The Medical Care I had before starting this Blog

This might be useful for other people under treatment. Loads of detail below - but here's a summary:

• GP's didn't seem to know much about these kinds of problem
  
• Expensive MRI's confirm what a (free) good understanding of the symptoms can tell you
• A good physio is a god-send - but you need to explain very clearly where it hurts and how so they have fair chance of helping you
  
• There is still a common approach to offering steroid shots - and I've read bad things about their long term effect on tendon health
• Lots of folks warned me away from surgery!
  

June 2008: Saw GP (doctor) because I was getting come crackling when bending knee and a tingling on side of right knee and bit of tingling on quad tendon. Told me to stop running but carry on swimming and cycling to keep fit, Prescribed ibuprofen. So told me nothing I didn't know and not very supportive and did not prescribe any specific exercises/stretches or refer to physio

July 2008: Got some spots of pain on the knee so (still not running) and started seeing a private chiropractor. I was not great at describing where it hurt and she went down the path of patella tracking causing rubbing and soreness (under the knee cap). Not the right diagnosis - but not really her fault. Very emotionally supportive - got me into some good stretching routines. Introduced me to the idea of trigger points. Also suggested I get sports massages. I was still cycling and swimming (which I think was probably bad) but all of this (plus, of course, the time off running) helped to reduce the quad tendinopathy. Back to running at start of October

Jan 2009: Through the Autumn and winter I trained hard and ran a half marathon. Was still getting some quad tendon niggles but managed them with stretching. But then after a long run (14M) a few weeks after flu, in the cold I got the first taste (of what I now know to be) patella tendon problems -sharp pain just under the kneecap and also a flare up of the quad tendon as well. Went to see a private knee specialist because I wanted to know what was wrong. Had an MRI and he was able to diagnose the quad tendinopathy but thought the lower knee pain was wear under the knee cap (no MRI evidence of this though). Offered a intra-articular steroid shot for this which I took (probably a bad call given that it was really my tendon that was the problem - but where the pain referred made it hard to describe at that time). I've uploaded one image he gave me. The paler parts on the quad tendon he said where the tendinopathy. I'm no radiographer.....but isn't there one of those a but further down below the patella as well? Anyway the jab worked like a dream (hmmmm..perhaps I was more inflammatory than tendinopathic at that point - otherwise I would not have thought the steroid would have done much). So this was expensive only partially correct, but I was back to running and now knew about tendinopathy. Started seeing a physio at this point as well. She was fab - got me strengthening my hips, more stretches, regular sports massage and strength exercises for VMO, buttocks. She also explained about eccentric exercise - but I did not do much of them (she gave me lunges which I hate!). Good emotional support and encouragement as well

March 2009: Through Jan, Feb and March I gradually eased back in and got up to 16 miles as my longest run - before a short but fast run caused the patella tendon pain to reoccur. Resting did nothing, tried to run anyway (felt really stressed as I'd raised 3K for Oxfam for the marathon in 7 weeks time!) the pain got really bad (in fact it has never been anything like as bad as it was at the end of March when I could barely walk). Saw the GP (different one) who had got the private MRI results - he agreed with the consultant and offered another steroid shot intra-arcticualr. I had a niggle this was a bad plan but just wanted it to work so I could finish my marathon training - so took it). Did not work this time - so I'm now guessing I now had tendinopathy rather then '-itis' type inflammation. The pain was now so diffuse that it felt like the whole knee - so the physio still never got to a diagnosis of patella tendinopathy - but I was rubbish at explaining exactly where it hurt.

April 2009: Rested, swam legs only and did leg strengtehning. Was getting patella tendon pain throughout. Just before the marathon the pain went (for walking - but would come back from running) and I could feel my right MPFL was tight. Pressed on and did the marathon - wow! what a fab day - but painfull ;-)