I had to go to Chapel Hill to see my Dentist, and since my knee was sore I thought I’d swing by the surgeon’s office to discuss it. I showed him where I’m sore on the medial inferior facet of the knee, and explained how the patella tendon area has felt tender recently (“squishy” while running).

He poked and proded and in the end thinks that this is just a normal part of my recovery. There’s still some inflamation in the trochlear grove that the patella is rubbing, and it will take some time to go away. He said continue to listen to my body and back off when necessary. If running seems to be the major cause, to back off running and conentrate on biking. He again suggested swimming and water running, but I don’t live close enough to a pool to make that possible on a regular basis.

I also expressed my concern to him that the patella now seems less mobile than before surgery, and he also said that was natural. After surgery the retinaculum fibers tend to tighten, and that I just need to continue to work on my mobilizations.

And finally he suggested iontophorsis for the two “nodules” that have grown at the portals. These seem to be tough fibrous tissues, almost like calcium deposits, but he just said they are scare tissue. Sometimes they have to go in surgically to remove them but he thinks mine will benefit from iontophorsis, which is when cortizone is massaged in electronically. So I’ll talk to my PT about that.

/Sean

I haven’t written in a while so here’s an update. Something I should have written about but did not was that I fell on Saturday 10/29. I was being silly and jumped on a vine hanging from a tree in our backyard, and down it came. My knees were flexed, so I landed hard on both legs, and the R leg flexed much more than it has since surgery. It was extremely painful – so much so that I got a little nauseous. But it seemed to recover relatively quickly after that.

I’ve been sore the last few days (weeks?) under the patella tendon, just a bit medially. I thought it may have been from some agressive stool vaults my PT had me try or the fall, or maybe a combination of the two. Looking back at my exercise log, my fall was on 10/29 but I ran 20 minutes straight on 11/1. But ever since that 20 minute run, I’ve been too tender to add to it. In fact, I’ve stopped running after 5 or 6 minutes a couple of times. Just last night I did 2 minutes running 1 minute walking 5 times for a total of 10 minutes running.

I have been biking w/o discomfort both on the trainer and on the roads. I’ve done just over 30 minutes so far. I’m about 1 minute per mile slower than before surgery on my 6 mile assesment ride to the boat ramp and back, but that is w/o pushing it at all and no standing while pedalling.

When we were in the hospital for a few days when Reece was born, I actually got sore by not doing anything! I was not icing there, so maybe that was part of it.

I am disappointed and frustrated with where I am. The patella tendon pain seems to be subsiding after a couple of weeks so that is good. The patella does not move very much — even less so than before surgery. My PT worked really hard on it today and it did loosen up.

A quick update on my progress:

• I actually ran for 5 minutes out of a 30 minute treadmill walk on Monday. I ran 1 minute on the 5, 10, 15, 20, and 25 minute marks. I was a bit sore later, but not much.
• On Wednesday the fitness center at the hotel I was at was closed, so I tired the run walk routine outside. But it didn’t feel good at all running so I stopped at 2 minutes.
• On Thursday the fitness center was back and I ran 2 minutes 4 times with 3 minute walks between. Knee was a bit tender so I did not do the 5th one which was my original intent.
• I’m up to 30 minutes on the stationary bike and that feels good.
• My PT had me start adding plyometrics — basically a “stool vault” where I bound from one leg to another over a stool, some straddling movements, crossover side running, etc.
• And I’ve added wall squats, mostly single leg with the right leg, and hamstring curls, to my leg lift exercises to work on the right leg’s strength.
• Finally, lots of stretching of the IT band and the lateral posterior hamstring. Well, the lower outside part that feels like a tendon.

I’d like to be doing more but overall I am happy with my progress. My knee is still tight but I recently reached 137 degree flex, so only a little more to go to be normal. But that is not very comfortable yet!! And it does get a bit sore here and there and is still somewhat inflammed. But again I had more than just a simple scope and recovery will take some time. And of course I won’t know if this solved the long term problem of patellofemoral syndrome until I can really start pushing it.

