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Friday before the weekend I had a PT visit with Jacquie.  My appointments are always at 7:30am, and begin the same each time.  I head in and warm up for 5 minutes on the exercise bike, then stretch and use the foam rollers.  At some point in this process Jacquie appears and asks if things have gotten better / worse etc.  Usually I respond that things are more of the same, a good day here, a bad pain day there.  I think it threw her off that I said they’ve been fine.  I’ve been biking minimally, swimming regularly, and doing stretches and exercises daily.  That’s not to say that I think I’m all better, my knee still throbs a bit before I stretch, or when I’m going down stairs, but things seems to be normalizing at the level of activity that I’ve been maintaining for the past few weeks.

To celebrate this minor victory and enjoy the (relatively) warm and sunny afternoon on Sunday, I rode to the grocery store to pick up the week’s supplies.  The store is less than a mile away, so if things got bad, I could just walk it in a pinch. 

I made it to the store in no time, and continued on another mile just for the sake of it.  I remember why I am drawn to jogging and biking, but often have to force myself to go swimming.  I love that cold feeling in my lungs as I’m riding downhill, and the warmth of the sun.  I had to reason with myself for a mile before practicality won the conversation and I turned around.  I woke up and swam this morning without incedent or stiffness.  I’m very relieved and reinvigorated…I really needed this boost of confidence that I’m progressing, as well as the reminder of what I’m getting myself back into shape for.

because I sure as hell have missed you all.  It’s been a little batty lately.  I had a great Christmas and New Year’s, which feels like it was so long ago.  Emily and I went on vacation out to North Adams, MA to visit Mass MoCA, which you can read all about here.

I know you’re dying to hear about my knees, which are slowly improving.  I have been biking fairly minimally, and am still waiting until spring to jog.  Swimming has been improving, which has been a wonderful way to start my morning.  When I began a month ago, I could hardly make it one pool length without gasping for air as soon as I touched the wall.  Now I am swimming a full lap without stopping, and am building my lung strength (and moreso my confidence) and this week am planning to try for two laps without stopping.

Jacquie and I are meeting once every other Friday basically just to check-in, but for the most part I am self-sufficient for the time being.  I’m doing low-stress cardio (swimming & biking) and on my rest days, am doing fairly intensive quad, hamstring, and glute workouts with my theraband and foam roller.

New Year’s blogsolution: more frequent posts, shorter length, less complaining.

When I began this blog way back in March, I never really took into consideration what I would write about during the winter months.  Granted there are many folks who ride through the winter, and to them my helmet is off.  But me, once the freezing rain starts falling, I bring my steed inside, give it one last wash for the season, and retire myself to my indoor trainer.  Knee injury aside, I probably wouldn’t be riding right now anyway, so what to write about?  I could weave a tale about how exciting it is getting up early, watching the news on mute and putting in a few miles before work…but I’ll spare you.

In PT related news, I’m only going once every week or two, just checking in with Jacquie as we slowly build my quads without flaring up my patella tendon.  I’ve been swimming, which is kicking my ass.  I thought that being a reasonably in-shape person would transfer to being able to swim pretty well of f the bat, but this is no where near truth.  I can barely swim freestyle down and back without stopping, and feel sore in muscles I didn’t really even know I was using.  The instep of my feet, my fingers, and pretty much every muscle that has gotten lazy on the upper half of my body.  Basically I’m planning to keep doing what I’m doing until spring.  Biking on the trainer will keep those muscles in use, and swimming is helping me mentally.  I was getting a bit antsy and stir crazy not being able to bike or jog, so until the snow melts, I will just stick with what seems to be working right now.

Last week I saw another physical therapist, who Jacquie called in as a ringer to do a consultation with me.  Rob is a veteran PT at Orthopaedics Plus, but also has a small tear in his meniscus, and battles with patella tendinitis like I do.  His knee gives him much more trouble than mine does, but still he was able to impart some great advice and stretches that have helped him get back to normal.  I learned some stretches and exercises that will strengthen my quads and hamstrings without putting unnecessary strain on my knees.

