Monthly Archives: May 2013

DNS (Diagnosis and New Start)

Ok, I’m trying to be clever with that title. The more usual meaning of that acronym is “Did Not Start”, which sums up my Brooklyn Half experience yesterday.

brooklyn_half

No need for this…

So no race report, but instead further developments in the life of an injured runner. I ended my last post on a suspenseful note, as I was about to receive the results on an MRI of the troublesome right knee that’s kept me from running since March.

And so I found myself back at the orthopedist a couple of weeks ago, sitting in a consultation room staring at a TV on the wall showing the results of my test.

mri_photo

Can you make sense of this? Nope, me either.

It must have been at least ten minutes before the doctor entered the room, giving me plenty of time to stare at the images, trying to make some sense of them. Somewhere on this screen must be an explanation for what’s been causing so much pain. Soon I had to give up, the only lesson learned being that an MRI is much more difficult to decipher than an x-ray.

Eventually the doctor arrived to give his interpretation of the MRI results. A little fluid on the knee, the calcified loose body that the x-ray had previously revealed, and something new: suprapatellar synovial plica syndrome. I’d never heard of a plica before; it’s since become part of my daily vocabulary. Although I’m the last person who should ever try to explain medical conditions, the plica is essentially a membrane that lives somewhere in or around the knee lining. If it becomes unusually inflamed, it can interfere with the normal flexing motion of the knee, resulting in sporadic but quite intense pain.

I was greatly relieved to have a diagnosis that seemed to make sense, something definite found in the precise area I was having trouble. So what do you do with a misbehaving plica? Whipping out the misfiring membrane with surgery is an option, but the standard first course of action is a cortisone shot to reduce the inflammation. Researching on the internet reveals all kinds of horror stories about steroid injections, on the other hand I found some positive accounts too. While I don’t want to get into a state of dependency on these injections, I wanted to give this treatment a fair chance to work: having put my trust in medical professionals, I have to let them use their skills and knowledge to try to help me.

I had the shot a few days later. Hobbling into work the next day was a little uncomfortable, but by the weekend I was ready for my first test run, with the blessings of the doctor. With two weeks before the next appointment, these would be important runs to determine whether the injection had worked, or if surgery would be necessary.

The first attempt to run was inauspicious. My running club, the Staten Island Athletic Club, has for years (decades?) organized a weekly 3 mile Fun Run in beautiful Clove Lakes Park. This seemed a perfect place to begin the comeback. See some friendly faces, run with others in case I break down, pace off others in case I don’t break down. Perfect. I signed in and did a little warmup, and OUCH. Pain radiated all the way across the top of my knee, and I had to stop after a quarter mile. Would I not even make it to the start line of a casual fun run? I walked a bit, then jogged a little more. Pain, but less than before. Ok, so it’s getting slightly better, I thought, let’s try this.

The first mile continued to hurt, OUCH OUCH OUCH.

I’ve been asked a few times how I’m handling not being able to run. It’s a valid question. Running is my way of coping with all the stresses and anxieties that life throws at me. I can zone out, or think my problems through, take out my frustrations… whether I need to be calm or aggressive to get to a resolution, running is an avenue to do it. It’s my lens on the world, the way I learn about stores opening, or restaurants closing. It’s allowed me to witness moments of sweetness as well as some truly bizarre human behaviour, often in the course of the same one hour run. If you take all that away, can I still be ok?

Surprisingly, the answer has been “yes”. And I’m not even sure that I understand why. I’ve put a little more energy into work. I’ve picked up my camera and been involved with running by doing event photography. I’ve stayed in contact with my running club. All positive developments, but combined they surely can’t compensate for the lost benefits of running.

During the first mile in the park, that frustration I’d been expecting belatedly reared its head. If it should turn out that I’ll never be fast again, I think I can be ok with that. But if I should never again be able to run without physical pain? Forget the relaxing zen run. Forget the “run ’til you’re numb” aggression run.

The knee pain did seem to get a little better over the course of the three miles, though this may have been more a consequence of my lack of stamina, giving me other things to worry about.

The next day – Mother’s Day – however, was an eye-opener. I woke up feeling like I’d had sledgehammers smashed into my thighs. After a three miler, at “easy” pace. Excuse me as I’m trying to keep up the quality of my writing, but WTF?! I then proceeded to throw my back out while lifting groceries out of the trunk of the car – more than likely because my thighs and knees didn’t want to bend. The comeback was on hold for a couple of days, and the next test run wasn’t encouraging. Half a mile, pain across the top of the knee again.

But then, a turnaround. A mile with less pain. Then 4.7 miles with still less pain. And then, a realization.

My loose body had become a lost body.

The little bump under my skin, trapped just above my kneecap, wasn’t there any more. Eventually I tracked it down, it had moved about an inch and a half to the anterior side of my knee. If I applied pressure to it, I could make it move almost back to its original position, or, alternately, end up losing it again. A very odd sensation!

But could this be the reason the pain was diminishing? Today (Sunday) I set out to test a new theory. After victimizing my plica for weeks, could it simply have been a secondary actor in this drama? Maybe the loose body above my kneecap was creating all the tightness in my knee, and the plica became inflamed as a knock-on effect.

