Dr. of Osteopathy and Prolotherapy

It has been one year since surgery. Things are better than 6 months ago, or 9 months ago, but I’m not sure if I’m better post surgery or worse. I guess the best term would be different. I am no longer getting sore on the lateral side of the knee, but instead under the patella, and mostly from impact, such as running. Cycling, elliptical, and even hiking all seem ok, though I really have not pushed those to long distances/durations like I’d need to to get back into racing seriously.

At any rate, I figured I go see a Dr. of Osteopathy who also does prolotherapy. I’ve heard some really good things about both on the Yahoo group for chondromalacia.

Well, I was somewhat disappointed with the Dr. of Osteopathy. I had heard they spend a lot more time with you than a typical orthopedic surgeon, looking at the entire body to determine what might be causing the problem. But she did a fairly quick and typical knee exam, and that was it. She does think that prolotherapy is worth a shot — as she put it “you have nothing to lose.” It is a pretty non-invasive procedure. While there will be some short term pain and discomfort, because it is intended to be like a minor injury so that the body will heal itself, long term, there should be no issues. (It is very targeted, unlike a normal injury.)

Basically the doctor would inject a mixture of dextrose and water under the patella, in an attempt to get the cartiladge under there to heal up more, so that impact from running does not bother me. It would be a series of at least 4 injections, about two weeks a part. I would be able to ice and take tylenol for pain, but no NSAIDS, as the inflamation is needed as part of the healing process. I’d have to really limit activity during the cycle and for up to 4 weeks after, so we’d be looking at 12 weeks. 😦

At this point, I have a race scheduled in a few weeks, so I will definitely wait until that is over before I decide.

30 minutes

I haven’t written a knee update in quite some time, but I ran 30 minutes on the treadmill today. That is the longest I’ve run so far since surgery. We’ll see how it feels later today and/or tomorrow. Right now, I can tell that I used it, but it doesn’t hurt or feel tender. I’ve not taken any NSAID or iced it yet either.

Running is still the thing that bothers me the most. I can hike, bike, do elliptical, etc., all with no problems. Hopefully I’m on the way back to 100%, but I’ve decided that if I can never run another marathon, as long as I can keep on hiking, I’ll be ok.

Now that the basement is 98% done (I think the last 2% is the hardest!), I can really start working out at home again. I need to get back to the PT routine of strengthening and stretching, and I really plan on doing yoga at least once or twice a week. When I was doing lots of yoga a few years ago, that is pretty much the only time I’ve been injury free.

HuckaBuck Mountain Bike Race

huckabuck.gif

This was my 1st race in way tooo long… I knew I missed racing — racing of any kind — but I didn’t know how much until I did this! It was a 12 mile course, 2 loops of 6 miles, and relatively flat for this area. It had been a couple years since I rode these trails so it was all new to me.

I signed up for Begginer Men, and ended up in 22nd out of about 40. But if you look at the times, it was less than 5 minutes slower than the winner. Overall not that bad considering almost all of my biking has been on paved roads or fire roads as I’ve worked on re-habing my knee post surgery. In fact, the knee did great — no discomfort the entire race, and here it is the next day and it is still fine. I was actually worse off cardiovasculalry, and even more than that, the hands, wrists, and forearms were dead after the 1st lap. I guess the lack of single track was really showing there.

Looking at the splits, I was just about even at 36 minutes per loop. The 1st 10 minutes or so was pretty slow, as I started near the rear of the pack as I wasn’t sure how I would do and I’ve never done a mass start for a mountain bike race where there was only 100 feet to the single track. So I had to work my way up as I figured out who was slow, and as others crashed. Then after that I was pretty much able to ride my own pace for the next 60 minutes, though whenever I heard someone trying to catch up, I was motivated to push it. I think I was passed only three times total, and probably passed about 20 or 25 riders.

So, overall I am happy. The knee handled it very well, and now I know I can at least bike at a decent clip. I have a ways to go on running before I can do even a short AR, though hiking is going really well so for a long AR, where there’s more hiking than running, I may be ok.

