25 Jun Never Give Up
In February 2018, I won the 100 mile National Championship. Eight months later, I couldn’t run without tremendous pain. This did not come on gradually. It happened seemingly overnight. I have been quiet about what has been going on, because I haven’t really had very good answers.
Mentally, I have tried to stay positive, knowing that everyone has periods of time when they are injured and can’t run. However, after 8 months of ups and downs, and once being told I just need to find a new sport, I’ve been all over the place. Worries of never getting to run again have crossed my mind, leading to periods of bawling and anger. I have felt like I was stuck in a bad version of the “Groundhog Day” movie, not having figured out how to get it right, reliving a sort of grief cycle over and over. When a possible solution to my knee presented itself, I got my hopes up, only to be crushed again. Eight months ago, I was an ultrarunner who felt powerful, fit, and strong. I have certainly been humbled, even feeling feeble at times, needing help to do things I took for granted months ago. I still want to run again. But with my knee in its current condition, the thought of trying to run elicits anxiety, literally raising my heart rate about 20 beats per minute. I know that if I run, every single step will hurt. The pain while running is tolerable for up to 2-4 miles, but the worst part is always just around the corner. Starting about 6-8 hours following impact and lasting for a couple of days, my knee swells and causes me immense pain. It isn’t worth hobbling for days afterwards and grimacing with every altered step down the stairs. I fell back into eating to cope with being sad…old habits die hard. I had watched my weight back creep up, as much as 10 pounds. I lost 80# by eating right and running in 2003. I worried I wouldn’t be able to control my weight without running. I know that 80% of losing weight is what you put in your mouth. So, I have resigned myself to logging most everything I eat in the myfittnesspal app to get my weight back down. I miss the carefree days of eating a big, juicy cheeseburger and fries or gorging on cookies and ice cream after a long run. I am still doing everything possible to stay as fit as I can. I elliptical, walk fast, “hike”, bike, whatever I can do to burn calories every day. Myfitnesspal says I can eat 1540 calories, but I am happier if I can eat closer to 2000 calories so I can have dessert. So, I am exercising for calorie burning so I can eat.
Running is so many things to me: freedom to eat, exploring new places while I travel (generally traveling because of a race), mental release for various reasons, social time with friends, and the feeling of power, independence and strength when racing or after a good workout. I have learned I can live without running, but I certainly don’t want to live that way. I have always imagined running forever.
However, my current reality consists of daily pain. I have had to alter how I sit (on the floor for work), walk, move, work with kiddos (I am a pediatric PT working with birth-3 years old kids)…it has invaded every aspect of my life including waking me up at night on occasion. I don’t have equal flexion or extension in my left knee and my quad has lost ~10% of its strength due to pain inhibition, near-constant swelling, and just using my right leg more to alleviate my left.
So, what happened?
9/5/18: Ran 25 miles pain-free
9/9/18: I fell trying to trail run down a large section of boulders in Maine. I banged my right knee into a rock (bloodying my knee). I caught myself on a tree limb with my left hand and my left leg planted and did its best to stabilize my foot on a different rock than my right. I thought I just hurt my right knee until the next day when I couldn’t bend or straighten my left knee fully. I took some days off running. I thought I just sprained or strained something.
9/15/18 I paced the USAF marathon. It hurt while I ran, but not terribly. It was a different kind of pain than anything I’d had before. The next day my left knee was really unhappy to say the least. I tried to run, but cut the run short and walked back. Something wasn’t right, but I couldn’t pinpoint it. (I now know it was bone pain). Bone pain for me, started as a dull ache, and my joint swelled (usually 24-48 hours later). I still thought something was sprained or strained, so I took more time off, but still planned to do a 50 miler 10/6/18.
10/6/18 Running 50 miler as training. Knee started really bugging 12-13 miles. DNF’d at 20 miles. Hurt to put weight through my leg shortly after I stopped. Limping horribly, using furniture as a crutch later that evening.
