Severe Tendonitis & Partial Tear

workout003That’s the official verdict. After all this time, after three doctors, x-rays, physical therapy, personal training, self-medication, and a couple of jars of snake oil, I finally have an answer.

There is severe tendonitis of the proximal patellar tendon with superimposed partial tear of the articular sided proximal tendon fibers, comprising 50% of the tendon thickness.

I went to a new doctor in my neighborhood recently and was referred to Laith Jazrawi, M.D., a sports medicine expert at NYU Langone. Dr Jazrawi and his associates performed some physical examinations of the joint in addition to x-rays and an MRI. The MRI confirmed all the suspicions but also highlighted the additional tearing of the tendon fibers which was probably been exacerbated by my stubborn refusal to stop running over the last year.

Although slightly worse than expected, it’s actually somewhat of a relief to know what the problem is. I’m tired of laboring up stairs and popping pills to mask the pain. If I’m going to make the NYC marathon later this year I need to be more serious about fixing the problem.

The initial round of treatment prescribed by Dr. Jazrawi was a relatively simple process involving nitro patches designed to promote restorative blood flow in the region. It’s only been a few weeks, but so far so good. The pain crops up less frequently, and even more encouraging, rarely strikes when climbing stairs – the one place it would hurt the most. If that wasn’t positive enough, throughout the diagnosis and treatment process, I have been running between 15 and 20 miles per week.

I’m delighted to finally be making progress with this issue and hope that, over the next few weeks and months, I can continue my recovery process and take my place on the starting line at Fort Wadsworth, Staten Island in November.

In The Saddle Again

bike_001It’s not a widely known fact about me, but back when I was in my early teens I used to compete in bike races. And not just neighborhood races … I actually held a competitive racing license and would race against other young lads in my age group all over the country. Truth be told, I wasn’t very good – I spent the majority of my time at the back of the peleton. But I was eager and enjoyed the competition, not to mention the feeling of freedom that you get when you’re cruising down a long stretch of flat road. Unfortunately, something happened in my late teens and I lost interest in cycling for a long time.

Over the last few years I started to feel the pull of cycling again. I watched the Tour every year and occasionally longed for the experience of riding down the open road under my own steam. Late last year I took the plunge and bought myself a nice bike. Unfortunately, marathon training and dodgy weather combined to limit my opportunities, so it spent a lot of time over the fall and winter covered up. Following my recent struggles with knee pain, I decided to take a complete break from running. However, I didn’t want to become idle and so started to take the bike out on a regular basis.

Having the park so close was definitely a big help, as it provides a relatively safe environment for a spin and there’s a couple of hills that give the legs a good workout. It wasn’t long before the same old feelings came flooding back and since then I’ve been riding the bike four or five times a week. I clock up a good 60-80 miles over the course of those rides, and even bring the bike to the lake house now. Getting out for a couple of hours in the Appalachian Mountains is a totally different experience to Brooklyn.

I still love the bike, and who knows … maybe this renaissance will eventually  inspire me to sign up for my first triathlon.

Another Year, Same Old Injury

soreknee_001Ever since I ran (some of) the Manhattan Half-Marathon, my knee has been acting up again. Early last year I experienced some discomfort in and around my left patella that turned out to be a case of patellar tendonitis. I had to take some time off in between the NYC and Brooklyn Half-Marathon’s to rehab the knee and rebuild strength in the muscles around the patella. After the rest and rehab my knee stood up well to the punishment, including an 18 week marathon training program. However, following a layoff over the new year and a reduced workload in the through the first few weeks of the year, the problem has resurfaced with the same symptoms. I’ve tried short bursts of rest between training runs, but that doesn’t really help. My guess is that I need to take an extended break and seek some professional help otherwise I’ll be self-diagnosising and treating the same thing this time next year and probably making it a whole lot worse.

The timing of the injury is pretty bad (when are they ever convenient?), with two races coming up in the next month including the NYC Half-Marathon. The fact that this is the same injury as before worries me, and points to the slow erosion in health of my knee which could lead to more serious problems in the future. Despite the recurrence, I want to get through the next two races before taking any time off from running. I have a decent break after the NYC Half, with the Brooklyn Half coming eight weeks out. It’s probably not the best course of action, but I’m loathe to miss one of the biggest races of the year. With a modified training plan and a modest goal of two hours, I believe I can complete the race with minimal additional damage to the knee. I’ll work with my doctor to setup an MRI (last year’s x-ray showed nothing unusual) to see if we can get a better idea of what the problem is and how best to treat it.

Between now and the NYC Half, I’ll modify my training plan and stick to the stationary bicycle to maintain stamina and strength and minimize the impact effect on my knee. This is probably not a typical preparation for a half-marathon, but it will be interesting to see how it effects my performance on the day and how my fitness and stamina levels are after the decreased workload.