Now I need to find the next race to put on my calendar so I continue to train! 🙂

Adventure Racing

A friend of mine posted this recently:

click here

And it reminded me of an old email I saw on the same subject that I saved because it was so well written. I figure posting it here is better than keeping it in my email with the chance of it never seeing the light of day.

It has now been 2 years and 1 month since I did my last big Adventure Race — the PHEAR race up in WV. Since then it has been a lot of work on my bum knee. I’m riding well these days — up to an hour with no ill side effects. Running is still tougher, but I did run 23 minutes just yesterday and i don’t feel any tendernesss at all. So hopefully things are coming together. Even if running never comes back to the level I need it to be to race (fast!) again, I’d be happy hiking, mountain biking, and paddling. But I do miss racing a ton!

Anyway, on to the article….


Why I do Adventure Racing:

By Bob Blundell-Team Pushin’ Up Daisies

It was one recent Monday afternoon at the gym and I was bent over studying the recent demise of my feet. I prodded several blisters that I had popped the previous day and marveled at the blackened toe nails that I sport pretty much year round; a byproduct of my chosen sport. While I’m performing this inspection, some guy next to me gags (maybe a little exaggeration) and says something like…”My God..what happened to your feet?

I smiled and responded cheerfully….” Did an adventure race over the weekend”

He nodded and started to say something.

“Adventure racing,” I explained. “You know like the Eco Challenge.”

He shrugged and looked again at my toes.

I started to explain that I’d just spent 32 hours at a race in Northern Georgia in sub-freezing weather. At one point I had spent 14 painful hours with my rear end on the seat of a mountain bike, pushing and sliding through snow in weather that never got above 30. I considered adding that blisters generally came with the territory in most cases, but these here were more likely the affects of trekking through snow for 16 more hours. By this time I noticed that he had opted to move a little further down the bench away from me and my feet.

I have to admit this wasn’t the first look of confusion, dismay, or incident where someone, upon inquiring about the sport I love, treated me more like a Leper than an endurance athlete. Often when I first meet people and tell them that I’m an adventure racer, they smile and nod their heads like they know what I’m talking about.

Sometimes they say things like “oh. Yeah…I’ve heard about those things.” or ” isn’t that kinda like a triathlon?” or maybe they don’t say anything at all and just look at me with a mild curiosity. That ‘s typically when that mild curiosity turns to total apathy.

As I think about this now it occurs to me that their lack of understanding probably stems more from my own inability to articulate and describe the sport I love, than some ineptness on their part. So now I sit and ponder…really think about what Adventure Racing is about.

Adventure racing is being around a bunch of people who are fit and strong and a little twisted. These people tend to like it when their knees bleed and they have mud on their legs, on their glasses, in their teeth, and on their bike. If after a race, they aren’t bent or broken, mangled, sprained or bloodied, they feel like they didn’t get their money’s worth. They’d rather have their butts on the seat of a mountain bike climbing some torturous hill from hell, than in a first class seat on some jet going somewhere (unless of course they’re flying to their next adventure race). These people feel like slugs when they only get an hour workout in a day and they believe muscle cramps are just God’s way to telling them they are still alive!

They’re generally a resourceful lot that can speak intelligently about many obscure topics. This may include:

+ the best and worst flavors of gu’s
+116 different uses for duct tape
+ the countless benefits of carrying Vaseline with you during a race
+ How long AA batteries in a head lamp will last in 30 degree weather

They often speak in a language foreign to most normal people. Words and phrases like TAs, and Sevvies, hard tails and soft tails, camelbaks, and azimuths are common in their conversations. They also possess skills unknown to most like:

+ knowing how to use a chain breaker at night
+ Knowing how to turn an old fishing rod and surgical tubing into a bike tow
assembly
+ Knowing how to duct tape a flashlight on top of a bike helmet

Unlike many people they gain pleasure from some of the simpler things in life. Things like:

