Wednesday, December 16, 2015


The inflammation in my knee must have subsided finally, because I can move around with little to no issue. Per the doctor's orders, I'm supposed to run and log the kind of discomfort I have. Over the weekend I ran with long-time friend Ben Jenkins in the Ward Reservation. 5 miles very slow. My right hamstring was cranky but the knee didn't bark once. It felt great to run again.

On Tuesday of this week I ventured out to Andover roads with Alex. I did a number of PT exercises beforehand which I think helped a lot. We ran 8 miles including a loop around the Phillips fields. I felt surprisingly good aerobically. We rolled faster than I wanted from Phillips down to Shawsheen and it felt good but the right hamstring was the tiniest bit cranky again finishing up. No pain in the knee...

Friday, December 11, 2015

Visited the doc

I met with John Boyle out of the North Shore Center for Orthopedic Surgery and we reviewed my MRI and discussed what is probably the cause of the pain/issues that have been plaguing me.

What is definitive is that I have patellofemoral arthritis on the medial side of the knee cap. It's bone on bone for a couple centimeters. There is also some broken, floating pieces of cartilage in there causing an impingement. Apparently, a vast majority of people with this kind of arthritis are worn badly on the lateral side (outside) of the patella but my cartilage there looks fresh as a daisy. He told me very clearly that "going in and cleaning it up" would "almost certainly make (my) knee feel better".

But, given that most of the pain I experience is on the lateral side of the knee and actually behind my knee, he is suspicious that I have inflammation in the joint where the fibula meets the femur. He advised that I begin by trying a cortisone shot in that area. If the shot cleared me of the pain that prevents me from running, then the arthritis, though not good, is probably not the thing hanging me up.

So... step 1, if I want to pursue it, is a cortisone shot. I think I'm going to do it. But I don't know what to hope for. It would be cool if the cortisone shot took the pain away, but the implications of that would mean I have a complicated and difficult to treat inflammation of the joint there. But if the shot doesn't have an effect, surgery might be the only thing that could get me up and running consistently again. I'm wary of the possibility for other crap to result from surgery and in general I consider surgery a very last resort.

I guess the silver lining is I can still bike as aggressively as I want without any pain whatsoever. With or without surgery, maybe it's time to make multi-sport stuff more of a focus. When I consider the long-term, I get nervous that another 15 years of road running will trash my knee for the rest of my life. I've always understood that seriously training would yield some degree of arthritis eventually but I'm shocked at the degree of the breakdown in this one area of my knee. Ironically, the remainder of the knee looks super good. The primary joint in the knee looks "like an 18-year-old's". Completely healthy. My left knee is in super good shape, too.

So maybe I'll schedule a cortisone shot for next week. The doctor asked me to run for a few days to "make it hurt" and be sure the pain I'm experiencing really is on the lateral side of the knee before I go ahead with the shot. Meanwhile, OF COURSE  I'm sure that's where it hurts; I've been dealing on and off with this problem since I started this blog back in 2010.

That's all for now.

Monday, December 7, 2015

Injury update

Unwittingly, I included a bit of foreshadowing in previous posts about what is ultimately a flare up of a condition called patella femoral arthritis. I think I've described it in previous posts, but the basic condition is that due to an imperfect femur, my knee tracks poorly leading to breakdown of the cartilage between my kneecap and femur. Usually, it causes me no pain. And then sometimes it flares up and causes all sorts of pain. Usually, at the same time I develop something called a baker's cyst caused by poor drainage of the inflammation in the knee. The cyst bulbs out behind my knee and causes pain and poor firing of the calf and hamstring. The nerve pain caused by the pressure of the cyst can be felt down to my foot and up to my hip. All in all, it makes for the feeling of an unstable leg and the impossibility of running without a limp.

Basic treatment... varies. You rest. You can have it drained. You can have a cortisone shot. Those things aren't permanent and the likelihood of recurrence is high unless you can do something to basically restructure the tracking of the knee. It's also complicated because as the cartilage breaks down, the treatments, exercises, etc. that worked before won't necessarily work the next time. I used to be able to "pop" the cyst by rolling on a lacross ball and all would be well! ... except I still had arthritis. In this most recent bout of cyst-li-ness, I haven't had success trying to roll it out. Stretching doesn't appear to help. I've been hitting the inflammation with lots of anti-inflammatory drugs. I tried a few different braces which definitely don't appear to help. Certain shoes help.

Anyway, rather than whine about it and get down on myself, I've decided to really pursue an end-game solution. I made an appointment with a knee specialist recommended to me by a couple of folks who have dealt with similar stuff. He's one of those mega-endurance athletes and "gets" runners and what running means to them. I hear he can do some pretty cool stuff that's minimally invasive. It's too early to say this, perhaps, but part of me thinks that if surgery could stave off further damage down the road and allow me to race competitively for a few good years, it would be worth it. Plenty of runners I know have had minor surgery on a knee or hip and come back stronger because of it. The appointment is Thursday and I'm excited to see what he has to say/recommend. And I'm really pumped to find out he is in my network and completely covered outside of a $20 co-pay. Amazing, really. I thought I was limited to the nice but generally uninspired sports medicine department at Lahey... guess not!

Fortunately, I'm able to cycle without pain or sign that it's prolonging the inflammation. Now, I'm off to Breakaway for a group workout on the compu-trainer. Probably won't be training Tuesday-Thursday, outside of standard core work, for this week as Day 1 of winter track starts tomorrow and I'm excited to get everybody off to a good start for the holiday season!!