Knee questions answered

Here's the deal. I've been having knee pain for a year. It's always hurt under the knee cap or around the knee cap on stairs, going up or coming down, some days not at all. It started off just hurting after a long run here and there last January.

 By March, it was becoming more of a problem, interfering with my training. I added in some xtraining, when to my chiro, dry needled and KT taped it. Ran my marathon at the end of April with no knee pain at all (well at least not this knee pain, IT band issues on the other leg)

May- I rested for weeks. I xtrained. I went to the Dr. who told me it was runner's knee and handed me a paper with exercises. I did those, nothing. Changed my shoes- seemed to work went back to my follow up. No pain in knee (with the new shoes- and I wasn't running that much). Started picking up my running, knee pain back. Frustrated, called a new PT instead of another Dr appt.

PT- I went from July til Dec. Not much improvement. Lots of dry needling, ASTYM, estim, etc. I was able to run, just would get a day or 2 of reprieve. I ran well too. Thanks, Coach Becki! I raced a decent 10K, PRd in 15K and 5 milers this fall. My last race, the Turkey Trot, was the last straw. My knee was killing after it. I couldn't run, yet alone walk without some pain.

Back to Dr, MRI ordered.

"Chondromalacia and chrondromalacic osseous changes involving the lateral facet and critical zone of the patella with extensive marrow edema involving the patella"

I'm not sure what grade mine is...assuming grade 4 since I have "osseous changes" Feel free to correct me.

In layman's terms the Dr said "In any other bone this would be a stress fracture" Read- zero running for 6 weeks.  The chondromalacia means my cartilege is thinning/damaged. Options for that were a Visco injection or PRP. Visco is used for arthritis and isn't covered with my insurance (read $700-$1400 an injection that might work and might need to be done every 6 months) or PRP (platelet rich plasma which isn't covered by insurance and is *only * $500.  I went with the PRP since it is more a healing thing than covering up pain.

More later on the PRP injection.

So, what's in my future? I'm not sure right now. Although, it looks like I'm going to have to ease up on the running and definitely find my fitness elsewhere for the time being. I hoping PRP will work and I can get back to running since I'm running the Indy Mini this May 5th. I registered before I knew what was going on with my knee so there's that. Feel free to join me on May 5 in Indy. I mean, you get to run on the speedway! Plus Meb will be there! Discount code is BRP2018 for $5 off. 

Ankle Surgery Decision

Back in April I had my MRI and discussion with my Dr about my ankle pain.  You can read about that here. I managed to do my big races at the Flying Pig in the beginning of May with not much pain.  Granted, compression socks and Advil were a pivotal role in my success. My PTs were very surprised that I was able to finish all three races and were expecting a mess when I came in on the Monday after.  My ankle was sore and crunchy but I could walk w/o pain. 

My newest PT, I'll call her Michelle, who comes from a sports clinic, gave me the talk.  "You need to stop running for 2 weeks and completely rest it.  It's not about running now, it's about running in the future."  Yep.  She's right.  Grrr.  So, I was good.  I rested for long 10 days.  Meanwhile, Michelle looked at my new running shoes that showed up in and deemed them unfit for my foot.  I have always wore a Neutral shoe (Mizuno Wave Riders) but she showed me why I needed to be in a shoe for Supination.  I had 2 weeks to try out another pair of shoes and return the old (new) shoes.  I was getting close to 2 weeks but I hadn't got to run in them yet.  That was part of my reasoning for starting to run again but also, my ankle felt the same even with rest.   If I try to dorsaflex, stretch my calf, lounge, walk up hills, walk down stairs it still hurts.  (Michelle gave me her blessing to go ahead and run again)

Michelle asked me when I was going back to the Dr. for a follow up- I told her I wasn't.  My Dr. told me to come back when the spur was killing me and we could do a "scope" to clean it up and shave off the bone spur.    Michelle looked at me, nodded her head and said "Just do it, it's stopping you from doing what you want."  She explained to me the general recovery for it and said I'd be walking within a day or 2.   Ok, doesn't sound THAT bad.  
 

I'm not a radiologist, but I think that's a spur hanging down from my tibia (left hand side, in the middle of the red triangle)

So, here I am, waiting to have arthroscopic surgery on my ankle spur(s?) next Friday.  My Dr. told me that he might have to open me up a little bit more than just the portals for the arthroscope to get at the spur- just depends when he gets in there.  Recovery would be 5 weeks in the BOOT and nothing about being non-weight bearing so that's good, although I did clarify with the nurse and she told me to bring my crutches and boot to the hospital, so...fingers crossed that will only be for a little bit. 