+ That wonderful first drink of cold water after a long trekking leg
+ The sheer ecstasy of finding a wadded-up peanut butter sandwich in their backpack when they thought they had run out of food
+ The unadulterated joy felt when your teammate offers you a dry pair of socks after you’ve fallen into a ditch filled with cold water
+ The soothing calm felt after applying a liberal dollop of Vaseline to araw spot

The sport of adventure racing has given me the opportunity to travel to places and see things I would have otherwise missed in my life. I’ve seen the amber cast of the sun as it rises over snow capped mountains of northern Georgia. I’ve seen farmers, men, women, and children in rural parts of China stand along side poorly developed roads and cheer me and my team as we traveled through their villages by bike and by foot. I’ve watched the sun melt into the horizon of the mountains of west Texas. I’ve marveled at the
beauty of an east Texas swamp under a December full moon.

I’ve run or biked with deer and wild hogs and turkeys, and porcupines. I’ve paddled alongside alligators and nutria rats and been chased by bees and wasps and an assortment of other insects. I’ve gone three days without sleep and witnessed some of the most incredible hallucinations on that third day.

I’ve witnessed the courage of team mates and others as they struggle to continue on with races, hobbled by broken collar bones, sprained and bloodied knees, fever and chills, vomiting and diarreaha. All these experiences have marked me; made me a little different.

But when I think of adventure racing, and why I do it, I most often think of my teammates and the trials and tribulations we go through together.

I think adventure racing is about the relief one feels as you struggle up a never ending hill, worn out and downcast, wondering if you’ll make it to the top, and you suddenly feel the weight of your pack lifted off your shoulders by one of your team mates. It’s climbing up a rock slope on all 4s carrying your bike on your shoulder and getting to the top and seeing a team mate struggle with theirs. And it’s taking a few deep breaths and summoning the
strength to slide back down the hill to help them.

It’s having the feeling that you can’t put one foot in front of another, and a teammate placing a reassuring hand on your shoulder in support. It’s coming off a bitterly cold paddling leg and shivering uncontrollably with few dry clothes to change into and your teammate offering without hesitation, a dry shirt or pair of socks or gloves. It’s watching a teammate crash on their bike hard and getting up and fighting back the tears and climbing back on that monster again to press on; fearful of slowing the team down.

It’s about pulling and pushing each other to levels that you’d have thought not possible for you to physically achieve individually. It’s running and pulling your slower teammate at a pace you shouldn’t be able to maintain and hearing them challenge you and the team to keep going; all for the sanctity of the race. It’s the almost cosmic feeling of going faster and harder as a team than you thought possible. It’s seeing your nearest competition in the race on your tail and the three or four of you (your team) suddenly becoming one stronger, faster force.

It’s watching and feeling the total sense of unity as your team succeeds and it’s feeling an equal responsibility when you do not. It’s a sport where the strongest of the team is only really as strong and fast as the slowest member, forcing the Team to focus and excel as one unit. It’s a sport characterized by a myriad of changing human dynamics and moods within a race. One person emerges as the strength of the team only to be replaced by
another who grows stronger. It’s where you can one moment be almost paralyzed by with desperation one second and then driven to great heights because you just found a Hershey bar or a big handful of trail mix to eat.

It’s about screaming and cussing each other over not being able to find a checkpoint, or over losing the passport or just because you’re tired and worn down and filled with frustration. And it’s about freely bantering among the team with liberal spattering of FUs and other colorful forms of speech and then hugging each other at the end with those obscenities forgotten.

It’s asking your teammate for something….for anything and knowing without a doubt that they’ll give it to you if they have it to give.

So……….I guess that’s why I do adventure racing

Knee update

It’s been quite a while since I had a knee update, so here it is:

Along with my PT, we came up with a plan in early March to do about 3 months of mostly strength training, with little to no running at all. I could mix in non impact things such as biking, elliptical, swimming, and walking/hiking. The thought was that since impact seem to be the biggest issue bothering the knee, that strengthening all the muscles surrounding the knee would help that.