10/12/18 MRI which showed a meniscal tear and “chondromalcia” Grade III & IV in my medial knee.
10/23/18 Saw Dr X who said I had a meniscal tear, but my problem was arthritis and I needed to find another sport. He said he understood….he was a collegiate swimmer. I was in shock and confused. I said that I didn’t have any knee pain prior to my trail running injury. He said, Nope, you have arthritis. That is how it works. I’ll give you a steroid injection (Tuesday). Try running on Saturday.
10/23/18 Crying on the phone to my PT/good friend…she called in a favor
10/25/18 Saw Dr. Y who said I had a meniscal tear and needed a repair. I liked him. He confirmed I had arthritis but that the repair would help.
11/7/18 Meniscal tears seen arthroscopically medially and laterally, both frayed and unable to be repaired, so trimmed. Weight Bearing As Tolerated with crutches. Told I could run in 4 weeks. Did PT religiously.
11/29/18 Start loading in PT (jumping protocol) turned 90 degrees and landed (LOUD AUDIBLE POP). The pop was believed to be in the Pes Anserine (muscle tear?, maybe break-through of scar tissue?). I continued to get through protocol even though it was painful, because I wanted to run (we don’t always make good decisions).
12/4/18-12/12/18 Progressively running with walk breaks after walking a warm-up (every other day) Ran total .5 miles, then 2.5 miles, then 3, 4, & 5 (5 runs over 10 days time). Pes Anserine hurt initially when running, no joint pain until the 5th run, when I stopped .5 miles short and walked home.
12/13/18 Waling on tip-toes in garage because I was in socks and the ground was cold…LOUD AUDIBLE POP, INTENSE PAIN, unable to bear full weight on my leg for days. Called the doctor.
12/17/18 MRI reportedly no major changes (“new full thickness chondral defect” was written on new MRI summary, but Dr. Z said on 12/20, it was there during the meniscal surgery in November)
12/20/18 Steriod injection by Dr. Y, wait to run again, but not as soon this time (8 weeks)
12/20/18 PT put my back on crutches until could walk normally again ~end of year.
2/12/19 9 weeks of more rehab (weekly PT), tried running again .5, 1, 1.5 (total run w/ day off in-between) Knee still pissed
2/18/19 Contacted Dr. Y who said my remaining options were a PRP injection or a Partial Total Knee.
2/19/19 Researching other specialists. There has to be another answer. I didn’t think 1 PRP injection would be magical and I am too young for knee hardware. I found Dr. Z (Chicago). 4/1/19 Appointment scheduled
3/21-3/28/19 Decided to run just to make sure the problem wasn’t miraculously better and to recently experience pain so that I could better describe it to Dr. Z. Ran .5, 1, 2, 1 (knee painful the day after running). Took 1 day in-between except for after 2 miles…took 2 days because I was hobbling and couldn’t do stairs normally.
4/1/19 After one of the PA’s review history and records, Dr. Z came in and shook my hand, looked me in the eyes, and listened as I spoke. He did an exam, asked questions, looked at the scans, etc. I didn’t feel rushed. He let me ask all of my questions. He told me he thought my issue was arthritis and the chondral defect. He wouldn’t have done the meniscal surgery. He told me I was too young to have a total knee. He preferred to exhaust all non-surgical options first. He recommended a series of 3 injections of PRP (Plasma Rich Protein) and HA (Hyaluronic Acid). If that didn’t work, he would recommend an osteochondral allograft.
4/1/19, 4/8/19, 4/18/19 Injections in Chicago. Supposed to feel full effect of shots by 5/17/19.
5/2/19-5/12/19 Ran 3, 5, 6, 4, 8 with days off in between. It still hurt to run and is considerably worse afterwards. The shots enabled me to run farther (6-8 miles instead of 2-3), but my knee blew up after runs and hurt for 2-3 days (progressively got worse because the swelling didn’t quite go down all the way before I pissed it off again).
