Tuesday, March 20, 2007

Patellar tendonitis

So my diagnosis has been upgraded from "angry knee" to "jumper's knee." At least this diagnosis makes a little more sense - even if it is a malady usually reserved for basketball players (and, apparently, people who can't pedal a bicycle as well as they think they can.) The bad news is my condition is at least "grade 3," which means I need to:

* Rest completely from the aggravating activity. Replace it with swimming/running in water (if pain allows).
* See a sports injury specialist/therapist who can apply sports massage techniques and advice on rehabilitation.
* Accept the fact that I've basically wasted an entire month.

The doc recommended physical therapy. That sounds expensive. But I'm willing now to accept that this is a problem worth throwing money at. The fact that I've been so stingy and stubborn is one of the reasons I've lost an entire month.

Because I acquired the injury in an interesting way - riding a 100-mile snow bike race - the doctor always ends up spending more time chatting with me about my bicycling than he does talking about my knee. He was asking me another string of questions about the Susitna 100 today when I finally dropped my most pressing question.

"So I want to be able to ride another 100-miler by early May. Think that's possible?" I asked.

"Yes, that's possible," he said.

I paused to wait for the qualifier, but it never came. So I said, "But ... um ... will I have time to get back into shape before then?"

"The idea is to not fall out of shape," he said.

I waited for more doctorly advice, but he just looked at me with a straight face. I was confused. This is the guy, after all, who recommended active recovery all along. But he wasn't gushing with specific suggestions. And because I'm pretty sure that I had it all wrong before, I went for something I've never tried."So, should I try swimming?"

"Swimming is good," he said. "Your physical therapist will be able to help you develop some recovery-specific exercises."

I felt a bit bewildered. There I was, fishing for an authoritative lecture about all of the things I shouldn't be doing, and I was only getting closer to having an actual MD tell me I should start riding my bike again. He chose that awkward pause to pick up our chat where we left off, in which I told him about my desire to ride the 24 Hours of Light.

"I'd like to ride the 24 Hours of Light," he said, "but I'm going to be in Coeur d'Alene that weekend."

I knew the doc was a cyclist, so I said, "Oh, are you going to do some riding down there?"

"I'm going to race the Ironman triathlon," he said.

"Ironman? Um. Wow. That's great." It's just my luck that I'd get a crazy enduro-nut for a doctor. He probably considers patellar tendonitis to be a perfectly normal condition, like blisters. He's probably tough enough to go out and run 100 miles through such a niggling injury, but that PhD degree forces him to recommend physical therapy to lesser animals like me.
This is all hugely speculative on my part, of course. But the diagnosis seemed to be good news either way. I had plans to go out after my doctor visit to consul myself with sushi. But instead, I decided to celebrate ... with sushi.

Now it's time to call those PT people and get to work. White Rim, here I come.



19 comments:

  1. Long time reader, first time caller.

    I understand your frustration in all of this "injury" stuff. I had an over-use (chrondo malacia of the patella) last year and had to take time off.

    The Physical therapist will have better advice than the doctor. If you don't have the dollar bills to see the therapist a bunch, let he/she know and they will work out a plan to get you the knowledge you need to recover in a session or two and then you can do the exercises/rest on your own.

    The hardest part is accepting the time off and just letting it heal compltely before working to gain your fitness back.

    I look forward to reading about your progress.

    Best of luck,

    Peace

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  2. Fitness comes back surprisingly fast most of the time (as long as you don't take 3 years off like me...). Get your PT and rest done so you don't lose any more time and then you'll be back.

    Okay aside from the practical side, it sucks being told to rest but hopefully you can find a way to exercise that doesn't break the bank or hurt your knee while it's getting better. Good luck, we're all sending healing vibes your way.

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  3. I told 'ya it was tendonitis a month ago! It won't go away without giving it a lot of rest, but it will go away! Swim!!

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  4. vicodin. and maybe some cigarettes.

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  5. I had a physio diagnose and treat a wrist problem that 3 different doctors were unable to fix, including a sports medicine specialist. They all diagnosed tendonitis but the physio realized that two of the small bones in the back of my hand were jammed together, probably from a bike fall. Years of pain fixed in a month because I'd finally asked the right person.

    Physios are humans, some are good, some are bad, but a good one will help immensely.

    Oh, and that sports medicine specialist I saw? He had been an NHL hockey player before taking up medicine. I got the same impression you did, that my injury wasn't a "real" one, pah,

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  6. Long time reader, first time commenting. December 1st I road into a tree/large branch that had fallen across the road I commute by bicycle on year round, went down hard and fast. Fractured my right pelvis in 5 or 6 places, because the pelvis stayed intact I was able to avoid surgery by doing nothing, nada, for 6 weeks. The seventh week I started intermittent walking and riding my fixed gear bike on a trainer. I bought a book "FrameWork, by Nicholas A. DiNubile,MD, so I had some knowledge of body repair and week nine I went to the PT, she had me do a bunch of strength tests some exercises and a series of stretching to regain some range of motion in my hip/leg region. As I was lying on the massage table she's checking my leg length/hip position and she tells me that my hip has rotated from it's normal aligned position. Well, I thought she was feeding me a load of stuff to make it seem worthwhile to be there, but she does some special stretching to realign the hip and when I stood up holy cow I actually could feel the difference. A good PT should be able to help you a lot. I come from a long distance running background where recovery time was measured in days, I don't compete much anymore, stress fractures that didn't heal, etc. And I'm taking this recovery very systematic and slow. Good luck with your recovery. Bill

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  7. Hi Jill,

    I am in a similar boat; I am trying to qualify for Paris-Brest-Paris, a 750mi, 90hr. ride held in France once every four years. On the second qualifier (300km) I experienced and rode through bad lateral knee pain and have been off the bike since (4 weeks). I've yet to receive a diagnosis, despite having seen many doctors, all anyone can tell me is stay off the bike...a very depressing answer.

