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Their knee problems started with an awkward twist or fall, and then an unsettling sensation.

For Kirstie Runion, it turned out to be an ACL tear; Beth Lammers' diagnosis was a hyper-extended knee. Ultimately, these injuries would keep these Cincinnati Christian seniors sidelined for the majority of their basketball careers.

After a combined six knee surgeries, they are finally playing at full strength — but not without a daily regimen of ice packs and anti-inflammatory medicines.

"I don't even feel the ice anymore," said Lammers, who plays with a protective brace. "At this point, it's almost like the nerves in my knee have lost all feeling."

"I've definitely lost a little speed," Runion said. "My goal in middle school was to play for a big Division I (college) program. But now it'll probably be Division III. And I'm fine with that."

In middle school, Runion played for one of the best AAU teams in Ohio — the Dayton Lady Hoop Stars — that included several current Division I college recruits.

But in the summer before her freshman year, she twisted her knee — an unsettling sensation that turned out to be a torn ACL. That December, after playing a handful games on the varsity squad, she underwent surgery to repair her ACL and meniscus.

The road to recovery was a long and painful process.

"I remember waking up in pain at 4 a.m., not being able to move," Runion said. "My mom had to go get pain killers and ice for me."

She returned to the court in June in time for AAU season. But the pain persisted, and soon she learned that the pins inserted in her knee, designed to eventually dissolve, were not actually dissolving.

So that summer, Runion underwent another meniscus operation. Soon after, she played through pain while helping the Dayton Lady Hoop Stars place second at the 2005 national U-14 AAU tournament in Salem, Va.

But after several months passed, there was "still no sign of permanent improvement," said her mother, Paige.

In December, six games into her sophomore season, Runion left the team to have a third knee operation.

That's when her doctor recommended a severe career-ending procedure that meant breaking both of her legs. Ultimately though, the Runions contacted Dr. Timothy Kremchek, the Reds team medical director, who said that such drastic measures were not necessary. He performed an arthroscopic meniscus repair the week following.

As a junior, Runion averaged 10.6 ppg and did so playing at "about 60 percent" strength," CCS coach Ken Bashford said.

Runion is much-improved this season. But in what is becoming a December tradition in her household, Runion got her knee scoped after an MRI detected a possible meniscus tear. Fortunately, the arthroscopic surgery — her fourth in less than four years — revealed no serious damage.

"We were shocked and so pleased," Paige Runion said.

Lammers, meanwhile, is often the first player off the bench for the Cougars.

Lammers' saga began in December of her sophomore season, when she hyper-extended her knee.

"When it happened, it felt really weird. But I kept playing," Lammers said. "The next day, I tried to get back into it, but I couldn't."

She underwent meniscus surgery, and in the subsequent months of physical therapy, her knee "never really got much better."

So she underwent a painful knee cap surgery — Arthroscopic Lateral Retinacular Release — and missed her entire junior season.

And it won't be her last knee cap operation. She plans to have another one after the season.

Additionally, Lammers has also had three ear surgeries for a perforated ear drum.

Regardless of what medical misfortunes have befallen them, and what may lie ahead, Lammers and Runion are just excited to be back on the court again.

"I never thought we'd play together again," Runion said.