My first drop out + solving knee pain

Last week I briefly mentioned in my July recap that I had to drop out of Hood to Coast due to some knee pain. I'm not one to back out of a relay (or any race I've booked travel to) so its actually a big deal for me to say no. I wish this was the first time addressing wonky knee issues, but sadly there were 2 other incidents while #racing50states, so I had an idea of what was going on.

 3 years ago it was  a bad case of ITBS that lasted months and 2 years ago an even more debilitating plica inflammation.  (not to be confused with PICA which Kim misunderstood me when I first blogged about it-- pica  is an eating disorder where you have an appetite for chalk, dirt, clay, sand etc.)--- yes its an actual disorder and there was even an episode about this on My Strange Addiction- is that show even still on?

Aside from all that, this time it was different. The previous two incidents it only hurt when I did high impact repetitive activities such as running, jumping, and of course going down stairs, whereas now it hurts all the time. My knee pain triggers when I'm walking, when I do squats, even when I lie down at night to go to bed and I sleep on my side. The most frustrating part is that this came out of NO WHERE. ITBS onset was in the middle of Tybee 1/2 marathon, I heard a pop, fell to ground then knee pain- boom. Plica inflammation I was in the middle of my 21 miler training for Air Force Marathon and at mile 18 my knee gave weigh. This time, I went to bed and woke one day and the pain was just there #worstinjuryever. 

Last Monday I did my normal run group and was in pain within 1 mile but somehow managed to squeak out 3. Luckily there were massage therapists ready for the runners on this particular night so I took advantage of being one of the first to finish and had a very painful and tear-felt 10 min deep tissue IT Band and quad torture session. My masseuse specializes in sports massage and since she knows my old roommie, Leah, she suggested I see her to get a better idea of what is going on since it appeared to be more than ITBS. 

Luckily in TN you don't need a Dr. referral to have insurance cover physical therapy, so I made an appointment with Leah for later in the week and after a few tests she found that I have both infrapatellar fat pad irritation and patellofemoral pain syndrome (PFPS).

My first goal is to just get the irritation down which will remove the pain, so she spent quite a bit of time performing Astym therapy - the before and after not only on my ROM, but also the decrease in pain was pretty significant. She also noticed that my knee cap was pretty "free floating"?? To help immobilize and support my knee, she did some fancy restrictive taping to last for 48 hours. Aside from changing how I walk and making it extremely difficult to bend knee (especially when first getting in the car to drive), I loved how it completely removed all the pain I was experiencing... even walking downstairs!!

As far as icing goes, I was given dixie cups to freeze and then peel around to ice my knee until the majority of the cup has melted- obviously messy, but quite effective and cuts down on amount of time spent icing as it typically lasts 10 min. 

Notice the difference in swelling after a few days?

Lastly as far as what caused this issue, along with injuries from previous years, all stem from poor hip strength and an asymmetrical pelvis. For everyday running this doesn't impact me, but when I make changes, over time, that is why I get injured. This go round the cause was taking so much time off + inconsistency when I did run.  My monthly mileage for the most part was around 50 miles which broke out  to 0-2x a week running. and if I did get in 3 runs it was because I added in a long run here and there. Mentally 10-12 miles doesn't seem like a lot based on what I was used to, but my body felt otherwise and my ligaments / tendons hadn't been properly "re-introduced" to those longer distances. 

Exercises

Aside from making love to my roller every day, I also have to do the follow exercises to increase the strength in hips...I assume strong hips equates to great child bearing hips so I can get a twofer out of this??

Side-lying Hip abductor raise... or as I like to call, the Jane Fonda 

Did you know there are different levels of the trusty clam shell exercise?? I can't decide if the fact that I have to do level 2 and level 4 means that I'm awesome to skip 1 and 3, or I'm terribly weak and need the advanced moves to make a difference?

Level 2 clam shell is just like traditional clam shell, only you separate your feet instead of keeping them together... burns that much more quickly 

Level 4 clamshell- this one is no joke. Top leg gets extended backwards until your top thigh is in line with torso. keep the knee still and raise your foot toward ceiling then back down.  I'm supposed to 25 of each of these exercises, but so far I can only manage 20 of these before the burning wears me out. 

Lastly no running for at least 2 weeks. Sunday I tried the elliptical yesterday to see how it felt. Thankfully I met Leah at the gym and we talked the whole 40 min. My knee felt fine but seriously I shouldn't be able to carry on a conversation the whole time, let alone the machine tell me I only did 3 miles and burned 200 calories--- no wonder some of these ladies are on these machines forever #aintnobodygottimeforthat.

Yesterday I went to kettlebell and modified my squats and skipped the lunges- still feel great! 1 week running free and my body is slowly coming around that I really do think I'll attempt a short run next Monday. 

It's amazing my mentality today vs. a few years back. During then I HAD to run races regardless of pain, thus 13 of my states were run / walk / shuffle with knee pain. I had TERRIBLE calf pain last summer / early fall which accounted for 6 more states- 5 of them being back to back every weekend. Needless to say I've asked a lot of my body and its time to finally treat her right.  I have 2 relays coming up in October (Bourbon Chase & Ragnar TN)- ideally I think I'll be better by then, but if not, I have no shame in putting me first and adding 2 more drop outs to my roster. 

Here's to the start of an injury free / strong rest of 2014!!

Do you experience the same injury over time?

When do you push through it and when do you call it quits?