Just What I Kneeded

What happens after a life-altering knee injury?

Leave a comment

Skiing on a hill of mud

I can’t believe how quickly this year is going. It’s not starting off any slower than the last one, that’s for sure.

I did another race near the end of February. Another quarter marathon. Thanks to the melted snow and a day of rain two days before the race, most of the trail was mud. Some places were easier to run on than others. At one point, I found myself sliding down hill of mud, arms flailing, screaming/laughing and cursing just a bit. Two good things about that were 1) I didn’t fall and 2) I passed someone on my way down the hill who tried to circumvent the mud.

Woman racing through the woods.

I asked my race buddy if I could post one of her pictures, and she graciously said ok. I can’t post mine because it looks like I lost my puppy. I’m not sure I could make the same face the photographer managed to capture if I tried.

At another point during the run, we had to cross a small (read super tiny) creek that usually has only a minimal amount of water in it during the summer. This time, it had about a foot of water or so, and I didn’t want wet feet for the rest of the race (I’m not hardcore like some of the people who were actually running the race as a race). A kind, older man gallantly stood in the middle of the creek and offered me his arm to help me across. He was willing to do it because he’d already lost his shoe in the mud and was a right mess. But super nice of him. There was a woman on the other side of me who held my other hand to help. I still ended up with one wet foot. Thank goodness that was almost five miles in; I had only about 1.5 miles left.

I did better with this race than I deserved. In fact, I finished in a faster time than the last one (shaved 12 minutes off!), so I did better than I even dreamed. Due to work obligations and a lingering desire to do nothing more than curl up and watch Netflix when I get home from work, I’ve managed to run exactly four times in the last 2.5 months, including the two races. This is way off the mark for my goal to run 365 miles this year. Way off. It’s also a little dumb to be running races with no prep, especially when you’re like me and have a bum appendage to consider.

To make matters worse, not only have I not run, I have not kept up with my PT exercises or… simply going to the gym at all. This is exactly the opposite of what most people do at the advent of a new year. I guess I’m not most people. I think I needed a bit of a break from doing daily exercises just to keep my knee in check. The less I do, the less the knee hurts. That’s always been the case, but I don’t want to be a couch potato for the rest of my life. Except being a couch potato for the last two months seems to have helped. So much so, I’m considering making it my new race prep strategy.

I kid.

I realized that I cannot do another race unless I spend the time properly preparing. It’s not just because my PT sent me a dire warning in the form of an email that said, “As your PT, I feel compelled to remind you that you are putting miles on an odometer that can’t be turned back (see Ferris Bueller). So think of the long term…” It’s because I am thinking about the long term. While it was fine during the race this time, my knee hurt more than it’s hurt in a very long time for two days following the race.

Two things come to mind. One is proper planning, prep and conditioning. The other is that it would likely be a better scenario for my knee if I wasn’t packing so much extra weight. Part of the problem with taking two, almost three, months off is that you might gain weight if you don’t also alter your eating habits. Or if you stress eat. So… there’s quite a bit of work to do before June. Why June? Because that’s the next quarter marathon…


1 Comment

Slogging (my version of running)

Slogging. Short for “slow jogging.” It’s what I actually do when I tell people I’m going on a run. I never go fast enough to legitimately call it a run, but I do go slightly faster than a fast walk.

As soon as I crossed the finish line at the Little Miami Triathlon, my tri partner and I started making plans to do the HUFF 50k trail run in December. Not sure why since I barely made it across that particular finish line… It’s fine. You can say it. I’m nuts.

I’m not going to defend myself. I tell myself I’m nuts every time I step out on to a trail to start a training run. But I’m not totally insane! I will be doing the relay version of the race. It’s 50k split three ways, so I only have to do roughly 10.8 miles. Since I did basically half that in the triathlon, I figured I could work my way up to be ready by mid-December.

I am not now nor have I ever been a runner. I don’t really know that I enjoy running all that much, but I do enjoy the feeling I get when I get to the end of a training slog. I feel like I’ve accomplished something. Not sure what, exactly, because I have nothing tangible to say I did anything at all (MapMyRun app stats aside). The only thing motivating me at this point is the finisher medal that comes with completing the race. I made it a goal to earn a finisher’s medal this year, and this is my chance to make my goal. Yes, I could have picked something a bit easier (read shorter), but that’s not really how I roll.

