gloves and broke the fall. I have a bloody elbow and both knees got bloody. I was wicked nauseous and dizzy, so I went back home right away. Finally, the nausea subsided. At first, I was more concerned about my elbow, as it's got a terrific gash in it. But now, it seems one knee only stings, while the other is somewhat stiff and I see a small amount of swelling. I don't feel pain, nothing extraordinary. I'm thinking of stopping by at the medical clinic since maybe the elbow needs cleaning and bandaging anyway. What overwhelmed me most was the nausea, actually. I'm sure not going to run for a bit.

  7. THANK YOU! I am just coming across this in 2016 as I train. I can't telly you how grateful I am you took time to share this. This is exactly what I am going thru and so welcomed the thoughts and positive energy. Your writing is real and authentic. Thank you! _Sadie in Texas (sorry this only allows me to comment as anonymous below)

  8. I fell a week and a half ago and was diagnosed with a patella bone bruise. The doctor told me not to run for two weeks. I cheated and ran yesterday and it was painful after about a 1/4 mile. I don't see it being better at the end of 2 weeks. I am running Boston this April for the first time and am super bummed. What I can't find an answer to is when/ if it's ok to run through pain. If it just hurts because it's a bruise, that's ok, I can deal with it. But I don't want to be causing more damage or making it worse for myself later on.

  9. I just found this almost 2 years later… And, I am so happy to read you were still able to run Boston in 2014. I was there too. I am in the midst of gearing up for my third Boston and had a nasty fall a couple weeks ago. It didn't really hurt compared to my bruised elbow and palms, so the following day I went out for my tempo/long run. I ended up limping home when I was nine miles out. Ugh! I took a day off and felt better, so started running again, but not fast and not far. The next weekend I went for my long/tempo run and made it until about mile 16 when the knee just froze up worse than ever. So, this week I just didn't run much at all and iced, and heated…. and popped pills and went to a couple spin classes to try to stay sane. Tomorrow I will try to get out there and hope the pain doesn't hit me. I am going to bring my phone though just in case. I was training so well before this and just starting to build my mileage. But, we are 7 weeks out from Boston now, so I bet it will be fine. Thanks for giving me hope.

  10. I went for a 21 mile run…. mostly easy and then did miles 14-20 on the slower end of my tempo training pace yesterday. All was fine until my knee froze up today when I was sitting in a meeting. Didn't run this morning and won't run this evening…. but track tomorrow? Ugh. This is a very frustrating injury. Sorry to post on your blog so much. I might just stop running for a bit and let Boston just be a fun run….. a very expensive one.

  11. After mile one of the 1/2 marathon I was completing 2 weeks ago, I feel down and my knees hit the pavement ( among other body parts.) I finished the race. Afterward I noticed major bruising on one knee. Running was difficult because of the ache. I went to my physical therapist who said I had a contusion under the knee cap. He lasered it and supported it with the sports bandage. Hopefully I'll be better soon. BTW, I'm no spring chicken! 🙂

  12. Hi, just read this and I think I have same issue as everyone else. Seems like rest/walk/take it easy is right thing to do but being a runner it takes me a few weeks to really get that in my brain. It was 10days ago I banged my knee and running has been painful since. After reading this though, it's a good reminder that these bodies of ours are all different and no two rehabs are the same. I will plan to walk for a while and continue to be thankful for all that I have in life. Sometime without running I forget how great I have it. Maybe this God reminding me. Thanks again for all posts.

  13. great post. I found your blog through a google search. i am a runner as well and recently had a recent fall on a mountain bike ride where i fell and smashed my left knee on a rock. i'm coming back from an injury to the opposite foot. Doh! patience is not in abundance with runners, but this reminded me i need to practice it. thanks for sharing your detailed experience.

  14. Thank you for sharing your experience, very helpful and encouraging for me, as I just encountered a blow to my right knee a few days ago, and am seeking treatment and all the advice I can get. I am an avid distance runner so the inertia is killing me right now. I am trying to practice patience and humility.

  15. Patellar Tendinitis is a condition commonly called “Jumpers Knee.” Jumpers knee describes pain around the patella or knee cap. The tendon connects the quadriceps muscle to patella and then patella to the tibia or shin bone. Contraction of the quadriceps muscle causes the lower leg to extend through the patella tendon. I find this website for Knee Problems Shoes. You can visit this site.

  16. I had like the same thing happen to me. I was warming up for a race March 1st this year and my left shoe's lace loop was apparently too big and my right foot caught in it and I fell and hit my knee against a curb. I ran the race anyway, went to a pole vault camp all day the next day, ran a easy 7 miles the next day, and then I felt pain midrun the next day. I have not really ran since. Furthest I was and have been able to go is 3 km. It has been really hard because I was maxing out mileage to get a 940 3200 m. I got an mri and it was diagnosed as patellofemoral syndrome or a bruised knee or knee cap. He said to run what I could without hurting and just wait, but for someone like me that didn't work. I have stopped running and am about to try and start back up again somehow. It is amazing that after 8 months I still have issues with it. I am hoping that cross country skiing is easier on it so I can get active again this winter.

  17. Slammed my left knee on a curb being a bit stupid on a bicycle. It was severe pain for 30 hours and then I was walking fine. Thought I’d be back to it after 3 days. It is now 22 days later and I’m still not running. I had 16 days to run 30 miles to reach my yearly running goal. My patience and emotion has been beyond tested. I haven’t had it looked at but I’m certain it’s a severe patella contusion. A fair amount of RICE has been my treatment. In the past two days I have run 2.5 miles with pain but the knee hasn’t worsened. Guess it’s time to just start running but will worry about injury to another part of my legs. Good fortune to all who have or will share in our plight.

    • I am so sorry that happened to you. I know how hard that is. It took me about 6 weeks to be completely healed if I remember correctly. You will be better soon!

  18. This blog post is old, but so relevant to me now!! Four days ago I fell down hard on concrete (tripped on construction work happening along the road – pretty furious!) . I’ve been icing knee, and elevated it the first evening. The next morning went straight to the doc who said it didn’t seem to be anything serious like a ligament or fracture as I can still put weight on it. But its day five tomorrow and it’s still painful when I bend it! I am running 23km in two weeks time for an event I have been SO excited for (Great Ocean Road in Aus). I don’t know how much I should push myself… I’ll try a small 5km run tomorrow but I am scared its going to hurt and that Ill do more damage… I have two weeks until the event, which I am very determined to do…I don’t know if its silly to think I can continue to train before the event?

  19. I tripped on the hem of some wide pants and fell smack with my left knee onto cobblestones in Rome the other year. I had soreness under the patella, stiffness around the knee, and pain even when walking. I saw my physio when I got home and she said bruised kneecaps heal surprisingly slowly. She ultrasounded it and so on…and three and a half careful months later, I was able to hike for a week in the Alps (no pack)..and was fine. Don’t panic, don’t push through it, and be patient! These things DO heal, just v. slowly.

  20. I bruised my kneecap last week, when I slipped in the rain and landed hard on my knee on concrete. I am able to walk normally (movement doesn’t seem to make it worse), but it has a constant ache to it, and it really hurts if I touch the swollen area right below my kneecap. Ouch. I hope it won’t take too long to heal.

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