LCL Strain and Plica Syndrome

A month has come and gone post Rocky Raccoon and I am no closer to running 1 mile, let alone another 100 miles.  The ART work and foam rolling I did got me feeling nice and loose but my knee pain has remained constant.  I had x-rays which showed no issues so I made an appointment with an orthopedic knee specialist.  As a side note, I also had an x-ray done to determine my leg length and found that my right leg is 3 mm shorter than my left leg ... more on that later.

I saw the doctor for all of 2 minutes when he determined that I needed an MRI, which is what I was expecting.  So, I scheduled the MRI for Thursday and received the results on Friday.

Results: Low grade strain of Lateral Collateral Ligament (LCL) and likely Plica syndrome (determined by exam during the administration of the cortisone shot, not MRI)

Course of Action: Knee brace for three weeks, anti-inflammatorties, PT and cortisone shot.  No running for the next 3 weeks, cleared for cycling only. 

What is the LCL?: The lateral collateral ligament goes from the top part of the fibula (the bone on the outside of the lower leg) to the outside part of the lower thigh bone.  The ligament helps keep the outer side of the knee joint stable.

What is Plica Syndrome?: Synovial plica is a fold of the synovial membrane - the inner lining of the knee joint. These folds are normal structures which develop in the first eight weeks of a pregnancy when the embryo's joints are developing in its limbs. The plica are usually harmless and unobtrusive; Plica Syndrome only occurs when the synovial capsule becomes irritated, which thickens the plica themselves (making them prone to irritation/inflammation, or being caught on the femur).

It then forms scar tissue which clicks as it slides across the surfaces of the joint and with exercise the plica becomes painful and inflamed. The process is on-going and progressively becomes worse with time especially after sporting activities.

Next Steps:  Re-evaluate in 3 weeks, if pain persists, arthroscopic intervention may be needed but (crosses fingers) is unlikely according to the doctor.

If this all sounds clinical it is because at this point, I am just happy to have a diagnosis and a course of action.  Stay tuned for recovery progress, but for now, my bike and I are becoming best friends again! 

Once I am cleared to run again, getting to the root of the problem to prevent future injury will be key.  I plan to add a lift to my orthotics to compensate for my leg length discrepancy, focus on glute and hamstring exercises to address some of my muscle imbalance and finally, get a gait analysis completed to see what I can do to improve my run form.

If you have had a gait analysis done, did it help you?  Any advice?

Undetermined Injury

The week leading up to a PR distance race - meaning the first time I race a new distance or racing into the unknown is particularly stressful because the self-pressure to finish the race is incredibly high.  As for taper craziness, the week leading up to the 100 miler was a typical taper week for me - you know, worrying about things that are totally out of my control, like the weather, getting sick or anything that would keep me from getting to the starting line.

Once race eve arrives and the forecast is fixed and I haven't gotten sick or suffered a freak injury, first and foremost I am thankful, and next my thoughts move directly to worrying about sustaining an injury or getting sick during the race or anything that would prevent me from getting to the finish line.

So, naturally, when I get to the finish line, I am incredibly grateful  -- and that is exactly how I felt when I received my buckle.

I needed that preface because the rest of the post may sound like whining ...

I realized going in that I might walk away (pun intended) from my 100 mile adventure with an injury of some sort, and honestly, I was just hoping it wouldn't be a broken bone from tripping in the dark.  I was so incredibly grateful during the race that I didn't have even a single angle roll (big improvement for me!) and I only stubbed my toe a couple of times.  I was hurting at the end of the race, but hey, it is a hundred friggin miles, it should hurt a little, right?

Well, here we are three weeks later and my knee is still hurt, and what's worse for me as a type-A planner, the ART doctor is not sure what is wrong with it.  I have been foam rolling, stretching and getting ART a couple of times a week for the better part of two weeks now and my knee has not improved at all. 

I can bike, do the elliptical, yoga and some P90x, but running?  I can't make it more than a quarter of a mile without the stabbing pain that makes me pull up lame.  I am thankful to at least have other forms of exercise that do not hurt, but I want to run again, or at least know when I will be able to run again!

The pain is odd - stabbing/fire pain on the outside of my knee and near the fibular head, that comes when my knee is bent, typically after walking downstairs, walking after extended periods of driving, crossing my legs for too long or sleeping with my knee bent.  I haven't tried to run through it because I have been trying to be good and I certainly don't want to exacerbate it.

I have "passed" all of the clinical test, meaning I exhibit no pain when asked to push or resist the doctor at various angles.  That should be good news because it should mean that I do not have a tear or anything "serious", but if it were my IT band, it should be getting better by now, and honestly, my right leg (the side of the injury), is feeling pretty darn loose otherwise.  I do have muscle imbalances - strong quads and weak glutes, so I am working on strengthening my glutes, but my knee pain still eludes me.

I had x-rays done, which as expected, showed nothing, other than my right leg is 3 mm shorter than my left leg, so I need to add a lift to my right orthotic.  Good to know.  X-rays were step one before potentially getting an MRI if the pain doesn't stop.  So what's next in the mean time?  A week of seeing how things go with a re-evaluation the first week in March, which will be a month post race.

So, while I not-so-patiently wait to get better, I try to remind myself that this too shall pass, to be thankful for a successful race and to enjoy some much needed unstructured training and time off. 

Although, honestly, all of that would be easier to swallow, if I knew what was wrong so I knew how to fix it ...  

Oh, and ironically, I vaguely remember telling my pacer Eric I wasn't go to run for 2 months after the race - runner's intuition?

Have you had an undetermined injury and how did you overcome it?

Injury Update and What's Next

It has been two weeks since the 50K and things are starting to look up. I have learned over seasons of endurance training that if I don't let my body recover properly, I pay for it.

I am (loosely) following Hal Higdon's 4 weeks between marathons plan, which essentially has a reverse taper, two weeks of 30-ish mile weeks and then a taper the week of next marathon. He even encourages cross training in the two 30-ish mile weeks in place of running workouts, if that is what your body needs.

I have been spending some quality time on the elliptical to let my ankle recover properly and I think it is nearly 100% now. I did a 6 mile run today and felt great! My calf, which was bothering me for weeks before the 50K, still flares up, but it is manageable and I am doing calf stretches to improve the range of motion in my calf and ankle. Tomorrow is my first longish run (2 hours) since the race, so I will see how those deep muscles are feeling.

I am really looking forward to a bit of R & R this week beginning on Wednesday. I think it will be just what the doctor ordered for both my body and my sanity! It may even give me some time to reflect on what my goals (and ultimately) races will be for 2012.

Happy Training, Safe Travels and Happy Thanksgiving!