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Status = unchanged

12/20/2012

So, the knee pain. It’s still here. And I’m still completely stymied by how quickly it emerged. This noise sneaked in out of nowhere over the course of a half-mile stretch on ONE run, after two weeks of time completely off and low-intensity running. I was innocuously jogging along doing nothing out of the ordinary. WTF, knee. I just don’t get you. WHY COULDN’T WE HAVE TALKED ABOUT THIS BEFORE THINGS GOT BEYOND REPAIR?!

I saw the campus sports medicine people a few days ago, and the doctor diagnosed this as some kind of quad strain  along with pes anserine bursitis. I’m not too worried about the bursitis. The pain I feel is mostly that “quad”(?) pain at the insertion point alongside the medial kneecap.

I’ve become so used to my injuries magically evaporating overnight that I’m really, REALLY ready for this to go away now. I have essentially taken two full weeks off from any notable form of cardiovascular exercise since the day this pain popped up, and, if we get down to it, I haven’t been very active at all since the Philly marathon.

I do have a rowing machine and have used it a couple times, but, man, I forgot how mentally tough I have to be to make it through any kind of meaningful session on that thing. Lately, every time I thought about taking it down and slaving away inside on it I just… didn’t want to. So I didn’t.

This past month has seen my lowest physical activity since maybe high school. I don’t feel like too much of a slug yet because I usually walk around a lot, and because it was good timing for a rest anyway… but I’m kind of over this “feel-like-half-a-person” and “the-days-don’t-seem-as-wonderful” thing at this point. I want to get moving and sweating again, and I want it to be in the form of running (wouldn’t say no to XC skiing either). I don’t want to be inside. Any motivation I may once have had to tough it out through indoor cross training is entirely absent.

I’ve been doing some really low-intensity body circuits focusing on core work, but yeah, other than that and walking, zilch. I keep convincing myself I’ll be able to run soon, and therefore this is fine.

The doctor said that if I was still in pain after school break, I should come back and we’ll get started on some real physical therapy and maybe a cortisone shot. I mean, after school break? That’s not until January. I really have no plans to be injured until damn-ass January. Unfortunately, I’ve tried a few runs and they usually hurt too much by the ~20 minute mark to warrant continuing on. The thing is, the runs start out feeling completely fine and don’t start hurting until about 10-15 minutes in. Not really sure what that means. I suspect, as with any ache I’ve had in recent years, that this problem stems from some kind of weakness or misalignment in my hips.

I expected to be back to running by now and I’m getting frustrated by the apparent lack of improvement. I also wonder if maybe this pain isn’t as bad as I think it is — maybe I can run through it? If I were training for something, I know I would have pushed this a lot further than I am right now.

Anyway, I guess I just have stretches and exercises to do, and a week’s worth of Naproxen. I’ve never used NSAIDs for an injury before, but I’m already at the point where I’ll try anything so I’m dutifully popping them every 12 hours. To be honest, I wonder if this might do more harm than good — it’s treating a symptom instead of the cause; maybe it’s masking pain that I should be heeding. I was also a little turned off by the immediate suggestion of doing a cortisone shot. Seriously? Again, at the risk of showing off how uninformed I am, what the hell is that going to do to treat the root of the problem? I guess I just feel as if this entire pain was exposed by some combination of weaknesses, imbalances, and misalignments, and I’d be best served to make sure I’m addressing those. Anybody with cortisone shot experience, feel free to share your thoughts.

Yeah, not super thrilled about this. I mean, walking is nice too and I’m glad for the option… it’s just not running…

14 Comments leave one →
  1. Kelly permalink
    12/20/2012 07:42

    I had Pez (pes anserine bursitis) that put me down for months. I ignored my pain for far too long and allowed it to get out of control, to the point where I could not walk down stairs. It took many sessions of physical therapy strengthening my quads/hammies and correcting my awful running gait. Mine was apparently caused by knee and hip misalignment. It took 3 months to be able to return to running and my mileage stayed low.

    Thankfully though, once I addressed the problems the knee pain has not returned after 2 years. It even survived a year of training for several half marathons at higher than my normal mileage.

    • 12/20/2012 08:05

      Thank you for sharing your experience. Three months, oof! I seem to feel the “bad” pain a lot higher up than the pez area (I think), but it must all be connected and feeding back on itself somehow. I’m happy to hear that yours cleared up with some diligent physical therapy… starting to think that might definitely be in my future!

  2. 12/20/2012 07:43

    Sorry to hear that. I admit I am a slacker when it comes to taking NSAIDS and everyone has their own opinion but they should help with inflammation instead of just covering up pain.

