Friday, January 3, 2014

What have I been up to?

Well, the last ~6 months have been pretty uneventful.  I injured my knee in July running on a cross country course with some major downhill running.  It was a little too much stress to the knee.  When I woke up the next morning, I was in agony - patella tendinitis.  I tried to rehab it and over time it felt like it was getting better. But when I ran the Army 10 Miler in October, that was the final straw.  I was unable to squat, kneel, or bend (which are major components of what I do at work).   Walking up/down stairs was painful.

I finally broke down and asked the doctor down the hall from my office for a prescription for an MRI. I was suspecting some tendinosis and a possible tear. Well, the MRI came back with that and more. Tendinosis, small tear and a 'stress reaction' of the patella. I knew the only thing that would bring me back fairly quickly would be a PRP injection.  PRP is Platelet-rich plasma that has growth factors and and cytokines to bring about healing.   This would pretty much be my last resort to get this to heal.

I scheduled an appointment with Dr. Paci @ Stony Brook. He's a great sports orthopedist and I knew I would be in good hands with him.  I went with my MRI and we talked it over.  He agreed that PRP was the solution. His protocol is 2 injections into the tendon a week apart. He uses diagnostic ultrasound for accuracy of the injection. The only major downside of the injection was I had to pay out of pocket for it as insurance won't pay for it.  Each injection was $500 ($1,000 total).

So right away I agree and they bring in the equipment. He left the room and his PA and the nurse drew about 15cc of my blood and spun it in the centrifuge to separate the blood cells from the plasma.  When it's done it looks like this (but less fuzzy):

The yellow/clear fluid was injected back into my tendon
Then the doctor came back in and performed the injection. I think he used the biggest gauge needle he could find.  I have to say the needle didn't hurt, but the pressure from all the fluid going in was incredibly uncomfortable.
 The yellow stuff outside my leg is the ultrasound gel. 
All of that yellow fluid in the syringe went into my tendon.

 The big black section is where my tendon was breaking down

All of that missing tissue.......

After the injection I got down off the table, was handed some crutches and a prescription and told to return the next week for injection #2. My instructions were very specific - no NSAIDs, only tylenol; ice it like crazy to bring down the acute inflammation. And NO RUNNING.  No worries there as I couldn't even walk.

The next two days I spent on crutches trying to gently load my leg. Once I could walk normally, I got on my bike trainer in the basement and gently pedaled for ~10 minutes. I started doing some basic rehab stuff to load the tendon. Before I knew it, I was back at Stony Brook for injection #2. 

For some reason injection #2 was more uncomfortable than #1. It seemed to take longer as well. The injection itself is maybe 10-15 seconds, but when you are very uncomfortable it seems like minutes.  I reviewed my rehab plan with the doctor and he was on board with it.

I survived this injection and repeated my same protocol. After a few days I was off the crutches and working out. I did some cycling (indoors), walking, squatting, dead lifts, kettle bell exercises, etc.  1 week after the 2nd injection I started some easy rowing.  I was progressing with no major set backs. Just prior to Xmas, I started noticing that I would do things at work (squat, etc) and it wasn't until after the activity that I realized it didn't hurt. Needless to say I was thrilled. I started to jump rope for low level plyometrics to prepare myself for my return to running. I had a soft date of January 4th to begin running if I had no pain.
Earlier this week I was doing 12" box jumps with no pain after activity. This was a huge step. I was that much closer.  I was testing the tendon with every activity.  I wasn't necessarily monitoring for pain during activity, it was coming down to how it felt 24-48 hours afterwards. So far, so good.
I went on 3 hikes with my friend Teresa and the Wingman. I brought my trekking poles to help offload the knee.  We had two 6 mile hikes with almost 500' of elevation and one 7.7 mile hike with almost 600' of elevation.  The last hike was New Year's Day.  I brought the poles but didn't use them until 5.5 miles in when I was getting tired.  I mentioned to Teresa that my plan now was to run for 10 minutes January 2nd if I felt good after the hike.
Well January 2nd rolled around and my knee was sore and tired.  I erred on the side of caution and skipped the run. There was nothing to be gained by pushing it.  I've waited 5 weeks to run, what was one more day.  When I woke up this morning to a blizzard outside I headed down to the treadmill and warmed up. I then set my timer for 10 minutes and off I went.  The time seemed to fly by and I felt great. But when 10 minutes arrived, I stopped running and continued to walk. Once the workout was done I was ready for the next test. In the past, when I would step down from the treadmill I would get a sharp pain in the knee.  Not today!  Progress!! I was so relieved to feel nothing. I did my regular rehab afterwards.  We'll see how it feels tomorrow.

My 6 week ortho follow up is Tuesday. Got my fingers crossed that when we look at the ultrasound, that black hole is smaller, if not gone.  I've got big things planned for 2014 and I can't have this slowing me down anymore.

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