Today on the Ask Coach Parry Podcast we answer a question relating to knee pain. Nonkululo Mcuntula is hoping to run the Comrades Marathon in 2015 and had the following to say: ‘Hi coach. I have an extreme pain in my right knee when I start running downhill in a marathon. I struggled with swollen knee right through the finish, I went to see the doctor and he prescribed some steroid injections and said it is just a ligament and would go away.’

Nonkululo  says that he rested it for 4 weeks but now the pain is waking him at night. He wanted to start training for the Comrades Marathon but it is really really sore.

He thought the doctor would recommend an x-ray, what would you recommend?

Brad Brown:  Today on the Ask Coach Parry Podcast we answer a question relating to knee pain. Nonkululo Mcuntula is hoping to run the Comrades Marathon in 2015 and had the following to say: ‘Hi coach. I have an extreme pain in my right knee when I start running downhill in a marathon. I struggled with swollen knee right through the finish, I went to see the doctor and he prescribed some steroid injections and said it is just a ligament and would go away.’

Nonkululo  says that he rested it for 4 weeks but now the pain is waking him at night. He wanted to start training for the Comrades Marathon but it is really really sore.

He thought the doctor would recommend an x-ray, what would you recommend?

Lindsey Parry: It does depend entirely on what the injury is. The first question I would ask is did you see a sports doctor or did you see a gp? If it was a gp, the chances are that he probably injected you with a cortisone, which is a steroidal anti-inflammatory.

Is a cortisone injection the answer to knee pain?

Obviously in the week that you had that injection you would have felt very little pain as it is a very powerful anti-inflammatory. But clearly whatever the problem is is a little more complicated than just a ligament.

To be fair there can be many things wrong with a ligament, so it’s not to say that he got the diagnosis wrong. But a ligament, depending on how sever the damage is, can take 6 – 12 weeks to heal.

There could be a number of problems wrong. You haven’t specified whether we are talking inside the knee (when I say inside I'm talking towards the middle of the knee), or if we talking to the outside of the knee. Alternatively are we actually physically talking in the knee itself.

Those are thing we need some specifics on if we are going to try and steer you towards some kind of diagnosis. I wouldn’t be comfortable giving a diagnosis over a podcast like this. I would certainly try and see a sports physician, because clearly the injury has not healed up and you do want to figure out whether it is a ligament or ITB or Pes Anserine Bursitis or if it is perhaps a miniscal tear – there are many things that can be wrong with a knee and particularly if there is swelling present it probably is some kind of ligament or miniscal damage.

It could be one of those two things and if there is swelling with the ligament then it means it’s probably quite serious ligament damage and you do want to want to know what it is because you might want to take some weight off – perhaps even get in a brace.

You might need some physiotherapy intervention, but the place to start is with a qualified sports physician. It is also very important not to run on it now until we know what the problem is.