Well, another month has passed now, and i find myself back to rest, rest, rest...
The cycling went as i wanted it to, pushing my rides up to some days, 15km in a single cycle. Around an hour on the bike. My knee would start off sore in the first few minutes, and then warm up and i was able to get into a nice rhythm, but then usually, the pain would return and the knee get really sensitive around about the 45min mark.
In the end, after 3 weeks, and 240km cycled, i was forced to abandon the bike as my knee became really sensitive and painful even when not on the bike!
It was a big blow to my hopes of what last month could possibly hold in store for my recovery, but also forced me to go back to resting my leg again and see if i could relieve the pain.
This turned out to be somewhat of a blessing in disguise.
After a week of icing my knee and resting it during the day, with no exercise at all, i found that the pain was slowly dissipating. I decided to try some of my physio exercises on strengthening the knee. This once again sent my knee backwards in pain-ville, and i abandoned this as well and returned to total rest.
I decided to give the hospital that had been treating me a call and set up an appointment for yesterday. It was a month earlier than when i was supposed to be heading through to see them, but i needed some clarification on what was wrong, and how to proceed.
I have done a lot of research online throughout this adventure, post op, and i found a girl on an injury blog that was experiencing much the same symptoms that i was. I got chatting to her, and it turns out that after 2 years of exploring possibilities, a specialist diagnosed her with Iliotibial Band Syndrome, or ITBS for short.
It is a repetitive strain injury usually causing pain around the fibula head and anterior part of the knee. It can also be brought on by high impact injuries to the tibia/fibula/femur/knee.
The normal treatment is RICE - rest, ice, compression, and elevation.
I had long suspected that this might be the cause of the problems, but had been told repeatedly by my physio that i just needed to strengthen the surrounding muscles and i would be fine.
After my correspondence with her, and my personal experience on the bicycle, i was now more convinced than ever that this is what i was experiencing.
I called the hospital and setup an appointment to see the physio and also the orthopaedic specialist.
Yesterday was my visit, and i arrived and collected my file from the reception and headed up to see the physio.
He lay me on my back and checked range of motion and twisted and turned my knee, which produced quite a lot of pain. I chatted to him about what i thought the problem to be, and he seemed to agree, but stated that i needed to stretch out my quad muscles as they were very tight. He said that they were a bit better from when he last saw me, 5 months ago, but that they still had a long way to go, and that until i had them fully stretched out, there was no way i could exercise them properly.
He told me to use a hot water bottle on my quad and outside of the leg, where the ITB runs down from the glute muscle to the side of the knee. I was to warm the area up, and then to take a hard ball, like a tennis ball, and run it up and down my muscles and ITB, trying to release the tension in the muscles.
After i had done this for a while, and i could feel that they were more pliable, then i was to do stretches on them.
The best stretch for me for my quad area with the pain associated with my knee, is to lie on my stomach, and bend my injured leg as far as i can towards my backside, and then to take my good leg and wrap it around my injured leg, and force it as far as i can, further towards my backside. This produces a stretch in the quad area of my injured leg. Hold this for 30s, and then release to both legs lying straight out on the floor. Then repeat this another 2 reps at least.
For an ITB stretch, the best method for me is to sit cross legged, or as close as possible to this position as my injured leg allows, with my left (injured) foot over my right knee, and then to lean my upper body forward , and at the same time use my left hand to push gently down on my left knee, towards the floor. This produces a stretch that you will feel in your left ass muscle (gluteus), and possibly down the side of the left leg as well (which is where the ITB runs).
He heated up a bean bag in the microwave, and put it on my leg, and after it had warmed my muscles up, he did some deep massage on my quad and ITB. It hurt like hell when he pressed in with his thumbs, and this was without much pressure even being asserted! I realised that it is gonna take a while to totally stretch these muscles out.
Then it was off to see the orthopaedic specialist.
I chatted to him and told him about the continued pain in my knee and the biking i'd done, etc, and he sent me off for xrays of the knee to see if he could see anything unusual.
The xrays came back and we sat and looked at them and he said that my knee looked perfectly healthy. He was very happy with the healing of the bones, and also mentioned that he would not recommend taking the tibial nail out, as it was seated perfectly in the tibia, and would only cause a lot of damage to my knee were i to remove it.
He told me that he thought that possibly i might have ITBS. This was brilliant to hear, confirming my unprofessional opinion on things.
He said that he would give me a cortisone injection in my knee to relieve the inflammation, and help with the pain, and that for the next month i was to take it easy, and not do anything too strenuous on the knee.
So, like i mentioned earlier, i am now back to rest and recuperation.
In a months time, i have another physio and doctors appointment, and they will reassess the situation and see if the ITBS treatment has worked. If so, we can then move on to strengthening exercises again, and hopefully walking in the not too distant future! If the treatment has not helped, then they can at least cross ITBS off the list of possible causes of the pain, and we can explore things further.
I dont think that i could of hoped for a better visit to be honest. I am just a bit frustrated that it has taken 5 months of struggling along, only to find out that i need to go backward in order to possibly go forward again! At least all the strengthening exercises have not been in vain. I can certainly feel that i have a lot more muscle tone in my leg, so therefore more to work with when i do finally get back to strength training.
For now, stretching and rest.
And hopefully good news in a months time.... 8)