The tricky part to training for an actual race is how to do it without angering the knee. I sat down and hobbled together a training plan that incorporates sage wisdom (don’t start by running 5 miles at a time 5 times a week), my PT exercises (keep doing those leg presses and deadlifts) and cross-training (just keep swimming, just keep swimming). I’ve never had a training plan for running before, and I don’t have a coach now. It’s on me to figure this out, and it’s been a little rocky so far. Lots of stretching, rolling and icing that I don’t regularly do anymore. Until now anyway.

The one problem I didn’t foresee was the pain I experience in my “good” leg. Pain right down the shin and to the outside of the ankle into the foot. Problem is, you see, I don’t have a perfectly even gait when I’m walking, much less when I’m running. I put a lot (a LOT) of pressure on that leg when I’m going up/down hills, so I’m currently working on how to even out the load and not cause any real damage to my one good leg. It’s a work in progress. But it’s forward progress! I managed to do four miles on hills in under an hour last weekend. It’s not record-breaking pace, but all I’m hoping to do is complete the race. I think I can. I will.


Conspicuously absent

I don’t know where the time goes. I don’t know where this year has gone. I don’t know how it’s already March. MARCH. That means one-sixth of 2015 is already in the books. Yikes.

Good news is that my right knee continues to have incremental improvements. I’ve been focused on the patellar tendon exercises for… um… a long time now. Since December 9 when I last met my PT. Over the past few weeks, I’ve been doing fewer and fewer PT exercises as I add in more diverse strength training. The knee doesn’t seem to mind. I’m pretty happy with the improvements that have happened over the last three months, and I’m excited to see how much more I can get from the knee as I move forward.

One test will be a trip to Florida next week. I have not been on a plane since the surgery in September 2012. I have had trouble even riding in a car for more than an hour, so the thought of trying to sit in a crowded plane for any length of time has been less than appealing (read terrifying). But that’s going to be put to the test in less than a week. My need to see the beach and feel the sand between my toes overrides any lingering fear of pain. I’m sure there will be some, but riding in a car has improved significantly, so I’m not too worried.

For the last six weeks or so, I’ve been working out with a gym buddy who has pushed me more than any personal trainer I’ve had in the past. I feel as if I tell you that he’s ex-Army, that should explain a lot. I meet him at least three days a week right after work, spend an hour on strength training, and then do laps in the pool. This week, we’ve kicked it up to five days. My arms and abs hurt so much at the moment, the knee doesn’t bother me at all.

It’s mostly because of this added workout that I’ve been absent from this blog for a while. I’m too exhausted to type by the time I crawl through my front door in the evening. I’ve also joined a book club (my first book club; I’m so excited!), so my required reading takes up time, too. There is just not enough time in the day to do all the things I want/love to do AND work to support all the things I want/love to do.

I think I need to work on two things in what’s left of 2015. One is better time management. And sleep. So make that three things because the other is weight loss. I gained weight after the initial injury that I never lost. I’ve now spent literally years strengthening my leg and the last six weeks strengthening the rest of me. But I’ve continued to eat like someone who doesn’t need to count cupcakes. That has led me to some internal “discussions” about how I’m putting in all this work and should see the results in the weight loss department–that hasn’t happened because I still justify all the fro yo with various reasons from a good day at work to a bad day at work to a good workout to… you get the point.

I said I don’t make resolutions, but I’m making two now (yes, it’s March). Figure out how to fit in all the STUFF while still getting enough sleep. Then figure out how to gain/enjoy all the benefits of working out in the gym every day. I feel like there are SO many people out there who have the same exact intentions that I figure Google will help me figure this out (I’m sure there are about 1 million web pages devoted to these topics).


Goals are generally good

I frequently overestimate my ability to do anything that requires two healthy knees. It’s like, if my surgeon or PT gives me a glimmer of hope or a confirmation of a small progression, I’ll take that small thing and turn it into a giant RAINBOW OF OPTIMISM. I don’t necessarily know that it’s a bad thing. Sure, I’ve overdone it before with PT exercises or physical activity because I don’t always pay attention to my own limits, but on the other hand, this optimism is largely what’s kept me going.

Now that I’ve had three weeks of positive progress, I can’t help but begin to think about all the possibilities. I’m trying to temper that with what’s realistic, but it’s so hard. Because rock climbing and snow skiing. And biking and competition.

I’m setting goals to have something meaningful to work toward. Below are some of the ideas rolling around in my head. I’ve no clue whether any of these are possible because I have a hard time visualizing my progress past the week in front of me. Meaning that I don’t exactly know what it’s going to take to reach any of these goals. I also haven’t breathed a word of these to anyone on my healthcare team because I suspect most of them are unrealistic. Nevertheless, I’m spending my time making grand plans.

