Recap of injury:
Right after a super-sweet 10k race (the Great Race, end of September), I started ramping up for my never-to-be fall marathon, California International in Sacramento. I'd taken a day off, was feeling good and in shape, and was excited to go after a low 2:50's marathon. My workouts the week following went well, despite being alone in a new city (Philadelphia). My hips and glutes were somewhat tight, but I was foam rolling and stretching to try and counteract this. I decided to do some strength (step-ups and downs, lunges, etc etc) since I realized it'd been a good while since I'd done strength (read: a few weeks since I'd done anything other than abs and a 6-9 months since I'd done any regular strength training). I went for an epic workout in the rain, which went really well. I stopped to take a drink, and when I took a step after stopping, my knee shrieked in pain.
I limp-walked home and called around to find a PT appointment for the next morning. I assumed the problem was my IT band, since it's often tight and I had issues with it a few years back, where it made my knee hurt. I took an entire week off all forms of exercise other than PT, which I went to 4 times in 7 days. After that, I began using the elliptical heavily (as many hours in a week as I usually ran, so on the order of 10), probably to the detriment of the healing process, but I was going nuts. I tried jogging a bit at the end of the week, and the pain was still very much there, on the inside of my knee. That was the point at which I did slightly more internet-searching: the pain from ITBS was on the outside of my knee last time, and this was more medial/on the top/under my patella. My suspicion was that I had patellafemoral pain syndrome, or PFPS. A trip to an orthopedic doctor in Philly confirmed this: he said my PFPS came from a strength imbalance (that my hamstrings were much stronger than my quads). He also said that it might take 6 weeks to clear up, or longer, and that the strength training should help but it'd take a long time to fix the imbalances. I asked about a marathon in December; he said it would probably be ok to run it but I wouldn't have much time to train. I told him I didn't want to run it without training, that that wasn't my goal. He seemed to not understand the idea that I might want to run a time that couldn't be accomplished taking 2 months off of running leading up to the race. Cue crying in public due to injury and the sense that no one other than a serious runner gets it, round 1.
Fortunately, the strength and stretching and whatnot that is prescribed for PFPS is much the same for ITBS: clams, monster walks, leg lifts in all 3 directions, and when the knee is less inflamed, leg press, step ups and downs, lunges, and single leg squats. This is all to strengthen the medial glutes, hips, and quadriceps (at least in my case). I was also told to stretch my glutes, hamstrings, quads, soleus and gastrocnemius, as well as foam roll my quad, IT band, and glutes. I started going to a new PT place in Pittsburgh when I returned, which had me doing all of the above. They gave me a good bit of Graston along my IT band/quad intersection point. For those of you who aren't familiar with the Graston technique, it basically involves taking various metallic tools (shaped like thick cutlery) and scraping the tools along various muscle and tendon groups, aiming to break up scar tissue and promote blood flow. In case you hadn't guessed, that hurts like a bitch, and made my leg look like this:
I still think that I could do this to myself with a butter knife and a stick of Land o Lakes...
After 4 weeks of this stuff, I still wasn't running. My knee still hurt when I went to do step-downs or lunges or single-leg squats. The PTs weren't doing anything differently to me and I was feeling stuck and dejected: not only was I hurt and unable to run, they didn't seem to get how much that bothered me. They didn't know what would make it feel better, or when, or have any new ideas as to how else it could be treated. I also felt like every time I expressed frustration or dismay, they tried to convince me the situation wasn't that bad, and that I'd get my fitness back quickly once I could run, or that I should just take it one day at a time.
This was the lowest point for me: I was biking and swimming for over an hour a day, doing all my strength and stretching, being the perfect patient, and I wasn't getting any better. I felt completely defeated. I had been in *such good shape*, I kept reminding myself. I had been in shape to run the best marathon I'd ever run, by a long shot. I'd never been injured seriously enough to need to take more than a week or so off from running, and I had no idea how long it would take to come back, to regain my fitness. Moreover, running well had allowed me to keep at bay a whole slough of emotional issues: it is my therapy and my medication, and if my body is able to run as well as it normally does, that means I must be taking good care of it. Without the ability to get a lot of endorphins from running, and without the reinforcement that my body was awesome because of all the awesome stuff it could do, I felt horrible. I was tired, depressed, dejected, and hated my body. Mostly I hated my knee, but I felt pretty horrible towards the rest of my body, too.
I felt my knee all the time, sitting at work, walking around, biking to school, at the gym: even if I were able to put it out of my mind, the pain was always there to remind me that I was broken. My friends were having great workouts leading up to CIM and I wasn't sure if I'd be able to run at all by December. I knew my fitness was slipping, despite my insane amounts of time doing cardio at the gym. I tried to figure out the amount I should exercise by time, by calorie count, by any metric I could get my hands on. I certainly worked harder than I knew I could on a stationary bike, and probably harder than was good for my knee. I had my annual physical where I didn't want to talk much about my knee, but my GP asked me about running, and I broke down and cried in front of health professionals #2 and #3, respectively. She said, "I don't run, but if someone told me I couldn't bike I'd shoot someone in the head." At least she understood how I felt about being injured...
About 5 weeks in, I asked the PTs what they thought I should do differently, since I wasn't seeing any improvement and we'd been doing the same thing for weeks. They weren't sure what to say, and I told them I was worried it would never get better if we kept doing the same things. They told me I was focusing too much on my knee, and that was keeping it from getting better. That was nonsensical, and mean, so I made sure to cry in front of everyone there at UPMC Sports medicine to show my disapproval.
A couple of weeks later, after the PTs decided all of my exercises needed to be isometric (held longer and done more slowly), I decided to try jogging a bit. Much to my surprise, it felt fairly ok; I was out of shape, and my knee wasn't perfect, but it wasn't screaming in pain, either. I jogged a few times that week, mostly with the aid of a small amount of ibuprofen, since that seemed to keep my knee from getting inflamed and staying that way for a day or two.
Since then, I've been running a little. For an average person, I guess 20-35 miles a week is more than a little, but for me, it's just enough to take the edge off as my knee and everything else get stronger. I'm in pretty bad shape: an hour feels like a lot of running and 10 miles is the longest run I've managed so far.
What I've found most helpful, oddly, is stretching (and foam rolling, plus rolling my hips out on a lacrosse ball). I stretch before, during, and after running, every day. It seems to be helping keep my knee in check, though there is definitely still some discomfort.
At this point I am planning on ramping up to a 10k A-race for late spring, and a half marathon some time this summer. I don't think I'd be able to handle the mileage necessary for a full marathon prior to the weather getting horrible for the race (I want 20-24 weeks with high mileage before I run a marathon, and I definitely am not ready for 80 miles a week yet). I'm not sure what my timeline for a fall marathon will be; I might want to go back and run Chicago, or wait around until CIM to really build back my base. I guess we'll see how it all comes together, but for now, I'm glad I can do the little I can do running-wise.
Merry Christmas everyone! Hope to see you out there running in the coming weeks, and be careful on the snow and ice :)