 I do have my doubts.  I can run with little pain.  BUT, I'm in pain later.  Today, I went for a run and as usual I was hyper-focused on my ankle.  It didn't hurt to bad, just on hills (up and down) and I thought "Why am I having surgery on this? I can function, with some pain, but it's not horrible."  BUT, if I didn't do anything about it, I'd stay in this stupid, frustrating situation.  Run, then pain, repeat. 
I want to compete. I don't want to have to run every other day and only 3 miles. I don't want to be the person who can't run because it hurts her ankle too much.  I refuse to stop.  So, I guess that's it.  I have to get this taken care of.

My PT added some anxiety since she asked me if he was going to be doing a micro fracture on the ankle and asked if Dr brought up OCD (Osteochrondral defect).  He didn't, thank goodness, since Dr. Google brought up some scary stuff.    My real Dr. did not mention this, and when I look at my patient summary for the surgery it mentions "General or localized osteoarthrosis" which means I'm old that I have arthritis. If you google "localized arthritis" it is this OCD stuff. I looked at my MRI and at MRIs online of an OCD of the ankle and I think I'm good- but then again, I'm not a radiologist.  (Although it is fascinating, maybe a second career option...) 

my lovely ankle MRI of my talus

someone else's MRI with OCD in the talus

  Since, if I timed it right, 5 weeks in a boot gets me to Aug 2 (perfect for me-done with it before going back to work mid August), and gives me 6 weeks to train for the Air Force Half which stupidly I signed up for back on Jan 1.  I'm hoping this is an easy recovery. 

Has anyone had arthroscopic surgery on their ankle before?  I'd love read about your experiences.

and the results are in!

4 weeks later and I finally know what is going on in my ankle!  I'll spare you the details of what scheduling was like...but I ended up getting in at 7am.  Good thing I'm an early riser (not by choice- but for work).



So here is what the MRI report says: (my comments in pink)

There is signal abnormality within the distal fibula which is non specific possibly related to bone contusion.  Additional marrow signal alteration is also seen however with the medial malleolus (inside ankle bone) as well as the as the more inferior portions of the talus.  Little if any calcaneal signal alteration noted.  Freaked out about this- but Dr says it's pretty normal and it doesn't match my symptoms- although I'd say I have pain in by medial malleolus when I stretch my calf.  Whether these areas relate to additional areas of contusion etc. is difficult to determine.  There is fluid with the ankle joint.  Soft tissue swelling is noted medially and laterally. Yep.  The anterior talofibular ligament is not well defined on this examination compared to prior study and may have partially torn. That would be the goose egg next to anklebone  Exclusion of injury of deeper fibers of the deltoid ligament is difficult.  Had to google this one- once again that inside medial malleolus pain... hum.  Ligamentous structures about the ankle appear to be maintained.  That's good, since it was my calcaneofibular ligament that detached and must have reattach sans problems.There is some non specific enhancement with the bilateral soft tissues which should be clinically correlated particularly if there are any symptoms referable to an infectious/inflammatory process. WTF?  No soft abscess seen.  So, what is that hard lump in front of my ankle? 

Can you find the superior extensor retinaculum?  That's the lump.

Of course, google was not my friend since the MRI report was vague and I knew my Dr would probably tell me it was nothing...and it kind of was. 

He told me that the signal alteration in my marrow is pretty normal to see in a MRI, swelling, yep, and the lump was a thickening of my extensor retinaculum but my tendon in front was fine.  He did find a bone spur that the MRI report didn't include which seems to be my problem.  It is pretty small but as soon as he put his thumb on it- yikes it hurt.  It's right at the distal (bottom) of my tibia next to the medial malleolus.  He told me that we could try an injection or arthroscopic surgery if it hurt too bad.  I heard surgery and started shaking my head.  He said that if/when it was killing me then we could revisit that option later.  He also mentioned that I have mild arthritis (NO! I'm NOT that OLD!). 

So...all this MRI drama and I have nothing really resolved other than knowing what it is.  I'm cleared to run "as tolerated". (I didn't think I had to ask!) And so I did.  6.2 miles right after and 2.62 later that night for Boston. (I don't think I can express my sadness in the whole Boston Marathon attack- too awful so I'm going to spare you). 