Physical Therapy/Rehab Goals

Not completely sure what I can accomplish here, but I’ve been told from the get go that strength is the key to successfully rehabbing my knee. It follows, then, that the rehab goals are largely strength related.

1. Single leg press 180 lbs. Why? Because that’s the number I tested at when I did the machine test, but there’s no way that I can do that without pain right now. I’m working on just the eccentric single leg press, and I’m only at 105 lbs.

2. Single leg extension with 70 lbs. Again, that’s the test number, but I can’t get there without pain. My goal on these first two is to be able to do the full movement (full ROM) with no pain at the level I tested at in early September.

3. Use the elliptical for 30 consecutive minutes. Right now, I’ll use the elliptical for about 10 minutes to warm up, but no more. If I fully engage my quad, I’ll get a nasty spike of pain right through the middle of my knee, so I’m still compensating with my left leg. I want to be able to increase my time on the elliptical and be able to use it without pain.

4. Do 3 sets of 10 full squats. I could do these now, if I simply used my left leg. The goal is to be able to do them with my body weight equally settled through both legs. Squats are an important exercise, and one that I’ve struggled with for a long time.

5. Do a Bulgarian split squat. Just because.

6. Find some more rehab goals. These don’t seem like all that much…

Cycling Goals

I’ve admittedly not been on the bike in months. While I’m still willfully ignoring that my absence from the bike might play into improving on the rehab, I’ve made some goals for this next year.

Tour de Lou (Louisville, KY; in conjunction with Kentucky Derby) on April 26; choice of 20- or 35-mile routes
April might be a little ambitious for much more than simply getting out on my bike. But… one can hope.

Tour de Cure (Indianapolis, IN) on June 20; choice of 50k, 75k or a century
While 50k translates into only 31.0686 miles, it falls well within what I used to be able to do without even thinking about it. But I’m no longer at that level, so we’ll see. The end of June seems more realistic than the end of April. Plus, I have friends who have done this ride, and that makes me more inclined to join them.

Tour de Upland (Nashville, IN) on August 14-16; choice of 50- or 100-mile relays
This has the best description. “30 hours of cycling (road and mountain bike routes), beer, camping, and music in Nashville, IN. Plus the toughest Century in Indiana.” This one is a relay, so I could crap out and still have fun because beer.

Little Miami Triathlon (Cincinnati, OH) on October 4; 6 mi of kayaking, 5.5 mi of running and 18 mi of cycling
The running here might be the issue. Plus, the biking is mostly hills, and I don’t know how well I’ll be able to handle those. But the kayaking? I can do that! I’ve done this “triathlon” before, so I think I can do it again.

Hilly Hundred (Ellettsville, IN) on October 9-11; two days of riding approximately 50 miles each day
The description makes me nervous: “The challenging terrain is a wonderful mix of gently rolling country roads and breathtaking hills (literally).” Again, it’s the hills that might mean I can’t do this, but I should certainly be able to pedal 100 miles in a weekend by October.

Life Goals

Indoor rock climbing
Apparently, indoor rock climbing is a thing. I knew that there were places where you could go and climb walls, but I don’t think I ever realized that there are places dedicated to indoor rock climbing. A friend of mine told me about Climb Time Indy where you can get private lessons and day passes. My real goal is to go climbing “out west,” but I think this is the best first step.

Hiking at Red River Gorge
I love this place. I must go back.

Finisher’s medal
Basically, I just want to do something to earn a finisher’s medal. I’m all about the competition, but for now, I just want to finish something. I’m going to try to do this as part of a relay for the Muncie Ironman 70.3. I found two willing teammates (a swimmer and a runner) last year, but we’re kind of waiting to register until I figure out if I can actually ride. I guess this could go under the cycling goals, too.

I don’t want to set any goals that pertain to riding because I’ll be brutally disappointed if I don’t make those. I think I need to be happy with whatever I’m able to do with the horses.

That’s about it. I’ll need to work on those PT/rehab goals in order to make the others happen, but I’m very much looking forward to 2015. This year is nothing but possibility right now.

Leave a comment

Suck it up, Buttercup (part deux)

I explained in the last post that a new MRI clearly showed patellar tendinopathy (degenerative process in the patellar tendon). This post will explain what we plan to do about it (I mean “we” as in “my healthcare team and I,” not in a royal sense).

I have a lot of pain right straight through the front of my knee during a specific ROM (have since about four months after the big surgery), and I thought perhaps that was the scarred fat pad because it feels like there is something physically in there that my knee has to work around (I’ve described it like someone jammed their finger into my knee right below the patella and now the knee has to bend around it; it’s weird). Doc said he doesn’t think it’s the fat pad; he thinks that the tendon is so thickened, it’s catching/rubbing during ROM.