Patellar Tendonitis

patellaA couple of weeks ago I wrote about a recurring issue with my knee, specifically a sharp pain in behind the top of my knee cap. The pain only started in the weeks after the NYC half-marathon and initially I was self-medicating. As time went by and the problem remained, I started to get worried. Last week I had a doctor’s appointment regarding another issue, so I decided to bring up the topic of my knee pain. His initial diagnosis, based on the flexibility of my joint and location of the pain was bursitis, but he recommended I go for an x-ray to be certain. When the results of the x-ray came back and confirmed there was no structural damage he referred me to a physical therapist.

I found a therapist near my home and started to attend regular sessions. During my first visit the staff put me through some rigorous tests and determined that I was suffering from patellar tendonitis. Tendonitis is not a particularly debilitating injury, although it does get quite painful when trying to climb stairs or simply sitting down for extended periods. However, as I had continued to run on the injury over the previous week’s my body was not getting a chance to heal. And, according to the physical therapist, would not recover unless I stopped running for 4-6 weeks.

The news could not have come at a worse time, particularly with the eagerly awaited Brooklyn half-marathon quickly approaching. I was only two weeks away, but here was a medical professional telling me I had to stop running. Stubbornly and against all advice, I refused to stop until after the half-marathon – although I did concede and agree to skip the UAE Healthy Kidney 10K scheduled for May 12.

Despite my stubbornness, the staff at the physical therapy office agreed to work with me to get me through the half-marathon, using a combination of stretching, strength exercises, and K tape. Essentially, the two activities that I had stopped paying attention to following the NYC half-marathon (minus the taping of course). Because I had neglected to stretch and build muscle, my quad was pulling my patella in an uneven manner (one side was stronger than the other) and therefore causing irregular wear and poor traction to put additional strain on the tendons. For the next few weeks I have to take it really easy with the running, trying to maintain my current condition while stretching and working out with weights. The goal is to get me through the half-marathon without further aggravating the injury and then taking time off to allow it to heal properly.

Knee Pain

knee-painEver since I ran the half-marathon I have had some discomfort in my left knee. The problem manifests itself in two ways; when I’m going up steps or when I sit with my knee bent for an extended period of time. I had been self-medicating with Aleve (it’s the easiest on my stomach while still providing effective pain relief) on-and-off but was getting a little concerned that the problem had shown no signs of dissipating. Admittedly, I have been running three to four times a week to stay in shape for the Brooklyn half-marathon. Although common sense suggests that rest would be the best thing for my knee, I kept pushing myself.

Ask any expert and they’ll tell you – listen to your body. Out of stubbornness and the belief that I could run it off, I kept popping pills to mask the pain and pushing myself to log additional miles. Although common sense suggests that rest would have been the best way to allow for recovery, for some unknown reason I was not heeding the warning signs. After a couple of weeks the pain had not subsided, so I decided to ask a professional. I was due a visit to the doctor anyway, so as we were going through various topics I asked him about the pain in and around my kneecap. I had done some self-diagnosis (always a bad thing) and thought it might be runner’s knee. The doctor did some basic tests and determined the ligaments and cartilage to be in great shape. He said it was probably bursitis, but had me get an x-ray to eliminate the possibility of some other hidden problem. I’m still waiting the results, but in the meantime I got a cold wrap for my knee and have started using it to reduce swelling and inflammation and hopefully lessen the dependency on painkillers.

I’ll circle back to this in a week or two, once I know the results.

Unhappy Feet

unhappy_feet_001This is what happens when I try to break in a new pair of running shoes that I bought without proper research. It’s actually not so bad, but it’s a lesson in how to avoid changing gear without getting the right help first. I have been using the same pair of sneakers for the last 4-5 months – Brooks Defyance 4. They are the most comfortable sneakers I have had and provide just the right amount of support for a moderate over-pronator like myself. I got them late last year when I visited the Jack Rabbit on Lex & 85th. One of the sales people helped me with an assessment of my gait and based on what we saw on the video replay, recommended the shoes. I have been extremely happy with them, but they’re almost at the end of their useful life. With only two weeks to race day, I mistakenly thought it would be a good time to break in a new pair. Stupidly, I bought these new sneakers based on the online description only and this is the result.

I’ll return the sneakers, but in the meantime I hit up the Brooks website and got two pairs of the Defyance 4 (soon to be out of stock and replaced by the 5th generation shoe). I definitely dodged a bullet with this one – things could have been a lot worse. But I also learned two important lessons:

  1. I will never try to change running gear right before a race. In future I will plan to break in a new pair at least six to eight weeks in advance of a big event.
  2. When buying new shoes, I will do lots of research and get a professional opinion. A good pair of shoes can make the world of difference.