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Running Ragged: A Runner's Road to Recovery

My ragged knees

My ragged knees

Runner's High Withdrawal

Running is a drug. And with that fact in mind it’s safe to say I’m going through withdrawal. Yes, I’m one of those crazy people who love to run and unfortunately right now it’s loved to run. It’s difficult to explain one’s love for running, especially if you’re talking to a non-runner. It takes some time and dedication to reach the point where one experiences a heart-pounding, calm-filling, and euphoric run. Non-runners just label us "crazy" and maybe it's because they've never ran long enough to reap the psychological and physiological benefits of long-distance running with our feet thumping and hearts pounding. Or quite possibly, their brains just aren't wired to enjoy running for hours on end; like so many of us “crazy” runners. Science has performed few studies on this so-called “Runner’s High” with interesting results, but none seem to fully explain the euphoric and mood-stabilizing effects of long-distance running. Nor are there many studies researching what happens to these euphoric-driven long-distance runners when they're injured and forced to rest (agonizing!) and encouraged to replace this high-impact exercise with other low-impact exercises; such as, swimming or cycling. I have no doubt that this scolded runner would try running at least one more time before throwing in the towel on running altogether: Which is exactly what I did.

Dopamine Pathways


What is a Runner's High Made of?

"Natural Painkillers"Storage & FunctionEffect of Increased Levels

Beta Endorphins (most studied)

Secreted into the blood by the pituitary during vigorous exercise.

Decreased sensitivity to pain (hypoalgesia), lowers rate of breathing, slows heart rate, contracts the pupil, reduces body temperature, increases dependency to action, behavioral indifference, & endogenous opiods (natural painkillers)


Stored in adrenal medulla

Associated with learning, memory, and endogenous opiods (natural painkillers)


Stored in Hypothalamus, Medulla, Pon, Midbrain

Reduce anxiety, associated with fear memory, & endogenous opiods (natural painkillers)


Stored in Midbrain (Substantia Nigra)

Motivation, addiction component, Reward-seeking behaviors

Initial left knee effusion before & after aspiration & steroid injections

Initial left knee effusion before & after aspiration & steroid injections

Synovial fluid off for testing

Synovial fluid off for testing

Knee Burnout

Okay, so I tried more than once to return to my beloved running. I guess my years of cross-country running and gymnastics have finally worn me out, causing recurrent knee effusions that have kept me in the pool and off the trails. My first knee effusion occurred six years ago after improperly training for a short 13.1 mile race, causing the typical knee swelling and achiness that goes along with an overused joint. So, after a quick knee aspiration and a new ban from running, I turned to hiking, biking, and swimming.

Six years passed without an issue and I slowly increased my hikes to jogs and finally runs because frankly, those other activities just weren't the same. I started slow at twice a week and increased my mileage to five percent a week. I was cautious and I was up to 30 miles in a couple of years and completed a 10-mile Tough Mudder without a problem. I was ecstatic and felt I was ready to try a half-marathon one more time; but this time I was ready. I guessed wrong.

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Two weeks later my left knee swelled and that whole rest, ice, compression, elevation routine didn't help. Two knee aspirations, a pricey MRI and a steroid injection followed which allowed me to enjoy a few short weeks of cycling until my opposite knee reminded me of my over-ambitiousness when it decided to do the exactly same thing. Add recent graduation, unemployment, and subsequent lack of health insurance on top of that and four weeks later I've finally had my knee aspiration and steroid injection yet again. At 28 years-old I've had my orthopedic docs stumped as to why I have such old knees in a young body. However, this time my synovial fluid wasn't perfectly clear, so it's sent off for testing and I'm crossing my fingers it's just benign. Unfortunately, I know all the differential diagnoses so I'm hoping I don't have to wait too long for answers.

Causes of Knee Effusion

Direct Injury OveruseNo injury: initial episodeNo injury: Recurrent

Twisting motion with "pop" or instability= ACL tear

Osteoarthritis (typically ages 55+)

More than 1 joint involved: Reddened, swollen, tender, cloudy synovial fluid= Gout or infectious arthritis

Multiple joints & morning stiffness= Rheumatoid Arthritis

Direct blow to knee, unable to bear weight= Fracture

Patellar chondromalacia (damaged cartilage under the kneecap or "rice crispies when bending the knee)

Immunocompromised, IV drug use, recent illness, fever, redness & warmth of joint, cloudy synovial fluid= Infectious Arthritis

Fever, night sweats, unintentional weight loss, night pain= Tumor

Twisting of knee when carrying heavy weight (lifting or squatting)= Meniscal tear



*This list is not all-inclusive and provides a general idea of common knee effusion causes

Swimming: It's just not the same

Recovery & Rehab

Recurrent knee injuries mean that I most likely will not return to running anytime soon. I have a few weeks of physical therapy and lots of pool time ahead of me. Swimming is therapeutic, but it's just not the same as running for me. With all the time I get to dedicate to pull buoys and the blue waters of my gym's indoor pool, I hope that one day I find that "Swimmer's High," if it even exists...

Euphoria-Driven Runners: How Many Exist?


Kylie White on December 13, 2013:

Hey there ! I love your articles. Can you email me?

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