I was inadvertently making the problem worse over the last couple of months. I knew the pain had increased, but I didn’t yet know for sure that the pain was coming from the patellar tendon. I was doing leg extensions with increasing weight/pain, and some nights, it was all I could do to get through the leg extensions. I had to turn my headphones all the way up to help take my mind off the actual exercise, and I’d occasionally sit in the gym literally talking myself into doing the sets. I might go deaf because of a knee issue, but, by gum, I’m going to do the exercises I’m told to do. I’m sure I looked and sounded like a crazy person talking to myself and singing along to my tunes.

I knew I had a problem when the knee started hurting in the pool, but I didn’t stop because the PT had told me that I should push through the pain. I’d worked the knee into such a tizzy that, by the time I had the MRI, I was having all kinds of trouble going up/down stairs again. The pain was so bad, I would throw my leg out from the hip to get it bend enough to go down the stairs. Not good.

I was not a fan of the new PT for a number of reasons. I think a lot of the issues stemmed from his inexperience. He had a specific protocol for a specific diagnosis, and he couldn’t tailor it to a specific patient’s needs. I had to make a quick decision when the doc said to continue with PT for the patellar tendon issue, so I decided to go back to my previous PT (the awesome one who has helped immensely over the past year). It’s a bit odd since she’s in a different clinic, but I trust her and value her guidance.

I met with my previous PT last week, and she showed me a few things to do to see if the tendon will respond favorably. She also did ultrasound while in the office (we’re not sure it will work, but it shouldn’t hurt). I’m supposed to do some at-home work to see if I can reconfigure the scar tissue in my knee and to see if I can stretch the quad to allow my kneecap to drop down into a more normal position (we know from the exam and a previous MRI that I have patella alta). In addition to these things, I will do eccentric exercises to load the tendon in a protected manner. We didn’t specifically talk about squats on a decline board, but quite a bit of the research I’ve read in the last couple of weeks shows decline squats are something that works for patellar tendon issues. Like with everything else, there are also detractors who don’t think decline squats are the way to go (so confusing!), so I’m unsure whether or not I will do those. I will, however, go back to the leg extension machine and use it in a slightly different way. I’m only using 30 lbs (so lower weight), and I use two legs to push it up and then lower it with just one very slowly. I still freaking hate this machine.

We’ll see if all of this helps a tendon that first showed signs of a problem on the MRI in May 2013. That’s 19 months that have gone by without directly addressing this issue, though we did work around it because I’ve always been sore there. In some ways, like the single-leg extensions I’ve been doing, we’ve probably made the issue worse. Seems like it’s going to be a lot of slow work, but I am glad there is something specific to address.

The good news is that, through all of this, the lateral portion of my knee that had caused such pain in the past has not been affected. At some point during the summer/fall, that particular pain largely dissipated (I’m willfully ignoring that there might be a connection to the fact that I was swimming so much, I stopped biking very much at all), and it hasn’t returned. Let me be clear. There is “pain” there, but it’s minimal and totally manageable. That really just leaves the big pain through the front of my knee. I feel like there’s nothing I won’t be able to do, if we can improve that pain. Well, nothing other than running and other high-impact activities. But the doc indicated he sees no reason I can’t ride, as long as I can manage the pain. Exciting!

1 Comment

Suck it up, Buttercup

It’s been nearly three months since I updated on the knee. It’s about time I bring y’all up to speed. Much has happened.

I wrote in September that I’d had an x-ray, been diagnosed with some bone loss and a “deconditioned” knee. Then I started another round of PT that began with regaining ROM followed by strength building. (This was a new doc and a new PT. I’d given up trying to get my surgeon to own that he’d fixed the cartilage problem as best as it’s ever going to be fixed–a good thing– but that there was something else that needed to be addressed. He just seemed to be focused on the cartilage.)

We started with single-leg extensions with a 5-lb ankle weight and single-leg press with 60 lbs. Those low weights were all I could do without eliciting significant pain, even though the strength test indicated I could do much more (but there was pain with the test). I worked up to 30 lbs on the leg extension and 90 lbs on the leg press in the first four weeks. I thought I was doing pretty well, despite increasing pain.

After the second round of strength testing (four weeks after starting the exercises), I was told that I should push harder to add weight and that I should push through the pain to do so. Ok. Bring it on!

