I’ve always been one to avoid x-rays and surgery. I now have a crater in my knee cartilage because of that reluctance. I’m writing this blog entry in hope that others can avoid these “pit” falls. With Ironman Coeur d’Alene now out of the question, consider this my non-race report.
While cruising along at a 7mpm pace during the 2004 Seattle Half Marathon, something gave out in my right knee at mile 11. I was immediately reduced to a walk and thought I was finished. After 5+ minutes of walking, I did a test jog and it didn’t hurt too badly so I sort of limped the rest of the way. When I reached the stadium, all inspired by the cheering crowds, I went into a full sprint for the last 100 yards. I mention this because I shouldn’t have been able to run at all with a meniscus tear. But this tear was unique. When the torn meniscus was out of position, I was in pain. When it slipped back out of the way, I was semi-ok. Don’t know what caused the tear except that I was massively dehydrated. I didn’t know much about nutrition at the time, and was running hard trying to break 1:40. Sometimes the body finds a way to slow us down when it must to avoid even greater damage.
When the doctor examined me, the miniscus was behaving itself during the visit, so it wasn’t apparent that it had been torn. He offered to do an x-ray but I declined. Bad move. Two years earlier I had seen him for chronic knee pain. His exam revealed no structural issues, and he recommended physical therapy first. We would follow up with additional procedures if the PT wasn’t effective. PT did the trick. So it seemed that if it worked once, it would work again, and it did, but this time it took longer. The only difference was that I couldn’t kick a soccer ball with the side of my foot for over a year without a sharp pain. There was no other indication that I had an injury until Ironman Canada 2007.
Having completed 2 half Ironman’s in the 2 months prior with no sign of trouble. I was off to a great start in Penticton , but 40 miles into the bike, my right knee started aching as I was climbing Richter Pass. I began pedaling with just my left leg, but by the time I reached the top, it hurt so bad I couldn’t even do that. The pain was bad, so I thought I was done.
The mystery was that simply stretching my quads out for a few minutes on the ground caused the pain to dissipate enough that I was able to resume cycling with both legs - for a while, and then I had to stretch again. Given the information obtained from surgery today (pictures below), I have a possible explanation - inflammation is what was triggering the meniscus to move out of position. Stretching helped move it back into position. When I got to my special needs pack and took 2 Ibuprofen, this reduced the swelling enough that the meniscus didn’t pop out and irritate the cartilage, and no further stretching was necessary.
When participating in a race or training, there are times when you should tough it out; and others when you should back off and opt for a close medical evaluation. Hopefully someday I’ll be wise enough to know the difference. This case was very difficult for the doctor to diagnose because the symptoms were only present when the knee was inflamed, which wasn’t the case during my examinations. It was also tough because the damage occurred very gradually over time, and I didn’t associate the arthritic pain that began years later to the original injury until the recent MRI. Based on the location, amount of pain I experienced, recovery time and effort, I'm fairly confident the injury occured during the Seattle HM in 2004.
The MRI wasn’t even done for this injury. It was for prepatellar bursitis triggered by wrestling with our kids on my knees. After 3 months of swelling, draining 100 cc’s of fluid, and 2 cortisone shots, it finally stopped swelling 1 week prior to surgery. My guess is that scar tissue from previous injuries made it susceptible to swelling, so I decided to have the bursa removed while having the meniscus repaired, even though the swelling finally stopped. The perpetallar bursa only serves to reduce friction between the knee-cap and the skin. In most cases it grows back in about a year.
I’ll be doing 10 minute bike rides on the trainer in two days, and probably cycling outdoors in a week, but Ironman Coeur d’Alene in June is now out of the question. I haven’t trained in over 2 months. Putting my knee under an IM load without proper preparation in this circumstance doesn’t make sense. If work isn’t too crazy, I hope to be there for the swim and to cheer on my friends.
While cruising along at a 7mpm pace during the 2004 Seattle Half Marathon, something gave out in my right knee at mile 11. I was immediately reduced to a walk and thought I was finished. After 5+ minutes of walking, I did a test jog and it didn’t hurt too badly so I sort of limped the rest of the way. When I reached the stadium, all inspired by the cheering crowds, I went into a full sprint for the last 100 yards. I mention this because I shouldn’t have been able to run at all with a meniscus tear. But this tear was unique. When the torn meniscus was out of position, I was in pain. When it slipped back out of the way, I was semi-ok. Don’t know what caused the tear except that I was massively dehydrated. I didn’t know much about nutrition at the time, and was running hard trying to break 1:40. Sometimes the body finds a way to slow us down when it must to avoid even greater damage.
When the doctor examined me, the miniscus was behaving itself during the visit, so it wasn’t apparent that it had been torn. He offered to do an x-ray but I declined. Bad move. Two years earlier I had seen him for chronic knee pain. His exam revealed no structural issues, and he recommended physical therapy first. We would follow up with additional procedures if the PT wasn’t effective. PT did the trick. So it seemed that if it worked once, it would work again, and it did, but this time it took longer. The only difference was that I couldn’t kick a soccer ball with the side of my foot for over a year without a sharp pain. There was no other indication that I had an injury until Ironman Canada 2007.
Having completed 2 half Ironman’s in the 2 months prior with no sign of trouble. I was off to a great start in Penticton , but 40 miles into the bike, my right knee started aching as I was climbing Richter Pass. I began pedaling with just my left leg, but by the time I reached the top, it hurt so bad I couldn’t even do that. The pain was bad, so I thought I was done.
The mystery was that simply stretching my quads out for a few minutes on the ground caused the pain to dissipate enough that I was able to resume cycling with both legs - for a while, and then I had to stretch again. Given the information obtained from surgery today (pictures below), I have a possible explanation - inflammation is what was triggering the meniscus to move out of position. Stretching helped move it back into position. When I got to my special needs pack and took 2 Ibuprofen, this reduced the swelling enough that the meniscus didn’t pop out and irritate the cartilage, and no further stretching was necessary.
When participating in a race or training, there are times when you should tough it out; and others when you should back off and opt for a close medical evaluation. Hopefully someday I’ll be wise enough to know the difference. This case was very difficult for the doctor to diagnose because the symptoms were only present when the knee was inflamed, which wasn’t the case during my examinations. It was also tough because the damage occurred very gradually over time, and I didn’t associate the arthritic pain that began years later to the original injury until the recent MRI. Based on the location, amount of pain I experienced, recovery time and effort, I'm fairly confident the injury occured during the Seattle HM in 2004.
The MRI wasn’t even done for this injury. It was for prepatellar bursitis triggered by wrestling with our kids on my knees. After 3 months of swelling, draining 100 cc’s of fluid, and 2 cortisone shots, it finally stopped swelling 1 week prior to surgery. My guess is that scar tissue from previous injuries made it susceptible to swelling, so I decided to have the bursa removed while having the meniscus repaired, even though the swelling finally stopped. The perpetallar bursa only serves to reduce friction between the knee-cap and the skin. In most cases it grows back in about a year.
I’ll be doing 10 minute bike rides on the trainer in two days, and probably cycling outdoors in a week, but Ironman Coeur d’Alene in June is now out of the question. I haven’t trained in over 2 months. Putting my knee under an IM load without proper preparation in this circumstance doesn’t make sense. If work isn’t too crazy, I hope to be there for the swim and to cheer on my friends.
0 comments:
Post a Comment