I ran 7 miles this morning. I had no pain in the first mile. None. Sure, after that mile, my knee began to become numb on the medial side as a form of self-protection, just as it has in every test run I’ve done. But somehow things feel different. Runners have an innate sense of which pains are ok, and which are not, and I can’t help but feel optimistic. Did the cortisone shot free things up so that the calcified lump moved? Or did I do that by running? And now that this thing is floating around, can I safely run, or is it a ticking timebomb waiting to land in another bad spot, requiring surgery?

So many questions – but that’s how I like to end these posts, on a cliffhanger. I see the doctor on Tuesday Thursday, hopefully he feels as positive as I do about my outlook.

Ballad of the Injured Runner

Before I get started on this post, I have to say thanks for the response to my High Rock Challenge photography. It’s by far the biggest event I’ve covered in any kind of official capacity, and I’ve been flattered to receive some very kind comments. To hear that I’ve captured the essence of the event (you know who you are – thank you!) is the greatest compliment I could wish for. If they’ll have me back next year, I’d love to do it again.

The end of each month brings a regular ritual for the dedicated endurance runner, totalling up how many miles have been logged that month. Marathon training might result in 200 miles or more, a more normal month may see a solid 100+ mile accomplishment, money in the bank in the pursuit of a greater annual goal.

Less fortunate runners are confronted by something like this:

Screen Shot 2013-05-01 at 8.30.07 PM

I wasn’t able to find a solid consensus figure for the percentage of runners who get injured in a given year (I’ve seen anything from 24% to 74%, but then we all know that 46% of all statistics are made up), though you only have to look at the elites of the sport, who have access to the finest training and medical advice, to see that marathon running in particular is a lottery when it comes to staying healthy.

My own problems started as I was just starting to rebuild mileage after a winter break. I joined a Sunday group run with my running club, which I would normally consider to be an easy workout, a good way to get in a long run (14 miles) without it feeling too difficult. I found it harder than usual, but out of a sense of pride and feeling that I belonged in the front group, pushed a little more to keep up. I finished the run but began to experience knee and foot pain later in the day. In hindsight, it may also have been a bad idea to do my longest run of the year in a pair of unfamiliar shoes that I’d won for finishing second in a local 5k race last year.

Injury is a new experience to me, and it took some time to accept the reality of it. Last year I ran for a few months with what I believe was piriformis syndrome. I had tried backing off mileage for a couple of weeks, it didn’t help, so I went back to my training plan, threw in a few token pigeon poses, ran the two best races of my life, and concluded that I could run through pretty much anything.

So it was only after a few stubborn weeks of alternating rest, ice, compression (which absolutely did NOT help) and tentative rehab runs that I had to admit defeat with my knee, and seek medical advice.

I’d watched this video a week or two earlier, about Desi Davila’s injury that forced her to pull out of the 2012 Olympic Marathon.


Watch more video of Desiree Davila on flotrack.org

I’ve admired Desi since she famously came 2 seconds away from winning Boston in 2011, wearing the same model Brooks T7 racing shoes I’d worn for my own personal triumph (first sub-90 minute half) in DC a few weeks earlier. There’s a blue-collar toughness to the way she runs that speaks to me – gutting out every ounce of performance possible from the talent you have. I like to think that’s what I bring to my races too (at least the longer ones), a stubbornness that allows me to overachieve compared to my training performances.

From the video: “This is a picture, this is something real, you are hurt”.

That’s what I needed to see too. So last week I found myself sitting in an orthopedist’s office, staring at an x-ray of my leg, waiting for the physician’s assistant to come in and give her verdict. I noticed a white oval shape lurking menacingly above the knee joint, and knew that had to be something to do with it.

The initial diagnosis? Calcium deposits below the quadriceps tendon. That certainly makes some sense in terms of the location and the nature of the pain – I can be fine for a while, but flexing/twisting the wrong way triggers the pain, almost as if something sharp is digging into me. The PA gave a couple of possible options for how they might proceed to treat this condition. Removing the growth through arthroscopic surgery is one option. Another is a course of injections that the PA described as an “oil change” for the knee. That sounds attractive, take me in for a service and send me out good as new!

Joking aside, they did seem concerned at the general state of both my knees, particularly how they much they crack when I flex them. Arthritis does run in my family, so I’m likely getting a preview of what’s to come as I get older. Looking at it that way, I can’t help but feel slightly blessed: it takes a lot to get me to go to the doctor, but this injury has put me on the books of a specialist who I’ll likely continue to need for years to come. Better to start getting help sooner than waiting until there’s not much that can be done.

In addition to the x-ray I was sent for an MRI. I get the results back tomorrow afternoon, and hope I’ll then really know what’s going on, and more importantly, what I can do to help myself and how long I have to wait to get back out on the road. Before seeing the doctor, I was admittedly in denial about my injury, but I’m now feeling hopeful. Plenty of time to get better, whatever the verdict tomorrow.

Keep your fingers crossed for me!