Ortho Recap
I mentioned before that the Orthopedic doc I finally found has been really great and he understands running and triathlon - which is as important to me as any of his medical knowledge. On my first visit, pre-marathon, the goal was to get me through the marathon with as little pain as possible. I saw some moderate improvements in my knee leading up to the marathon and was able to do the bare minimum of training those last 3 weeks because of the help he gave me. And he did get me through the marathon = Goal #1 a success!
He told me this next appointment would be to “put things back together” after the race.
THE GOOD:
Current Diagnosis: Patella Tendonitis, IT Band Syndrome, Bursitis, possible fissures in the cartilage under my knee cap (not at all severe)
My Options for ITBS:
Steroid (Cortizone) injections at the lateral insertion site. This is a “fix” that we would use 2-3 weeks before my next event (Half Ironman) if necessary to get me through the race more pain free. I would have to reduce my training for a couple days after the injection. He said there is VERY little chance of tendon rupture at this site because the IT band is under very little stress - he has NEVER seen a rupture of the IT. It becomes irritated because of rubbing against bone, mostly, and the “yanking” that is required to stabilize the knee if the stabilizer muscles are weak. The steroid will reduce inflammation & reduce the rubbing and irritation. It will last about 6 weeks and is sometimes a fairly permanent fix - if you get the PT required to strengthen the stabilizing muscles around the knee during the effective time.
PRP (Platelet Rich Plasma) Treatment - I found this one fascinating!! It is a fairly new procedure. They take MY blood, centrifuge it to separate out the platelets & plasma, then inject the platelets-plasma combo at the lateral insertion site of the IT band. I would have to reduce my training for a couple days following injections. This promotes healing by stimulating your body’s immune system to have a faster, more aggressive response to the injured area - essentially the platelet injection simulates inflammation. I would likely need more than one injection (up to 6) and the whole process might take as much as 6 weeks. This is a long-term, permanent fix… as long as you do PT to strengthen the stabilizing muscles of the knee so the IT band doesn’t become injured again.
*** RUNLONG, He said this works GREAT in Achilles tendonitis - and that is where it was initially studied.
My Options for Patella Tendonitis / Bursitis:
Steroid injection under my knee cap and the sites of pain - This is basically the same as above, but does carry a higher risk of tendon rupture.
Hyalgan Injections - This is a 6 injection series of a drug that promotes healing in cartilaginous tissues. It is permanent for some people, and others need yearly injections after the first series. He doesn’t think I will need the yearly injections because we are not dealing with arthritis, but “early onset changes of the joint” in my knee (damn gymnastics!). I will have to make a call about doing this way before a race. I am thinking (and he totally agreed) I will try to make it through the Half Ironman and then decide what to do about the injections before even starting the major ramp-up in training for Ironman. I am seriously considering this! Mainly because of the “early changes” he sees in my knee and he is pretty concerned that I could have early onset arthritis in both of my knees. There will be MRI’s if I go this route - because I will want him to have better information if I go this route.
THE BAD:
Though he does not seem like the kind of doc to suggest missing a race, he suggested I skip NOLA. He said it wasn’t a necessity, but would go a long way toward helping get my knee on a better track for the Half Ironman. We discussed me doing the half marathon instead of the full, but his suggestion remained the same - “unless this race is important to your overall goals for the year.”
I am torn… it is important for my social goals… but is just a bonus for my athletic goals… I am going to sit on it a few days and hopefully have a new coach this week to talk to, as well. I also need to see what kind of penalty we will have with our plane tickets. I want to scream that this ISN’T FAIR!!
Lots to think about for sure…