With his and Jacquie’s blessing, I’ve begun riding again.  Sadly we’ve entered the cold and wet half of the year, so I scrubbed down my bike and have surrendered myself to my indoor trainer for the winter.  While riding on the trainer is better as far as my knees are concerned, it’s basically the biking equivalent of jogging on a treadmill.  Yea the motions are all the same, but all the things I love about biking are absent.  But I suppose this is just a necessary step so I can get back to riding and jogging the way I want to as soon as spring rolls around.

My goal is muscle soreness in all the right places without knee or joint pain.  After having been nearly dormant for the past 2 months, a morning of exercises and biking was enough to wipe me out and tire my legs, but I can tell I’m still putting strain on my knees.  Looks like it might be time for a bike fitting.  I’ve always considered it, but it seems a bit silly to spend more on a fitting than I did on the bike itself.  Which I suppose raises a red flag that I definitely need the fitting, as I never have been completely confident that the size and shape of it are right.  When I bought my bike, I never expected to jump headlong into cycling as much as I have, and the driving forces behind the purchase were the relatively low cost and relatively accurate size.

My second opinion doctor agreed with the first opinion.  That makes 3-2; 3 medical professions who think that the problem is solely weak quads and strained patella tendons / IT band vs 2 medical professions who think there is a small tear in my meniscus.  Good news?!  I guess we’ll just trudge along working on quad strengthening and loosing up some exhausted tissue in my legs.  As a part of this process, I’ll be receiving doses of dexamethasone via iontophoresis.  Don’t know what either of those things are?  That makes two of us, so let’s do some learning:

from the always accurate, never skewed Wikipedia:

Iontophoresis is a non-invasive method of propelling high concentrations of a charged substance, normally medication or bioactive agents, transdermally by repulsive electromotive force using a small electrical charge applied to an iontophoretic chamber containing a similarly charged active agent and its vehicle.

Still confused?

To clarify, one or two chambers are filled with a solution containing an active ingredient and its solvent, termed the vehicle. The positively charged chamber, termed the anode will repel a positively charged chemical, while the negatively charged chamber, termed the cathode, will repel a negatively charged chemical into the skin.

Ooooooooh, now it’s crystal clear.  What’s that you say?  You think that sounds a lot like a transdermal patch?  “Unlike transdermal patches, this method relies on active transportation within an electric field. In the presence of an electric field electromigration and electroosmosis are the dominant forces in mass transport”

So that’s ionto, the process, but what about Dexamethason,  the actual drug I’ll be receiving into my body via electrodes and wizardry?  Well, it’s an anti-inflammatory which packs 60 times the punch of a cortizone shot.  I’ll be attaching the negatively charged pad to my patella tendon, directly below my left knee, and the positive charge will be on a pad stuck to my left thigh.  This is, without a doubt,  the strangest thing I’ve ever had my body hooked up to, and it’s too soon to tell the breadth of the benefits yet.

Still curioius about dexamethason or iontophoresis?  (I know you are)  Turns out a Polish cross country skiier was disqualified and issued a 2 year suspension for her doping use of dexamethasone back in 2004.  Uhhh?

Into PT I walked today, proud to tell Jacquie the good news that the doctor had dismissed the notion that I had done some real damage, but rather than relief she seemed more upset. Adding a pinch of self-doubt to her diagnosis, she had one of the other therapists run a few diagnostic tests. After some pushing, pulling, squeezing, and bending he thinks I likely have a torn meniscus. Shit! I guess it’s just a lesson that I need to be a better patient and push for the MRI, question diagnose, and go with my gut.

So back I go to a specialist, Dr Evans to get a second opinion. My appointment is set for 3 weeks out, so I guess between now and then I’m just going to stick with the exercises etc. Oh and jump through more HMO hoops.

On the bright side, by the time I have my appointment with this second specialist, we’ll have a new president!

NO INTERNAL OR SERIOUS DAMAGE!!!!!

