Fear

I've been put under the knife only once in my life. In 2003 I got my wisdom teeth removed. I've never broken a bone (although I may have had undiagnosed stress fractures) and had to get a cast. I've never needed stitches. Nope, just wisdom teeth is the closest I've been to being sedated and cut into.

About 6 weeks ago, I posted a blog titled "what did I do wrong?". I thought I had a suprapatella burstitis. I was wrong, maybe. It's still not clear what I had. After seeing a massage therapist, a medical doctor, and a physical therapist (who each gave me a different diagnosis), I went to a knee specialist at Slocum, Dr. Stan James. Stan was also a bit baffled by my injury. I explained how the injury came on suddenly one day. I told him how I initially treated it with massage which made things worse. I explained how it swelled locally and showed him the bruising on my knee. He poked and prodded, and found a very sensitive area along side the top of the knee cap, not located on the patellar or quad tendon, but rather to the medial side of it. I got a series of x-rays taken which all pointed to a healthy, well padded, smooth tracking knee. He finally said, "well I don't think you have bursitis, and I don't think you have tendonitis. This is a very strange injury, and smells like a Plica. It seems to be on the mend. Try some pool running and come back in a week if it's not better or swells again."

I want to take a break here and add some side notes. The PT I went to was at Tensegrity. They put me on pressure sensored treadmill with electrodes hooked up to my quads and butt and took video of me running from the back, front, and side. I had run 7.5 miles before getting this gait-analysis done to tire my body out a bit- which also made my knee quite sore. The results were: weak right glut max that was not firing. Right leg would drop in and right hip would drop down. Right foot overpronated and did not land evenly compared to left foot. In all my time spent working on strengthening my left "always injured" side, I had somehow neglected my right side and it was now much weaker. Their diagnosis- patella femoral tracking issues/quad tendonitis. Although, the location of my pain did not match their diagnosis and my pain had come on suddenly on one easy run- they guessed I had to have one of these two things... maybe... they weren't sure. I decided that no mater what this injury was, I was going to begin doing pilates/yoga religiously focusing on glutes and core. Since day one of this injury, I've done glute/core/inner and outer thigh/back/and hip work. I dropped 5 pounds after stopping running and doing these intense workouts. The pain in my knee did not subside with rest, strength, and stretching. Nor did the swelling or pain diminish after icing 3-6x day and taking 8 Advil/day for 2 weeks.

My massage therapist thought it was tight quads and tendonitis, so he did an aggressive quad massage and worked on the "crepitis" on my knee tendon. My knee swelled up bad the next day- which my doctor diagnosed as suprapatellar bursitis, caused by doing pilates/bent knee lunges right before my run and the massage. Now, this was the first thing that made any sense to me, since from day one it felt like a bruise and I had a bruise on my knee in the most painful spot. It didn't hurt to stand or sit, only to bend my knee and let that bruise roll from my knee cap toward my VMO. That pain when running or walking would extend across the entire top part of my knee cap, not on the patella itself, but between the patella and the quad muscle. I could no longer do the bent knee lunge with my knee on the floor because it put direct pressure on the swollen painful area. Also, the edge of the computer under the desk at work lined up perfectly with the bruise on my knee, which I bumped twice gently since and almost yelped!

Now back to the story. I obeyed Stan and tried a little pool running. My knee hurt to pool run, especially as a I straightened my leg back and brought it forward through the water. I didn't feel I was doing it any good by trying to pool run. Walking would cause pain to build up intensely, to the point that I would start limping after just a few blocks. Down hill walking and going down stairs were excruciating. My knee would swell after walking too much. Also, sometimes I would find my knee would "catch" and suddenly feel like it was completely off track and send shooting pain throughout the entire knee cap. One evening, after icing my knee, the "bursa" looking thing swelled up again. I said enough was enough and called Slocum the next day.

When I went to Slocum (4 weeks post injury), the swelling in my knee had gone down from the night before and it wasn't as painful to walk. Stan was about to send me on my way again, until I showed him the picture of the swelling after I had iced. He was shocked that a knee could swell after icing. Now he was really baffled and wanted to do an MRI. I panicked, not because I didn't want answers, but because Stan had first told me Plicas rarely show up on MRIs and because he was now fearful it could me something else... but something he had never seen before. After some talking, we decided to not to an MRI, because he was still leaning toward Plica, and to do a cortisone injection instead. This way we could reduce all of the swelling in the knee and get to the root of the problem. If the cortisone worked, then we'd know it was an inflamed Plica. If there was still lots of pain after the cortisone, we'd do an MRI or arthroscopic surgery and see what was wrong.

The cortisone injection hurt bad. He put it in a soft spot on my patella. I left the office feeling stiff legged and was very careful the next few days not to over exert my leg in any way. Two days after the shot, my knee started catching again and was intensely painful. I had read that a day or two after a cortisone you experience much worse pain than you original injury. I tried to stay positive, although the intense pinching/maltracking feeling of my patella was not helping.

On Monday (three days after the cortisone) I was feeling much better. Tuesday was even better, and Wednesday was better yet. I saw Stan on Friday, telling him I had a few "almost pain free" days. He was pleased and said to again try to stress the knee a little with some run/walking next week. If the pain or swelling comes back, he'd do another cortisone injection since the first seemed to work so well. We decided if this injury becomes chronic, we'd skip the MRI, and go in arthroscopicly. That way he could see everything going on in my knee and remove the Plica at the same time if that was the problem.

The following week I pool ran pain free and decided that Thursday I would try to go for a run. I still had a "knob" on very outer edge of the patella which hurt to be pressed on near my VMO, not on the patella bone (tricky, since its not exactly tendon or muscle there... guessing it's Plica). The run went pretty well, compared to how I'd thought it would go. I had a very tight IT Band the whole time, but little to no knee pain at all. About 6 blocks from home, I had to stop at a stop light and I noticed the area above my knee cap was sore and just slightly puffy (Plica? Quad tendon? Suprapatalla bursa?) I finished out the run and made sure to ice afterward. I had a little tenderness after the run walking around- not really focused on any particular spot, but it seemed to be all around the top of the knee.

I pool ran the next day and felt on the side of my knee cap and experienced some discomfort, so I stopped early. I rested the next day and then decided on Sunday to try another run. This run went even better in regards to knee pain. My IT Band felt more sore and tighter, but I didn't have as much discomfort across the top of my knee at the end or after the run. I took an ice bath this time. Walking two miles after the run was fine.

I just started reading Running Tide, Joan Benoit-Samuelson's book. I skipped right to the chapter on her knee injury and found it to be like reading my own running journal. We both experienced sudden pain on one run out of the blue that felt like nothing else we'd ever had before. The pain would build and feel like tightening. Nothing seemed to work and no one could diagnosis it. Finally, after Joan saw Stan James, she got her Plica arthroscopicly removed 3 weeks before the Olympic Marathon Trials and went on to not only run in it but to win it! That night, I had a dream I got knee surgery. Unfortunately, I didn't get a chance to run before I woke up.

So, it's a waiting game at this point. I'm going to continue to run every other day and build up my strength and confidence, while being patient with my knee. I hope that whatever it is that's wrong with my knee had finally healed up with the 6 weeks of rest, strengthening exercises, and cortisone shot. If it comes back after all this... then its time to go under the knife.