Running buddies, photo by Cub

Cub

Around 2,000 runners running 11 laps at the local track for the victims of the Boston Attack

Obligatory Ankle picture (not too swollen from that angle) 14 weeks post injury

I'm going ahead and running the Flying Pig in 2 little weeks from now.    I can do a 10k and a 5k, so now, will I be able run/walk the half?  I'm going to try.  But one race at a time seems to be the best way of looking at it right now. 

Running update

11 weeks post injury- this is this AM before I've really been on my foot today.

•  Dr appt went well, told Dr my problems that I am still having, he again focused on my now hard lump in front of my ankle.  He thinks I might have an impingement which is why I can't flex my ankle.  I'm supposed to get an MRI...which is another story. 

 

• So Mon is Dr appt, I'm to get a call to schedule MRI, I wait til Thursday after work- still no call, grrr, call the Dr office, get call on Fri, "Oh, Dr never put in the MRI order, but it's in the office notes.  You'll get a call next week".  Yesterday, I get a call "Scheduling you for a CAT scan" "What?!, I'm supposed to get a MRI." "Oh, the note says MRI but the order is for a CAT scan, I'll call you back after confirming with the Dr".  So, here I am, day 2 of my vacation- waiting to get this MRI scheduled.  I don't want to take time off of work for the MRI and the follow-up appt if I can help it.  Seriously, people!  

 

• Ran again this past Saturday since the sun was out and the temps in the balmy 50s.   3.1 miles in 28:40.  Ankle hurt the entire time...grrrrrrr.  BUT I RAN 3.1 without stopping.  Yay for keeping my cardio up with spinning. Ankle was a bit pissed off after, but Hey, f- it. 

 

• Walked/Ran on Easter Sunday, again the beautiful weather drew me out and of course, being curious, my walked started with a small run to test out the ankle, then ended about 1.5 miles later.  Again, ankle not happy with me. Good thing it's cold out this week again- probably won't try anything for a while considering I could hardly spin last night it hurt so bad.  

Add caption

• So that's were I am...I've reached the F it stage.  I am tired of not running.  It's been 11 weeks.  I am happy I still have cardio so I'm not out of breath.  This running once a week is not making me happy.  

Yay! and Double Yay!

I had my Dr. appt today to see my results of my MRI.  Yep, I have plantar fasciitis but no stress fracture (which I never really thought I did) or anything weird (wasn't worried about that either).  The good news is that it hasn't been hurting now for almost two weeks.  My doctor wasn't surprised, since it is either the cortisone or it finally just went away.  I guess it just goes away quickly as it came in the first place. I'm still a bit nervous it will come back, so I will continue stretching like a mad woman and using my spiky hard golf ball on my foot. 

I went for a celebratory run with my new Garmin 405cx watch that came today in the mail!  I'm in love.  I have always liked to know my splits and between my old timex and mapmyrun app on my phone it's been kind of working.  I had wanted the Garmin for awhile but they are pricey and then with my heel, I figured there was no rush.  Someone posted that they had gotten one on Dailymile.com and I got curious again and looked around on Amazon.  The price seemed to have dropped since a few months ago.
http://www.amazon.com/Garmin-Forerunner-405CX-Sport-Monitor/dp/B0025UHKNS/ref=sr_1_2?s=electronics&ie=UTF8&qid=1327979812&sr=1-2

Yay for me.  It was super simple to set up.  You need at least 3 hours to charge it which worked out since I got it when I came home at lunchtime, plenty of time for it to charge, go to my Dr. appt, come back for a run!  It is really simple to use yet so high tech.  I loved to see my splits without having to be aware of where the mile actually was to press split on my watch....it just showed up.  There is a little runner guy that is supposed to be your ave. pace for your age/weight/fitness and it will show you if your pace is faster or slower than the suggested pace.  Afterword, with one little download from Garmin.com, my watch was talking to the iMac and voila:  stats galore!  Here's what my first run looked like.

Can you find where I stopped for a car? Hint: look at the blue part. So cool!

  I can only start to imagine what this means for my training....  speaking of....

