4 Weeks Without Running = Still Not Even CLOSE to Feeling Better

>> Monday, September 30, 2013

(This is a little long. Basically, my knee still hurts, and I've just recently gotten a few answers. Read the next few lines, and then scroll to the bold capital words after Sept 24 for the newest info.)

Here's the quick rundown of the last 5 weeks (with the upcoming things scheduled in blue):

August: too much running. My bad.

Aug 28: Left foot pain at the end of 12 miles.

Aug 30: Sports Med Doc said it was just tendon issues and told me not to worry about it.

Sept 5: Short, easy 3 miler to test left foot. No foot pain! But inside of right knee was a little achy by the end of the run.

Sept 8: Square Lake Half Iron Tri relay - only got 3.5 miles into the run before dropping out due to pain inside/above my right knee.

Sept 11: Saw a Chiropractor because I realized that there's a lot of pain in my lower back (on the right side) and in my right hip. He said my sacrum was out of whack (as I posted about here). Started doing some hip/glute exercises.

Sept 14: Saw a Sports Med Doc (a different one from the 30th) who basically agreed with the Chiropractor that I saw earlier in the week - I have weak hips/glutes and a SI issue (officially diagnosed on paper with "SI Joint Dysfunction") that may have been caused from limping on my previously sore foot. Gave me a "prescription" for a good Physical Therapist who can also do "adjustments," meaning he's very "hands on" and will work with and manipulate the muscles, etc, and not just give me more exercises.

Sept 18: Saw Chiropractor again - he was able to get more of a POP in my lower back this time. He was still confused by my hip pain (which, if anything, was getting worse), so he sent me for an X-ray just to rule out bone infection, bone spurs, etc.

Instagrammed this photo with the caption:
"Changing into some sweet shorts at HCMC for a hip X-ray."

Sept 23: Saw Physical Therapist for 90 minutes. He pointed out an imbalance in my lower half and weak hips/glutes (tell me something I don't know). He really tried to dig out the sore spot in my knee. I couldn't do a few of the exercises that he wanted me to do because I can't even do 1/10 of a squat with my right leg before being in pain. He still gave me a handful of new exercises for my butt/hip.

Sept 24: Saw a different Chiropractor (in the same office) because the one I saw the previous 2 times was out for the week. He didn't have the X-rays (or didn't look them up), so still no word on that.

THE MOST ANNOYING THING AT THIS POINT IS THAT I HADN'T RAN IN OVER 3 WEEKS, AND NOTHING WAS FEELING BETTER. No one told me what was wrong with my knee. A "weak hip/glute" doesn't explain my sore knee. A "weak hip/glute" doesn't mean I should be limping up any incline or decline, including 1 step up or down a curb. A "weak hip/glute" doesn't mean I should be collapsing in pain trying to get in the passenger side of a car. A "weak hip/glute" doesn't mean I should have major pain after 1 step of running after 3 weeks rest. WHAT IS WRONG? WHY CAN'T ANYONE TELL ME? I've been resting, stretching, foam rolling, icing, etc, and nothing was making anything feel better.

I've been saying "I'm good at being injured - I understand there are times the body just needs to rest up." But after nearly 4 weeks of no change, I was getting frustrated. I called Dr. Folske on Thursday, and he could get me in on Friday. He's a Chiropractor / runner / triathlete / Ironman who's never led me astray before. It had been 2.5 years since I've had to see him. But I stopped in on Friday...

Sept 27: Met with Dr. Folske. Explained the entire timeline above. The reason I love Dr. Folske can be summed up with one of the things he told me on Friday. After talking about what I'd been told by everyone, he kinda rolled his eyes and said "EVERY physical therapist will say you're weak somewhere.... And EVERY Chiropractor will say you need to be re-adjusted somewhere." And he's saying this as a Chiropractor. He gets it. After hearing my story and poking at me for 20 minutes, he started throwing around some big words. He whipped out a big anatomy book to show me what he was talking about, and I snapped pictures of the book. He told me he thinks it's a mix of this tiny muscle called the Sartorius being tight and sore, and some nerve pain from right underneath that.