I had a great consult with the orthopedic surgeon/specialist today, and after some tests and X-Rays he doesn’t seem to think I’ve done any internal damage to my knees. As he put it, I’ve got some “tracking” issues, but recommended I keep working on PT exercises etc to strengthen my quads. Considering surgeons like to perform surgery, he didn’t push for an MRI or to schedule another exam to see about the need for it. This is totally encouraging to me since it basically means that as far as his business is concerned, I would be a waste of time.

I wish I could show you a model like he had, but basically by “tracking” he means that rather than severe damage to the tendon or cartilage, my quads are simply not strong enough and have gotten exhausted from the amount of stress I’ve been putting them under. Once the quads and hamstrings are exhausted, they don’t hold he patella tendon, (which connects the patella and the tibia) in place, allowing the patella to shift when carrying weight. Because of the way the bones and tendons are lined up, there is a naturally tendency for the tibia to shift laterally, and the quads aren’t strong enough to fight that normal shift.

It’s not really bad news yet, but it’s a precursor to bad news. Jacquie did some more tests today since some of my symptoms have been getting better, while some have been persisting and/or getting worse.  Turns out I need to go get an MRI to check for a meniscal tear.  She and I had talked about the possibility of a small tear in my meniscus last month, but after having made great progress on the patella tendinitis, the meniscal symptoms stand out even more.  I spent most of this morning on the phone finding an orthopedic surgeon who could see me in the near part of the near future (somehow I wrangled a 9am appointment on Monday) and jumping through hoops trying to get a referral in place.  After the jump I’ve included my progress report from Jacquie, which is full of medical shorthand, some of which makes logical sense, some of which does not.  Anyone out there able to read between the lines?

The good news…even if I do have a torn meniscus, bikers don’t get them, joggers do; and therefore biking is permissable during my recovery, but jogging will take some time to get back into.  Slow and steady wins the race.

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This week I have been giddy with excitement. The kind that sort of embarrasses me when I realize how glad I am to get to ride tomorrow morning. Upon Jacquie’s suggestion, I tried to go for a jog last weekend and didn’t make it more than a block. I was feeling the same excitement that I do now; glad to get outside and get moving. Emily came with me for moral support, and after jogging around the corner I had to stop. The pain wasn’t any worse than it had been earlier this summer, but I knew well enough not to push it. In June when I had pain like this I would just ignore it and run through it, knowing that after a half mile or so it would go away.

I partially feel like suggesting I go jogging was a clever way to trick me into realizing that even though we’re making progress in my knee rehabilitation, I’m not ready to jump back in. Luckily when I told Jacquie about the pain, rather than advising I take another few weeks off, she took to my suggestion that I could ride to our appointments as a warm-up. It’s only 1.5 miles, totally flat, I’ll take it easy I promise. I tried not to push too hard or seem too excited by the thought, that somehow the suggestion is so fragile that it would smash if I try to force it.

I can’t help but feel a bit silly about my injury. I realize it isn’t anything TOO serious, but still. Thousands of people ride their bikes each day, many of them riding more miles with less experience and conditioning…so what did I do wrong? I expect it was all those days I got lazy and didn’t stretch before riding home from work, or having never gotten a bike fitting. But I am not alone! Yesterday I found Chris‘ page. Finally, someone who is a more experienced rider having the same troubles as I am. I hate to say it, but misery loves company, but at least I’m in good company.

You know how when you hear your voice played back to you and you don’t realize what you actually sound like? Well I had no idea how damn hairy my knees really are. Er..were I guess I should say. Jacquie, my therapist, suggested that i shave my knees before we taped them to avoid pulling the hairs out one by one when I remove the tape. I have a newfound respect for women and their daily time commitment to shaving their legs. I think I would have to set aside a full weekend to mow these guys down. The process reminded me of my freshman roommate, Timmy, who would shave his legs every week because he said it would make him more aerodynamic. Keep in mind he’s a runner, not a swimmer. But this is also the same guys who would light Marlboro Reds and let them burn on the window sill because he liked the smell while he studied and carried a mousepad in his pocket, just in case. After the jump, you can see my hairy beauties shaved down and aerodynamic in the name of taping.

This is before - I particularly like the natural wave to my knee hair
This is before – I particularly like the natural wave to my knee hair

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