In the next four weeks, I added another 60 lbs to the single-leg press (150 lbs total) and another 10 lbs to the single-leg extension (40 lbs total). At some point during this round, my knee started hurting when I was in the pool–even a simple flutter kick elicited pain. I’d never had much pain while in the pool, so I should have called it off at that point. But hindsight is 20/20, and I had a PT encouraging me to push through all the pain (suck it up!).

After the third round of strength testing showed that my numbers on BOTH legs were decreasing for the leg extension (because pain!), we decided it was time for another chat with the doc. I was, once again, not following the normal pattern of progression.

Doc said I was trying too hard to get the strength back (that’s going against what his PT said, but whatevs). I asked very specifically if we were sure that it’s the cartilage causing the problem. My thought has been for a very long time now that there is an issue with the patellar tendon; I’d even discussed it with my surgeon seven months ago, but he didn’t agree after a cursory exam. New doc said he would be disappointed if there was something else wrong with the knee (me, too!) but that he wanted to send me for an MRI to make sure since my last imaging studies (MRI, bone scan and CT arthrogram) were done 18 months ago.

New MRI taken a month ago showed a number of things. Cartilage fissures and subchondral cysts on the weight-bearing surface of the lateral tibial plateau were unchanged. There is a new fissure on the mid medial side of the lateral tibial plateau that is already more than 50%. There was a lot of info about the cartilage behind my kneecap–there’s thinning in a few areas under there, but largely unchanged since the last scan (all indications the graft is doing ok). There is arthrofibrosis or a joint body in the intracondylar notch near the tibial insertion of the ACL. There is scarring of the infrapatellar fat pad (Hoffa’s fat pad). And, wait for it… patellar tendinopathy.

I met with the doc after the MRI. I was concerned about the new cartilage fissure. I don’t think there’s pain from it because I couldn’t have said there was a new fissure or any other new problem on the lateral tibial plateau. But I was worried that there was a new fissure even though I’ve only been doing PT and low-impact activities for the last 18 months. He indicated that the degenerative process has started in the cartilage, and there’s just not a whole lot that can be done to stop it. I’m not going to make the problem worse, but I can hasten the process if I do high-impact activities like running. Good thing I’m not a runner.

We talked at length about the patellar tendon. He said it’s not an inflammatory problem (it’s a degenerative problem), but he thinks it’s worth pursuing PT geared specifically at addressing the tendon. He said surgery is not on the table because the degeneration is so widespread. If I were, say, a basketball player with a focal defect, he could go in and cut it out. The tendon would heal. I don’t have a focal spot that’s bad; it’s all bad. I’m glad we’re not talking about another surgery, but I’m not happy that there is such widespread damage in the tendon. I don’t want to dwell on it, but I wonder if the damage would be so bad if we’d addressed this specific issue when I first asked about it.

I’ll write more about what we’ll do for the patellar tendinopathy in another post.

Leave a comment

Side effects

I mentioned a while ago that I was taking Celebrex in a last-ditch attempt to find some prescription help for the knee. My OS isn’t a big fan and explained why he doesn’t typically prescribe Celebrex. Then he went on to say that a handful of his patients with cartilage degeneration had found some relief with the medicine, so he thought it might be worth a try since I can’t stomach any of the narcotics that were prescribed, and the injections didn’t work. We plain don’t have other options.

At first, I didn’t think there were any side effects. It was the first medicine that didn’t make me nauseous or otherwise destroy my GI system. (I would much rather deal with daily pain than some of the GI problems caused by the prescription narcotics and NSAIDs that I’ve had in the past.)

I started having weird symptoms over the last three or four weeks. My shins itch like crazy, and there is no rash (which made me think I really was going crazy). I thought maybe the pool water was drying out my skin, and I started slathering on the lotion (“It rubs the lotion on its skin, or it gets the hose again.” Anyone?). I wasn’t convinced that was the problem because I’ve been swimming for more than six months now with no issues, but I didn’t have any other ideas. Then, a little over two weeks ago, I started having extreme dry mouth. At first, I thought I was dehydrated–simply not drinking enough water. The dry mouth persisted for a few days and grew bad enough that I had to try to figure out the problem because drinking 100 oz of water a day wasn’t getting rid of the dry mouth. My tongue was sticking to the roof of my mouth and my teeth, and it was getting raw.

Turns out, both itching and dry mouth are potential side effects of Celebrex. I finished the last of my prescription, so I’m going to wait to get a refill. I’ll see if the itching and dry mouth go away. I might not ever get a refill because I can’t tell for sure that the Celebrex was helping my knee. Even without side effects, there is absolutely no reason to take a drug that’s not helping. We’ll see. In the meantime, I’ll just keep swimming.