I'm trying to decide between a 10k or another half in the beginning of May.  I was originally thinking the Flying Pig 10k again since I did that last year, I would only need 8 weeks of training which would give me some more time to build a base back up.  Or do I try for another half? There are 2 possiblities- the Flying Pig Half or the Cap City Half on May 5/6th.   I kinda want to do the half, since training would start in the next few weeks (but the mileage is still low) but I know it probably wouldn't be my best effort.  And, I don't want a repeat of PF...

What races are you doing this spring?  Any suggestions for running the 10k or Half? 

Feeling good!

So it has been 20 days since I got the cortisone shot and I think it's working.  It took about 2 weeks for it to kick in but for the last week I have hardly had pain in my heel.  I still have pain after getting up after sitting and at the end of the day. (of course, as I write this I get a weird twinge in my foot). But it has been much less- more of a reminder that I need to keep stretching.

I decided to run on it last Sunday.  I bundled up, waited for the football game to be on TV (since it was still snowy/icy- I wanted to run on the road- and around my neighborhood no one is out if a game is on).  Loaded my iphone with the new David Guetta songs off of itunes and map my run and took off running.  It's so nice to get out again and run in the neighborhood.  I felt great and just kept going.  I ended up running 5.23 miles!!!  Wow!  I couldn't believe it- I was more impressed that my pace was that fast.  I haven't run, really, in 13 weeks.  Unless you count the few times I went out for a few short runs.  I guess going to Spinning class 3 times a week can keep you in shape.  I was a bit nervous about much it was going to hurt later, but the heel felt ok. Not 100% but about 80%.   Just a bit stiff but not hurting.  Yay!!

Monday, my PT had me do something more exciting than ankle strengthing and stretching.  I got to JUMP! Nothing like a bit of plyometrics! My only problem was my quads were a bit sore from all the impact of running the day before.

Today,  I had to take a day off of work for my MRI that I scheduled before my "recovery".   I got to take the kiddos to school and then I decided to try another little run.  I did 4 this time.  My legs were frozen, esp. my thighs, which made them feel tight.    I guess that's what happens in 23 degrees!  Another good run, 4 miles in 35 mins.   Heel feels ok as of now.


Speaking of the MRI, I feel like a bit of a fraud now.  My heel feels better.  The MRI was to check to make sure I didn't have a stress fracture in my heel.  I can't imagine that I would and still be able to run.  Anyways, I guess I'll know for sure what's going on on Monday when I find out the results.  Then I signing up for some races! (in May and fall- nothing too soon)

In mommy land, my sons' school is doing craft beer fest as a fundraiser.  Got to love private schools!  (don't ask me where I work ;-) )  I can not wait for this!  I am a beer drinker.  Can't stand girly drinks or wine.  Well, maybe a killer cosmo that dh makes but that's it!  Anyways, if anyone is in the Dayton/Cincinnati area and loves craft brews here's a link to my friend KevBrews with the info and beer list. Yum!  BTW it's for adults only. For tickets: http://msdbrewhaha.eventbrite.com/

longest short week ever

Not much going on this week...just seemed to go in slow motion.  I had my dr. appt for my xray on Monday and the xray was negative so now I'm waiting for my MRI.  Of course, that requires approval from the insurance co. so I waited until Thursday to get the go ahead.  So now I'm waiting til Wednesday for the MRI and the follow up appt the following Monday. 
The last few days have actually been good, no real pain while walking just when I get up after sitting and at the end of the day.  Progress!   I've skipped wearing my night splint this week as well, since I never have a good night sleep and I don't have any pain in the am (until today-and it was minor).  I don't know what that means since PF pain is usually the worse in the am. I always assumed mine didn't hurt much in the am since I had the splint on.  I guess we'll see soon enough. 

My running partner tweeted this am that she hadn't run in 1 week. I'm totally jealous.    I got curious and I figured out that I have had this stupid heel issue now for 15 weeks, and I have "really" run since the Columbus Half so that's been 13 weeks.  Boohoo. :-( 

Speaking of the Columbus Marathon, today is the first day to register!  Here's the link http://www.columbusmarathon.com/. 
If you haven't run this and you live in the midwest.  It is a great race experience!  The expo wasn't great but the crowds and course are fabulous.  I WILL be running the half again this year. I'm going to wait to register for awhile- for obvious reasons. 

Time to get ready to head to a birthday party with Buster.  I going to get my workout scrapping the ice off the car.  I'll leave you with the picture Cub scratched out of the ice/snow.  He wanted the cats to have something to see out of their upstairs window.