Saturday, March 24, 2012

Days 9- 14: Doctors, Physical Therapists, and Knee Braces (Zero Days #1-6)

Days 9- 14:  Doctors, Physical Therapists, and Knee Braces (Zero Days #1-6)

On the way back to Asheville, my ham strings were cramping up in the car.  It didn’t matter how I stretched them.  When I finally stepped out of the car at the Asheville house, which I will refer to as “basecamp”, I could hardly use my right leg.  My knee was stiff and my whole leg was sore.  I literally limped inside.  Then I realized that my room is in the basement. 

I had never really paid attention to those 14 steps before.  I never really thought much about steps in general.  Now I would rate them as, “strenuous/ difficult”, if they had to receive a trail rating.  Each down-step started with my left leg bending in order to lower my right foot while keeping my knee straight.  Then stepping down with my left leg.  Repeat x14.  Reverse for up-steps.  I felt elderly. 

The following day, Erik got in touch with me and confirmed that he would be getting off the trail for a few days to rest his knee.  I did not want to take too much time off the trail but my knee was still very sore.  So, like all other times in life when you’re unsure of how to proceed, I inquired with the oracle that is Facebook, specifically calling on my athletic friends for advice.  Pretty much everyone, including a former thru-hiker and a couple long-distance runners, told me to take at least a week off.  This answer was completely unacceptable.  A couple friends even suggested I quit or do it another year because it was not worth the pain and/ or potential for permanent injury.  

Over the next few days, I heard the same thing from the orthopedic doctor, massage therapist (also a long distance hiker) and physical therapist #1:  stay off it for at least a week.  It was clear that I was just going to have to buckle down and take a few zeros.  You would think that this would be relaxing, having nothing to do but rest.  However, trail anxiety crept in quickly.  I wanted nothing more than to use my knee.  To make miles. 

The orthopedic doctor confirmed my mom’s initial diagnosis of patellar tendonitis, an inflammation of the patellar tendon due to repetitive stress.  The patellar tendons are the connective tissues which run over the kneecap that join the quadriceps musculature in the upper leg to the tibia bone in the lower leg.  Tight ham strings and quadriceps can exacerbate this condition.  Both my legs felt like rocks, they were so tight.  Typically, complete rest of the knee for at least 3 days is required, followed by 1-2 weeks of very light activity (no athletics).  Treatment is the basic “RICE” method:  Rest, Ice, Compression, and Elevation.  Training can resume slowly after the symptoms begin to resolve, first addressing predisposing conditions such as tight quadriceps and ham strings, typically returning to desired activity levels within 1-3 months with proper care.  Bracing is not required and does not necessarily provide quicker resolution, however, certain braces may provide relief through compression and/or pressure point(s) on the tendon.  (If acute pain is continuous during rest, or is debilitating for light-use, a medical professional should certainly be consulted, as there may complicating factors and/or a more acute injury)

We also discovered that I have a slightly outward rotated lower right leg.  Luckily, however, it seems that both my knees are still pointed forward.  When I was just a little kid, I caught my leg in a bed rail while falling out of bed, braking my leg.  I guess I used to roll around in my sleep.  The radial fracture of my tibia caused my right leg to grow ¼” longer than my left and my right foot to rotate just a little to the outside.  To see if this was going to be a problem over the long haul, I scheduled to see a 2nd physical therapist that specializes in long distance running. 

Miriam Nelson (MPT, COMT, OCS) with Southern PhysicalTherapy in Asheville is amazing.  She performed a full assessment of my gate, including a slow-motion video analysis.  This further confirmed that my right foot rotates outward when I walk.  Additionally, the frame-by-frame analysis revealed that I am rolling across my instep and big toe as my right foot leaves the ground, instead of across the ball of my foot and all 5 toes evenly, as was the case with my left foot.  This made it important for me to ensure that my knee cap was tracking properly, as we did not want it tracking to the outside due to the torque in my lower leg and causing/ increasing sub-patellar inflammation and pain.  This was achieved through a special knee brace with patellar tracking support on the outside and lower patella tendon pressure point.  She also gave me a simple foam heal lift to correct the leg length problem, though she didn’t think it was a primary concern. 

6 days of rest(lessness), 2 physical therapy sessions, 2 knee braces, 1 heal lift, 1 orthopedic doctor, 1 massage therapy session, and 11 new pills later (to add to the 7 I was already taking), I was ready to hit the trail again. 


As long as this is practically a technical article, the following is a list of the pills I’m currently taking:


-          Ortho Molecular Products, Ortho Biotic for gastrointestinal health

-          Ortho Molecular Products, Traumeric for musculoskeletal health and anti-inflammation

-          Walgreens, Glucosamine Chondroitin Complex w/ Chinese Skullcap root and Black Catechu (x2) to help rebuild cartilage and lubricate joints

-          Xymogen, ActivNutrients w/o Iron (x2) for multi-vitamin

-          Xymogen, CoQmax CF (CoQ10) for cellular energy and cardiovascular health

-          Xymogen, IgG 2000 DF (Immunoglobulin concentrate) for immune system boost

-          Xymogen, OmegaPure 600 EC (fish oil) for optimal joint function and cardiovascular health

-          PRESCRIPTION, Meloxicam 7.5mg for anti-inflammation


Ortho Molecular Products, Soft Tissue Support Pak (containing 8 pills) for musculoskeletal health and anti-inflammation

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