    I really hope this answer and your PT are the road to recovery! I look forward to reading more of your exploits, and I sympathize with feeling that hole in one's life.

    Agnes

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  8. i was diagnosed with the exact same thing a few weeks ago and i've got a 300 mile multi-night ride coming up in a few weeks. i went to see my ortho surgeon and he has me on diclofenac sodium 75mg twice a day and said to ice it after each ride to keep me going until my ride.
    i'll rest a bit more (maybe) after the ride and if that doesn't do the trick then it's pt.
    good luck.

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  9. Thank you to everyone for the good advice. I've received the best suggestions from commenters since this whole thing again. It's comforting to hear from other people who went through similar trials and came out OK. Thanks again.

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  10. Hi Jill --

    I am going to venture out on a limb here -- and do some advising.

    My father is a golfer, some years ago he is forced to stop golfing due to some aggravating pain in his right shoulder. Diagnosed as tendonitis, or maybe bursitis, sports doctors yeti yeti yeti -- His MD, my pediatrician (same one that hit my ganglia -- a cyst -- with a bible to break it), tells him to take Cod liver oil, twice a day.

    In a week he is back on the golf course.

    Now -- maybe it won't help, but -- it's probably good for you anyway -- so try it.

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  11. woo hoo, that is a great diagnosis, way better than a bursitis thing, once you have those they plague you forever, but this could actually become remarkable well and only flare up once in a blue moon, Yeah!!!

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  12. Trepid Explorer2:06 AM

    GREAT! Next time you see your doc could you ask him what he advises for flu, pushing glandular fever?

    Actually, I feel a ride coming on.

    It's about time all my work colleagues were at their desks... I should be able to get away with it...

    Cough. cough.

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  13. JIll, I'm awful. I've been too busy worrying about my own knee to get over here and check on yours. I'm glad they've made a diagnosis. I'm still waiting to see an ortho.

    Best of luck with it!

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  14. Hi Jill, I got the jumpers knee diagnosis as well many years ago. They simply said to stop running and playing ball. A couple of years later, as it got worse, a nother doc called it chronic tendonitis. Chronic sounds baaad. What we ended up doing was opening up my knee and slicing off the damaged (about 10%) part of the patella tendon and seeing how that would work. There was no guarantees with this procedure but I wanted to do something as even cycling began to hurt. Well its still bad, but i'm happy I did it as it offered me some much needed relief. I can even run now! It's great! What they want you to do is stop doing what you love and become a couch potatoe which is rediculous. Hope this helps if you hear something similar to this from a doc...
    kevin

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  15. Hi Jill, I got the jumpers knee diagnosis as well many years ago. They simply said to stop running and playing ball. A couple of years later, as it got worse, a nother doc called it chronic tendonitis. Chronic sounds baaad. What we ended up doing was opening up my knee and slicing off the damaged (about 10%) part of the patella tendon and seeing how that would work. There was no guarantees with this procedure but I wanted to do something as even cycling began to hurt. Well its still bad, but i'm happy I did it as it offered me some much needed relief. I can even run now! It's great! What they want you to do is stop doing what you love and become a couch potatoe which is rediculous. Hope this helps if you hear something similar to this from a doc...
    kevin

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  16. I was diagnosed with Patella Tendonitis 7 months ago and it hasn't quite cleared up yet. I did a 5 minute run last night for the first time but boy oh boy is it frustrating!

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  17. Anonymous1:30 PM

    Hello. I was just googling "patellar tendonitis cycling" and found your blog article on the first results page. I found this to be terribly coincidental because I happen to read your blog often, and have commented on here at least once before. Anyway, I read through it, and it sounds as though you are experiencing the very same problem that I am. I am at that stage where I am struggling to decide what course of action to take, given the stubbornness with which I want to continue my current training regimine. I was hoping we could talk about it, so I tried to call you at home, but got your machine. I left a message, and hope to hear from you soon. Its a small world. Bryan

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  18. Hey Jill... I just came across this post because I'm having issues with my undiagnosed patellar tendonitis and I was considering taking a break from riding and doing some swimming till my knee felt better. Did you ever start swimming?

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  19. Anonymous6:41 AM

    hi everyone, not sure how old these posts are but I came across it all searching for Patella Tendonosis relief. Yep 'tendonosis' not 'tendonitis' - apparently '...itis' is a short term condition due to rubbing and swelling of the patella tendon, '...osis' is worse - its a degenerative condition where the patella tendon is damaged due to overuse. For me I got it kickboxing over 6 years and I don't think snowboarding helped either. I've had it 3 years and like everyone on here its a royal pain in the ass for me. I've spent months trying to rehab it with stretches and exercises. Today I went to a sports doctor. After runing an ultrasound (where he showed me the clear 'dark' spot indicating the sick part of the tendon) - he said 'these things takes ages to heal, theres very little blood flow to that area of the knee and it means things don't heal quick. Plus we use it all day every day'. Great. His recommendation - PRP injection. Platelet Rich Plasma. Its not fully trialled yet but is becoming widely used in atheletes for achilles tendons etc. The platelets in your blood contain all the growth factors that are use in repair and growth of tissue and bone. Basically they take some of your blood, spin out the PRP to 5 times normal level, and then inject it back into the wounded area (patella tendon) in this case. Its still a bit out there but I thought you all might find it useful. For me I can't see the exercises helping, the other day coming up some stairs I just felt it go again. Good luck all.

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