Other than a vacation to FL and a busy week when we returned, I’ve been good about pretty good following this. It just so happens that the basement finishing work is in the stage where all of my workout gear is pushed into the middle of the room, so I haven’t been as good about it as I would have liked. And while in FL I did run 6 minutes to the pool, swam 25 minutes, and ran 6 minutes back, all on concrete. That’s the most I’d run in quite some time until yesterday when I ran 15 minutes on a treadmill.

I have had some stress/tenderness in the right hip as well. Many of the strengthening exercises will help support the hip as well, but we did work on a few new ones the other day that I will now incorporate.

Overall the knee is feeling much better, but I have not pushed it very hard. At this point I’m inclined to think that rest and strengthening are the way to go, though I really miss running. I will slowly add running back in, but still concentrate mostly on non-impacting exercise.

Knee Update

First, I haven’t updated here since I saw the Dr. to review the second MRI, which really didn’t show much. For a couple of weeks after that, I was really improving and didn’t have much discomfort at all. Then I tweaked it again when I was carrying Reece in the baby Bjorn, trying to climb up “steps” in this little tube. We were at a Children’s Museum and that was the only way to get to the top. At some point while climbing, with the R leg bent and pushing up, the patella tendon was not happy and let me know about it the rest of the day.

Since then, it has slowly gotten better and I’ve been swimming, doing elliptical, and riding, and even did some light running in the grass for a couple of minutes. The patella tendon area improved, but discomfort moved to the medial side, and then to a horizontal band above the knee, kind of in the two aspects of the condyle femur.

Second, I hadn’t seen my PT in some time, and I felt like I’ve lacked structure and consistency in my rehab recently. I have been slack on PT work (though this week I did do some of the strengthening and stretching, and the plyometrics (weave/straddle/skip)). So I went back, and both B. and M. (a doctoral candidate) examined my knee together. They feel at this point I have two things that are inhibiting my progress:

1. My anterior capsule seems to be really tight. What this means is that the sleeve around my knee is tight, either from shrinking or scar tissue, especially where the tibia comes into the knee. So when the knee is flexed, the tibia is kind of pushed in against the femur. They think this explains the recurrence of patella tendon pain, as well as the medial pain I sometimes feel.

2. Overall strengthening needs to occur, especially at the end of the motions. Right now any impacting activities tend to cause me the most distress, and they feel that with better overall muscle strength, the muscles will cushion the impact. We re-measured the thighs, and I’m still 3/4 – 1″ smaller on the right than the left about 6 inches up. I forgot to right down the numbers to compare them to the ones we got just after surgery, but I will try to do that.

So the PT routine will be:

1. anterior capsule stretching
(lie on back, place towel in knee crease, and resist knee extension for 5s, relax, and stretch by pulling knee in for 5s)
do this with internal and external rotation of foot

2. friction massage to patella tendon

3. anterior patella glides (push knee cap down in oscillating fashion) — 3 min

4. hip stretching

5. end-range theraband strengthening

6. squats against wall -experiment with depth

7. machine work

a. recumbent leg press
b. knee extension
c. hamstring curls
d. hip add/abd
e. heel raises (calves)

I can do almost all of these at home, though they think I should go to the gym to help with structure. I am going back to see them in a little over a week to walk through these exercises one at a time to make sure I understand them fully, but I will start them now.

Knee update

So I went to review the scans with the Dr. today. Apparently when he called me earlier this week, he was reading the radiologist’s report, which says:

“Findings consistent with horizontal tear posterior horn medial meniscus.”

But my Dr. showed me the scans and he doesn’t think there’s a tear at all. There is certainly something going on there, but perhaps just degeneration.

He also showed me some other areas of interest on the scans, and the effusion (bone contusion) of the condyle femur, which was strongly evident 18 months ago in my 1st scans, are really not visible. That’s consistent in the fact that I no longer feel pain laterally along the bone. Also, there is a “gap” between the patella and the femur, where he did some clean up, that is visible. There’s really nothing in the area of the patella tendon where it attaches to the patella, which is where I was really sore for 4-6 weeks. Perhaps the iontopherosis did something after all?