In my continuing attempt to document all of the things I tried before surgery, here’s some info on Rolfing….

A local rolfer writes for a local endurance magazine, and I saw her articles and liked what she had to say. She has a good background in physical activity, yoga, and Rolfing, and I like the integrated approach. She is the same person that gave me the bioprint, and so we also incorporated that information into the Rolfing program.

It’s somewhat hard to describe the process. It’s like a deep tissue massage, combined with body movements or certain positions, all used to facilitate proper alignment. I’m into proper alignment from all the yoga I once did. (I started yoga because of the knee problem!) In addition, there are certain exercises my Rolfer gave me to do at home to add to the effect.

Typically there are 10 sessions in traditional Rofling. I can’t recall the exact order or the specific goals for each session, but they all are aimed at integrating the body into proper alignment. Overall I think that something like Rofling, where someone physically manipulates the body with the goal of proper alignment, is good. But I question whether that can be done in 10 sessions. I would think soft tissue manipulation would need to be an on-going, continuous process, over a long period of time, to have any real lasting effects.

My Rolfer tailored each session more to me than the traditional sequence, though we didn’t abandon that altogether. But the bulk of time was spent trying to get my right knee to stop rubbing the femur. We found issues in my lower back, foot, ITB, etc. In the last session, we agreed that my problem was beyond just soft tissue manipulation. 😦 I had already decided I would go for surgery, but this was just one more “nail in the coffin.”

I think the person doing the Rolfing is very important. Someone that understands your goals, takes the time to really understand your problem, and works with you towards that goal, using Rolfing and any additional knowledge they have. I guess that holds true for the doctors and physical therapists and anyone else you may work with.

So would I recommend Rolfing? I think giving a few sessions a shot is certainly worth it. If you can get your insurance to pay for it, typically under “neuromuscular retraining,” it would definitely be worth the try. Otherwise it can get to be a bit expensive at $100 per session. My insurance company doesn’t cover Rolfing unless you claim it as neuromuscular retraining, but then the practionar has to be a certified physical therapist (not a certification in rolfing alone).

Well it’s been over a week again, so here’s a quick update on where I am:

– still doing about 30 minute walks on the treadmill, or this week in Boston
have been walking around the city
– 20 minutes on an elliptical, which felt pretty good
– up to 20 minutes on the stationary bike
– finally getting my heart rate up a bit — to 110-120 — and sweating a little
– lots of knee flex stretches and straightenings — need to get full range of
motion back!
– I’d really like to run! I tried a running motion at 4.2mph about 5 or 6 days
ago and it didn’t feel quite right. A bit tight above the knee area and I
could feel tenderness on the inside. But I think I will try again in the next
day or two.
– I’ve been doing some leg lifts with ankle weights and bands but not enough

It’s been a while since I’ve posted so here’s a quick update just about 1 month after surgery:

– I’m up to 30 minutes walking on the treadmill, with a high speed of 4.0 mph
– Just added some inclines up to 5%
– 10 minutes on stationary bike with almost 0 resistence
– lots of leg lifts (vmo/quad, hip abduction, hip adduction)
– still icing a few times a day
– knee flex stretches still hurt, and last measurement was at 133 degrees
– still doing patella mobilization stretches

The knee is still a bit swollen, but overall progress is good. Well, I see folks running after a scope in 2 to 3 weeks, and that makes me feel like I’m not progressing that much. But I know I had a fair amount done — more than just simple cartlidge clean up. So I have to keep it in perspective. I have good days and bad days with that, but more good than bad recenlty.

I would like to start running in the next few days, even if it’s just for 2 or 3 minutes. I see my PT tomorrow and the Dr. on Monday, so we’ll see what they say. Knee flexes are still somewhat painful when I get to 130 degrees or so, and I need to get back to 140.

Also, I’ve just noticed in the last day or two that the knee seems a bit unstable on non smooth ground. It seems to give or “buckle” very slightly here and there. Things change so much that hopefully this is just a passing phase. With the limited use of the past month, and the use it has had being all very controled, maybe this is expected.

/Sean