The Sartorius cutting across the Quad.

A septum and nerves underneath that.

He also had me flex both quads, and it shocked him. He said "feel this on your left knee... now feel it on the right." He had me poking at this little "bulgy" muscle as I was flexing:

On my left (my "good" side), it was rock hard. But on my right, it was squishy and was like it didn't exist! (Maybe from limping up and down steps for the lat 4 weeks?) He actually "prescribed" some eccentric exercises on a quad machine and on the adductor machine - meaning to put the weight down S-L-O-W-L-Y. I was to do 10-second reps where I go up for 2 seconds, and then take 8 seconds to put the weight down (and only with 1-leg at a time). He thinks that will help re-train the muscles to work properly. When I had my heel issues 3 years ago, I was really helped with some eccentric work on my calfs.

He also really worked out that little Sartorius muscle. Can you tell what leg he worked on?

I'm wearing shorts - don't freak out.

4-5 hours later, my skin wasn't red anymore, but the hair follicles were still pissed off.

Sept 28 and 29: I started doing the 2 things at the gym that Dr. Folske recommended. When I brought the (light) 30 lbs up with both quads and then took my left leg away, my right leg gave a little twinge. But it wasn't bad, and I lowered the weight for 8 seconds. I did that 15 times, then 15 times on the left, and then 15 times again on the right. Then some hammy curls, and then another 3 sets for my quads.

Then I headed over to the "Yes No Machine:"

Just think about it for 0.5 seconds, and you'll know why it's known as the "yes no" machine.

I did 2 slow sets with the pads between my knees (like she's doing in the photo above) going really slow on the way down (on the way from "no" to "yes"). Doing all of this slowly takes a lot of time! Doing what I just noted (3x quads, 2x hammys, 3x quads, 2x adductor) took nearly 30 minutes! But IMMEDIATELY it felt a bit better as I was walking around the Y!

And then I went back to the Y the next day (Sunday) to do it all over again. It's been the only thing to give a little relief right now! For the last 4 weeks, I'd call my knee and hip at 40% for the majority of the time. After doing these slow eccentric moves to re-train my muscles, my knee and hip feel more like 85%. That's HUGE! (Even if it does start to feel worse [back to about 50%] after a few hours.)

This Upcoming Week: (as noted in the calendar above...) I have a PT appointment later today, and I think that will be my last. I don't know know how much more he can help me anymore. "Let me watch you do your exercises for an hour..." Yeah, no thanks. And then 2 more visits with Dr. Folske so he can workout that Sartorius. We'll see where things are at by the end of this week. I'm hoping to have my hip / knee up around 70% by then!

So here are 4 final notes:

- I feel like Dr. Folske has given me a jump in the right direction, but I still don't have all the answers. I just feel like headed SOMEONE now and not just stalled out. Stairs, bending down, playing with Henry, and lots of other "normal" activities still hurt, but I may finally be moving forward.

- I still can't even think about running yet. I'll be shocked if I'm running by November. I'm laying off biking too, just because it's not 100% pain-free. I'll hit the pool when I can.

- This has caused me to miss 4 races (the 70.3 relay that I DNFed, the Victory 10K and 5K "doubleheader," the Treadman Du, and the upcoming TC 10 Mile), which sucks. But maybe I'll use this to get better in the pool. That can be my silver lining.

- And if all else fails, I need to remember that life is still good because I get to hang with this guy (as shown in a few Instagrams from the weekend):

Working on our new garage.

Shower time.

Sunday breakfast in bed! (I made crepes and oatmeal for these 2.)

Cousins holding hands on a long road trip yesterday.


Keith 6:56 AM, September 30, 2013  

Yeah. I had some of that. Both. It takes a long time. Think months. Do your exercises. You will think you are ready to run long before your right leg will. The problem is that the run will be fine. After it will hurt again. After you are cleared to run, run less than you think is "an easy start". Stop long before you notice anything happening in your knee.