He wants to wait 2-3 months before we make a decision on a 2nd surgery. I tend to agree as I have been improving a lot. Right now the only thing that bothers me is impact, such as running or hiking down steep hills. Biking and elliptical are fine. So I think I’ll wait, and just take it slow on getting back to running.

Torn Meniscus!

Dr. J just called after reading the radiolgist’s report from the MRI I had on Friday. The report says torn medial posterior meniscus! Dr. Jones has not read the scans himself yet — he’ll do that on Thursday when I see him. But I knew something was wrong, after the strong recovery that turned sour in mid to late October about 6 weeks after surgery!

Until he sees the scans he can’t say what we should do, but the options are to go in and trim out the tear (can’t really repair the meniscus) or just wait and see if the pain goes away. It seemed much better last week, as I actually mountain biked 5 times and had one 35 minute hike at a good pace. But that, of course, is no where near where I want to be.

Stay tuned!

Four month post-op follow up

I saw Dr. J. today, 1st time since just before Thanksgiving. That visit was somewhat unscheduled but my patella tendon had really been bothering me so I asked him to take a look. At the time he didn’t think much of it and just thought more time would help.

Since then, the patella tendon is feeling much better, but I have done very little working out or PT the past few weeks due to the holidays and baby Reece, 2 months old today. I did some elliptical and swimming last week in DC, as well as some walking. The last I tried running was several weeks ago and it did not feel up for it at all.

What I’ve now figured out is that any impact activities, like running, or even walking down a steep hill, don’t feel good at all. So things like biking and elliptical seem to be ok, but I haven’t really pushed them too hard or too long. About 45 min on the elliptical and 40 min mtn biking is it. But those seem to be ok.

At any rate, the Dr. was a bit more pessimistic today. I think he was surprised that I’m still hurting 4 months out. He wants to have another MRI done to see if the fall I had caused any problems, or if the scarring is messed up, or if there’s a loose piece of cartilage, etc. So that is scheduled for this Friday, and I’ll post an update after I see him again next Thursday.

Iontopherosis

I had PT today and we started iontopherosis. This is basically putting an ionized version of cortisone into my knee using a device similar to the electrostim device. I had thought my Dr. had said this would help with the scar tissues, but my PT said it is supposed to help with the swelling. I’m willing to try anything at this point!

As my patella tendon area has been sore the past few weeks, my PT 1st checked that out, and said it does appear to be “jumpers knee” or patella tendonitis, with the main sore part just where the tendon “inserts” into the patella on the medial side. I had started to doubt this as I thought it was the patella bone itself that was sore, but the PT found that it was where the patella connects to the bone, and that is still considered patella tendonitis. I still find it odd that this is a “new” pain 2 months post surgery that I don’t recall ever having before surgery. But then again I’m no longer sore where I used to be sore. :-/

We put two pads on each side of the knee where the portals are, with one covering the jumpers knee area, and two lower on the leg. The lower ones are link electro sinks so the current flows from the top ones down. It did not feel at all like electrostim where this is enough current to make the muscles contract. Instead, at the very beginning, there was a very tinly tingling. Towards the end I did feel a very minor burning on my legs under the lower pads, and when we took of the top pads, my skin was quite red. (I’m glad I shave my legs or pulling the pads off would have hurt!)

I need to do this same procedures approximately every other day for the next week before we know if it will help me or not. There is some controversy in the field on whether the process works at all — the question is whether the ionization can disperse cortisone deep enough, I guess. My PT thinks my swelling is close enough to the skin that this may help.

I sure hope so, as ever since I did that 20 minute run and felt great, I’ve had to limit myself to no more than 5 – 10 minutes of running due to the patella tendon tenderness. I have been able to continue to bike on an indoor trainer up to 30 minutes and walk on a treadmill without causing any problems.