    “the-days-don’t-seem-as-wonderful” <- Very good way to put it. I feel the same way on days lately when I'm struggle running-wise. I just want to get up and put in a good hour of running and be on my merry way. Frustrating. Hope you heal quickly!

  3. 12/20/2012 09:16

    I used to be very-anti-NSAID, partly because I saw it as treating symptoms instead of causes and partly because when a doctor told me to take them, I heard it as “please leave my office now; I have bigger fish to fry.” (Also partly because I took Aleve in college this one time and it made me feel like my brain was being stirred with an eggbeater.) Annnyway, I’ve somewhat changed my mind, in that a) I believe that a short, concentrated course of NSAIDs can really kill underlying inflammation, which maybe isn’t the root but also CAN be a cause of other problems, and b) I appreciate that taking an NSAID helps me know right quick if the pain I’m feeling is from inflammation or something else. Knowing how it responds to that 12 hours on the drugs is a helpful tool for me. Good luck!

    • 12/20/2012 09:23

      I came by to say exactly what has already been said: NSAID aren’t *just* painkillers; they’re also anti-inflammatories, and that’s what is important here. Abuse them as painkillers? Bad. Take them to make pain, like before a run? Also bad. Taking them to promote healing with an awareness of their use? Okay!

    • 12/31/2012 05:30

      “I heard it as “please leave my office now; I have bigger fish to fry.””
      -Yep, that’s exactly how I interpreted our entire conversation. I guess that’s why I like to try and see doctors who are also runners and therefore … understand. But it’s certainly not always an option.

      @ Kimra & Tracy: thanks for the NSAIDs education. I suppose I knew that at some point, but I still feel a little squeamish about them for whatever reason…

  4. 12/20/2012 17:14

    Ugh. I totally understand. I haven’t run in a MONTH! And my pain is the same!
    I did have a steroid shot for osteitis pubis this summer, and I don’t recommend it. For areas with poor blood flow like the pubic symphysis it sometimes totally eradicates the inflammation, but then – sometimes it doesn’t. it didn’t for me, and I had some of the typical steroid side effects, including facial swelling and hair loss (EW).
    If you need to stymie inflammation long enough to allow healing, I’d stick with the NSAIDS. The only concern here is that if there is tendon involvement, NSAIDS can delay healing (ps – I am a pharmacist, not just a big mouth lol).
    I have actually passed the point of “I wish I could run” and I’m all the way to “I don’t care if I never run again if this pain would just go away.”
    Two things I would recommend if rest alone isn’t helping: ultrasound to the area (can’t hurt), and Graston. I had Graston yesterday and it was this morning was the first time I felt genuine relief from pain. Still pain when going up or down stairs or walking (and, I assume, running), but not standing or sitting.
    I am seeing a chiropractor for the same reasons you mentioned – is it an imbalance causing this? Can I correct it? – but besides the Graston, he has not helped me much.
    I hope you heal quickly, and are graced with the patience needed to stay off your injured leg until it is healed!

    • 12/31/2012 05:32

      Good to know about the tendon involvement! I do trust your pharmacy chops. And I’m hoping to read more about your graston-induced or otherwise magical healing on your blog soon.

  5. 12/21/2012 20:05

    Totally sucks. Especially when time off seems to make no difference at all. I’m still happy for you that something this rude didn’t happen before your terrific marathon! And this IS the season to stay stuck and cozy indoors anyway….

  6. 12/22/2012 18:58

    Bummed for you that you’re still hurting. I’ll bet erging more will help strengthen and balance those things which need to be stronger and more even. Good luck with it!

  7. 12/26/2012 23:03

    Sorry about your knee. Not sure if you got any imaging (MRI) done, but a quad strain causing medial knee pain is something I have never heard of in my 4 years of medical school and 4 years of residency. I actually had medial knee pain that came on quickly when I was training for my first marathon. We never really figured out what it was (and I never got imaging done), but a cortisone shot pretty much completely cured it. Cortisone shots aren’t something you want regularly, but having it done once in the knee shouldn’t cause much harm, but I would discuss it with your your doctor: Is the shot diagnostic or therapeutic? If it’s therapeutic, is it to treat the bursitis? Do you know for sure that I have bursitis? Should I get an MRI before I get the shot?

    • 12/26/2012 23:05

      Reading the comments from above…a localized cortisone shot shouldn’t give you systemic side effects. I certainly had none whatsoever.

    • 12/31/2012 05:38

      This is such good insight. I have no idea about why the doctor suggested a quad strain for the knee pain, to be honest. Maybe he meant it was some kind of VMO thing? (My grasp of anatomy/physiology is pretty limited.) Thank you so much for the doc discussion questions — seriously, I need someone like you in the room with me. I’m never good about prodding the doctor for better information.

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