Did you notice the "months" part? I'd say write off the entire winter for races. Do your exercises. Swim. Easy on the bike. Get strong. Easy, and I really mean EASE into running.

Steve Stenzel 7:39 AM, September 30, 2013  

Thanks Keith... I'm actually glad to hear everything you said. If you're right, then I *WILL* get better, which has been a thought I've still be fighting with. I'm OK not racing until Spring if it means I CAN race again!

I'll take it slow...

Shinianen 8:53 AM, September 30, 2013  

You're missing the TC 10 mile? I feel your pain!! What a bummer, but definitely a good thing to take rest time.

SteveQ 11:38 AM, September 30, 2013  

You're starting to sound like me with your rehab posts. It also sounds like you have a common VMO (vastus medialis obliquus) problem and what you're doing should help. WHY you have the problem is tougher; heel-striking overstriders have different problems from me!

Steph 12:37 PM, September 30, 2013  

Best of luck to you! I know how hard it is to be patient with injuries. I hope that you can see progress soon, and that that will help you stay patient and be awesome for spring!! :)

Robyn 12:59 PM, September 30, 2013  

Steve, I sure hope you're on the right track here. Good luck with all the PT. Can you do core and upper body stuff? I did a lot of swimming (pull only, initially) when I had a hamstring injury last summer. It wasn't as good as running, but it satisfied the need for endorphins.

Anonymous,  3:18 PM, September 30, 2013  

You need to find a PT that does dry needling and is good at manual therapy. My left leg is an inch longer then the right, which was causing a lot of pain in my lower left back, because everything was twisted out of wack. My PT dry needled the hell out of my glutes, hamstrings, and piriformis. He also got my hips back in line and I now wear a lift in my right shoe. But dry needling is the bomb, I'm more flexible then I've ever been. It got rid of all the knots in those muscles.

Anonymous,  4:41 PM, September 30, 2013  

I have SI joint dysfunction! I thought that there would be no one who could help me, I saw a round of doctors and they all told me different things. Here's what helped:

1) a proper gait analysis (Gear West in Long Lake, MN - Wendi - highly recommended), where I discovered that I actually have Morton's Toe which is the root cause of the SI joint dysfunction. All I needed were some inserts and proper running shoes and the pain dissolved almost instantly.
2) a good PT who helped me learn exercises to activate those muscles that weren't firing which lead to my condition.
3) a good massage therapist who worked on the muscles in my back and hips while I worked on strengthening.

I CONTINUED TO RUN WHILE GETTING STRONGER. I still do my exercises but not nearly as often and I still need to change shoes nearly every 3 months with a gait from Wendi - as my body has gotten stronger, I need to change shoes. There is hope for you. Good luck!

Doc 9:19 PM, September 30, 2013  

I also mirror many of these same symptoms. My hip/knee pain was getting terrible and I was actually feeling numbness down my knee and calf. Be patient with the chiro - and tell them that you're in pain. I toughed it out a little too much during the initial adjustments, and when my chiro figured it out he put me on traction, which removed some of the pressure on my nerves (and thus removed the pain). I'd say the first month of 3x per week chiro appointments really sucked, but I now am running more in a week than I was able to do in a month over a year ago. I got my stride back and you will too!

Anonymous,  12:08 PM, October 01, 2013  

You have an overuse injury to your medial knee tendons that will take about 3 months to resolve. That is the amount of time it takes for most tendon injuries to heal. All the opinions you have gotten so far are guesses because you do not have an imaging study which actually shows the pathology. Pressing hard on the area will not do anything to heal the tendon; time and avoiding aggravating activities is the only thing that will heal it. I suspect you altered your running style with your foot injury and this provoked the injury. My advice, don't run for 3 months and avoid spending time with therapists and chiros who can do little to alter your recovery.

Steve Stenzel 7:57 AM, October 02, 2013  

Thanks for your thoughts everyone! Yeah, this is going to take time. I'll be updating now-and-then.


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