The price of admission

   
Dan Savage has a theory that every long-term relationship has a "price of admission" -- the things your partner does that drives you up the wall but is still worth it. Having a long-term commitment to ultra running is no different, there is stuff that happens that isn't great but you put up with it for the love of running. One of these things is an injury. 

Recently I went on a work trip to Berlin, where I ran 10 days in a row (excluding the 2 days I was stuck on a plane), and 2 of the runs were 20+ miles. I normally don't run more than 4-5 days a week with yoga and weight training on the non-running days. I knew it was stupid to run so many days in a row, but was stubborn I thought I had to workout everyday, which meant running. Halfway through my trip my left knee started to feel achy going down stairs and when I ran. But of course I kept running and running. I got home Friday afternoon and first thing Saturday morning I went for a 20 mile run, with my knee hurting the whole time. Sunday it was very obvious something was going on, it was hard going up and down stairs or kneeling on it in yoga. 

 

icing my knee after a long run and hanging out with Oscar

Monday morning trying to be smarter about it I made a doctor's appointment with a knee specialist, but it wasn't for another week. So of course I kept up my normal routine of running, yoga, and weight training, including a 22 mile run with Susan. And just like the previous week my knee suffered greatly the day after the long run. So I went to yoga, it hurt to do certain poses, especially anything where I had to kneel on my left knee. I had a hard time even kicking up into handstand, my teacher even commented after class that she knew I was strong enough to up into handstand. I told her my knee was hurting and I "didn't want to over do it". 

The day of my doctor's appointment was also the day I was supposed to start coaching with Ann Trason. I decided I should go for a run just in case the doctor told me I shouldn’t be running. The run didn't feel great but I managed make it through 4 miles. 

I specifically picked a knee doctor that works on athletes, so I wouldn't get any strange looks when I told him that I ran ultras. Dr. Johnson's office over looks the Portland Timber's soccer field; I knew I picked the right doctor. After I gave him the run down on all the dumb stuff I had been doing that might of caused my knee issues, he did an exam that consisted of various range of motion and strength activities. He said my left leg was weaker than my right, but overall my exam was good. He said he thought I was suffering from patellofemoral pain syndrome (PFPS), or runner's knee and that I should go to PT and take it easy, meaning running 15 miles instead of 20+ for awhile. I was so excited when I heard this news, because I knew runner's knee was something that would heal with time and no surgery was required. Dr. Johnson wanted to do an x-ray of the knee just to make sure nothing else was going on. 

Walking into Dr. Johnson's offie

I left the doctor's office with a feeling of relief, I texted Susan the good news and called my dad to let him know. As soon as I got home I called to make my first PT appointment and as soon as I did that I got a call from Dr. Johnson. He told me that they found arthritis behind the kneecap but he was hopeful that PT would help my knee since my exam went so well. 

I immediately started researching arthritis behind the kneecap, also known as Patellofemoral Arthritis. Everything I read made it sound like a death sentence, that I would never run or hike again without pain. I was trying to remain optimistic because I had my first coaching call with Ann Trason that night and was sure she would tell me something to relive my concerns. 

Ann Trason suggested that I get an MRI, so I know for sure what is going on. She also suggested putting training on hold until I got more of a handle on what was causing my knee issues. She was right, but I was devastated. I spent the rest of the night reading blogs, articles, forums, etc. on Patellofemoral Arthritis. I just knew my running life was over, I cried myself to sleep that night. 

The next day or so were a blur, I tried to hold it together enough to make it through work, but really the only thing on my mind was my knee. At this point my left lower back was starting to hurt, I couldn't touch my toes or sit for long periods of time. I finally decided I was going to lay off running and just ice my knee and go to yoga. 

Wednesday afternoon I had my first PT appointment with Ariel at Rose City PT, again I picked someone who specifically worked on runners. Sometimes you meet someone and within a few minutes you know you are going to get along well, that is how I felt after talking to Ariel. I gave her the whole history of my knee and lower back, plus the fact that I was now working at home and sitting a lot more. She told me that 30-40% of people have some sort of arthritis behind the kneecap and show no symptoms at all. After she finished her evaluation of me, she said that she thought my knee was more symptom of my tight back and pelvis rather than the cause of the problem. She also told me that injuries are amplified more with endurance athletes as opposed to someone who runs casually. She said she wanted to start astym treatment on my back and quads. She also said I should be fine to run as long as my knee didn't start to hurt more than it has. I think I had her repeat this a few times, just to make sure I heard her correctly.

For the first time in a few days I was optimistic again about running! On Thursday I went for a massage and Friday I went in for my first astym treatment (ouch), I started doing all the prescribed stretches. I also started taking glucosamine, drinking tart cherry juice and ordered a better chair for my standing desk. But the real test was going to be our long run on Saturday and seeing how my back and knee felt on Sunday. 

We ran 20 miles on Saturday and I started to feel my knee about a mile in, but it never hurt, there was just a noticeable sensation on the inside of my knee the whole run. On a scale of 1-10, I would say it was a 1-2. It is now Sunday and I went to yoga, my knee felt a lot better than it has the last 2 weeks in yoga after a long run. It still feels a little stiff going downstairs but nowhere near what it was like last Sunday. 

I am going to London this week for a work trip and I don't plan on repeating what I did in Berlin, if I have to skip a day of working out so I don't run everyday, so be it. 

I have a follow-up doctor's appointment after I get back. I still want to talk to the doctor more about the arthritis and see if I need to get an MRI or not. I am going to continue the PT as long as I need it and not run more than 2 days in a row. I want to continue running for a long time and would rather take a few days off than months off because I did something stupid. 

This might be the price of admission for being an ultra runner, but this is also the price of admission for being with an ultra runner.