MCL Strain or Pes Anserine Bursitis?

[Need2Run]

Hi,

I am a 40 mpw runner who competes in 5+10k races occasionally. Up until October, I hadn’t been injured for around a year. Up until this point I had never sustained a left leg injury.

In October, having had a lay off from running for a couple of weeks, I ran in some new shoes, doing mile intervals (flat concrete). The next day I awoke with a stiff knee, which was painful in the area I’ve marked in the attached photo. This was after trying new ‘stability’ shoes… It was suggested I try them after gait analysis… These shoes felt unnaturally ‘straight’, stopping my usual pronation. My theory is that the knee took the strain – instead of the shoe everting / pronating.

When I resumed running I found that, after around 20-30 mins of running, the pain came back. I decided it was due to running on uneven surfaces (particularly camber) and started using the treadmill. The treadmill doesn’t seem to cause pain…(I binned the ‘stability’ shoes). Around 4 weeks ago I started running outside again, gently ramping up mileage to previous level. There was NO pain on the knee and I thought I was rid of the injury.

Yesterday, about 8 miles into a 10-mile run, when running downhill fast (very steep) on uneven grass, I felt a sharp twinge in the highlighted spot… It didn’t stop me running and hasn’t been as bad as before. It was more painful this morning than last night. Note that I tend to run downhill with a lot of knee flexion, attempting to minimise braking forces. I suspect the foot hit an uneven lump of ground, whilst knee was flexed, at speed, under considerable load.

If I palpate the marked area I feel a sharp pain, as if the tissue underneath is inflamed.

If I plant my left foot on the floor, flat, and rotate my thigh CW with bent knee, I trigger the pain.

I have seen a physio (an expensive one who specialises in sports injury). She couldn’t decide between MCL or Pes Anserine Bursitis and told me to book another appointment... Can anyone here describe a fool-proof way to discern between the two conditions?

Thanks in advance.

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