5/13/19 Saw Dr. Z again. He said that a few more days weren’t going to make a significant difference in my knee since the injections. He said my options were A; to stop running and live with the daily pain which would decrease to some degree if I quit trying to run or B: operate. I AM NOT willing to give up on running, and at this point, I have pain on a regular basis regardless of running. I don’t want to live like that and I think it has only progressively gotten worse since the fall.
Thus, my surgery is scheduled for 7/2/19. I am having a type of cartilage restoration surgery. I will be having an Osteochondral Allograft (OCA) on my femur, a Tibial Microfracture, and a Bone Marrow Aspirate Concentrate. (I will describe what each of these procedures are below).
I am hopeful that I will run again. It is going to be a long road with 6-8 weeks on crutches and 8 months before I can return to sport. I have battled before and I am ready to fight again. I love this quote by Theodore Roosevelt
“Nothing in the world is worth having or worth doing unless it means effort, pain, or difficulty…I have never in my life envied a human who led an easy life. I have envied a great many people who led difficult lives and led them well.” I am going to work my butt off and be back!
Altra Running is my main sponsor. I have kept them in the loop periodically as to why I am not running with the most current information. Altra has frankly been amazing! Everyone has been understanding and have reached out with words of support! I have been with the Altra Team since 2014, and I have not only loved their products, but have loved the people the make up the company just as much. They truly care as much about their people as they do making a quality product.
SURGERY PROCEDURES DEFINED:
Articular cartilage covers the ends of bones in joints throughout the body. Normal cartilage is smooth allowing easy gliding of the joint. When cartilage is injured, the smooth surface can become rough. On occasion, the cartilage injury exposes the underlying bone. Osteochondral grafting is a method of treating cartilage injuries that expose underlying bone. Osteochondral grafts replace both the articular cartilage on the surface and the underlying bone. The tissue comes from a tissue donor.
The injured area of cartilage is identified and a core of the injured cartilage and the underlying bone is removed in a method similar to coring an apple. A replacement core made up of cartilage and bone from a tissue donor knee is then made to fit into the hole. The replacement core is gently tapped into place until it lines up with the surrounding tissue. No screws or other devices are typically needed to hold the replacement core in place since it fits tightly.
Patients can usually start to bear weight within 4-6 weeks of surgery. Activity is gradually increased with return to sport typically occurring after 6-9 months.
Microfracture is a technique that can be used to treat an articular cartilage injury or defect that exposes bone. It is an arthroscopic procedure using a small sharp pick to create a network of holes in the bone at the base of the articular cartilage injury. These holes allow blood into the injured area to form a clot. Over time, this clot turns into organized tissue called fibrocartilage which fills in the injured area. This tissue functions similar to native cartilage to restore joint function and minimize symptoms such as pain and swelling.
The recommended rehabilitation following microfracture is a lengthy process. Depending on the location of the articular cartilage injury, patients often need to use crutches to keep all weight off the knee for 6 weeks. In some cases, patients can put weight on their knee, but must use a brace to keep the knee straight while walking for 6 weeks. The use of a machine to bend the knee (called a continuous passive motion or CPM machine) is recommended for 6-8 hours per day for 6 weeks after surgery. Return to sports is often delayed for 6 to 9 months after surgery.
Bone Marrow Aspirate Stem Cell Concentrate (BMAC):
BMAC is a component of your bone marrow that contains growth factors and anti-inflammatory proteins which have been shown to promote bone and soft tissue healing as well as reduce symptoms of pain related to injuries, tendinitis and arthritis.
Stem cells can be found in many tissues throughout your body, but one of the richest sources can be found in your bone marrow. Fortunately, bone marrow can be harvested from several bones within your body and is relatively easy to access. Your bone marrow will be aspirated through a small needle puncture in your posterior iliac crest (pelvic bone) and placed in a special processing unit, which will concentrate your body’s stem cells, platelets and growth factors. The concentrate will be collected into a sterile syringe and injected into the targeted body area being treated.