Week 13-14

Pretty much straight after I started to get pain on LEFT knee quad tendon (up and down stairs) I knocked off the weights and went for resting (with wretched knee supports back on again...grrrr). Despite resting I got gradual build up of palpable crepitus symptoms in patella and quad tendons of both knees along with that pain on the left quad tendon attachment. This big surge in problems above and below both knees is a real blow! Looks like the gym weights have been overloading the tendons (despite trying to focus on eccentric phase) but it took a while to build up and become obvious

RIGHT KNEE: On the plus the pain on the right patella tendon seems to have disappeared. Still feels wet, squashy (often) and very scratchy and crepitus and still with a tight MPFL. 3/5

LEFT KNEE: 3/5

Full List Of Symptoms

Thought I'd just jot down a list of all the various symptoms I've had. I get problems in both legs but generally the right is much worse

LL = Left Leg. RL = Right Leg

Patellar Tendon

• Diffuse and very nasty pain all across the face of the patella - spreading up from the lower focal pain spot (RL)
  
• Sharp pain just where it joins the patella - felt quite deep inside (RL)
• Occasionally unstable and gives way (RL)
• Audible crackling noise wen going from a straight locked leg to a small amount of bend whilst the tendon stays tensed (RL)
• Squashy feeling (RL)
• Does not look (when fully relaxed) quite as substantial as the left one and has a slight concave. No visible difference between legs when patella tendon tensed
  
• Palpable (but not really audible) creaking when the tendon is tensed a bit and then gently touched (LL and RL)
  
• As if my trouser knee fabric were wet and cold even when the skin in warm and dry - really weird feeling (perhaps neurological?) (LL and RL)
• Prickly burning feeling
  

Quadriceps Tendon

• Palpable (but not really audible) creaking when the tendon tensed a bit and then gently touched
• Warm (but not to the touch)
• Prickly, mild burning feeling
• Tingling (neurological? - in fact this was the very first symptom I ever had - imagine if I'd taken a few weeks out then...sigh....)
• Wasted VMO caused by limping and avoiding that leg

Also a very tight band going from my medial patella - I think this is MPF Ligament (might have aways been tight but I just noticed because I now spend so much time fiddling with my knees :)

Weeks 6 -12

So, from the start of this period I've put away the neoprene knee supports (which make me feel a lot more normal!) and been in the gym doing leg weights. Having read a bit about tendinopathy I've been trying to focus on the eccentric phase over the concentric phase.
At the start there was visible wasting of the right VMO (I guess caused by all the limping) and a dramatic strength imbalance. After gradually building up the weight over 6 weeks the legs were the same strength and VMO had plumped up on right leg. Gained a lot of strength back and was feeling very mentally positive. Did try a bit of cycling but that flared up the pain on the patella tendon.

But it's gone a bit wrong at the end of this period....Started to get pain on the quad attachment of the left knee. Carried on despite for a few sessions and then common sense kicked in (I've learned something after all!). Just going to rest for a few weeks and see what happens.

RIGHT KNEE: The weights do seem to have helped the pain and wet feeling in the right patella tendon - but still got plenty of stiffness, twinges and wet feeling there. So would still say this was 3/5 for right knee

LEFT KNEE: Pain at quad tendon attachment on ascending, descending, lowering and rising from sitting - but not to sharp. 3/5

Weeks 2-5

At the end of these 5 weeks my symptoms were:

• RIGHT KNEE: No pain across face of knee (big improvement!). Medial patella pain point gone but feels like a very tight band going from medial patella to underneath VMO I think this is my MPFL. Still focal point of pain just under right knee slightly to medial - intermittent (whereas was constant before the marathon whenever moving). Also the right patella tendon feels kind of wet and squashy. I can tense the patella tendon without pain now but can feel crepitus (and hear it at maximum extension). Lets call that 3/5 for future reference
• LEFT KNEE: No problems. So lets call that 0/5 for future reference
  

Originally I was thinking I'd got PFPS (Patello femoral pain syndrome) but now I reckon the pain across the face of the knee was just diffuse pain from the patella tendon and really its nasty case of patella tendinopathy - which is consistent with problems from the prev year. I had audible crepitus before the marathon and thought it was coming from under the knee cap -but it's clear now that it's coming from where the patella tendon attaches to the lower patella pole

Week 1

Here's how my knees felt this week

• RIGHT KNEE: awful pain all over the knee. Specific focus (palpable spots) of pain just below patella on the medial side and on the medial edge of the patella. Could not bear to bend it, move it or even really touch it. So lets call that 5/5 for future reference!
• LEFT KNEE: had a nasty bit of ITBS on the outside of the knee and a corresponding medial patella niggle. Lets call that 4/5 for future reference.
  

Getting up and downstairs with two knees out of action was tough.

The story so far...

January 2008 - I decided to run the London Marathon in the following Spring. The next 15 months were a roller-coaster ride of injury! Increases in my fitness were interspersed with long lay-offs. Basically I trained too hard and did too much road running causing all sorts of problems with tendinopathy of my quad tendons in both left and right knees and pain right on my right knee. The start of 2009 was pretty good but one hard, fast run in the dark, in the cold, in the rain, in mid March saw it all flare up. I struggled on and still ran the marathon, firstly because it was a goal I was desperate to achieve and secondly because I had gathered pledges and donations worth nearly £3000 for Oxfam. In an attempt to clear the injury I had never run further than 16 miles and had not run at all in the 6 weeks before the Marathon. It nearly worked and, by the big day, I could walk, ascend, and descend stairs without pain – but running still hurt.

So here's the thing – it was still one of the most amazing days of my life! Yes my knee hurt. Yes I wasn't fit enough. Yes it was a real struggle to get round. But I still got a time I was pleased with and the sounds, colours and crazy things I saw will stay with me forever. The relief of stoping after 4 hrs 16 mins and 3 secs of running was enormous and the sense of achievement is huge. Perhaps having to dig that deep (I never walked despite how tired and sore I was) has changed me a bit inside as well?

Of course afterwards, and the next day (in fact week) my legs (and feet and arms, and stomach and lungs!) were sore – but it was worth it and I'd make the same choice again any time. Before the Marathon I knew that I was letting myself in for a huge relapse with my right knee and, sure enough, it was extremely painful the day after and only marginally less painful now, a few days later.

Going into the marathon my plan was to achieve that goal and then take the time out from exercise to really sort out my knee. To rest, rest, rest until pain free and then work back in incredibly carefully. I am guessing this will take something like three months – but I don't really know. I am expecting it to be a bumpy road with slow progress and lots of disappointment. I am hoping that keeping a blog will give me an outlet for that frustration but also, hopefully, let me look back and see the progress I am making. I'll try and collate hints, tips, links etc. - I've a fair few already from the last year believe me! Perhaps this blog will also be useful to other people with knee problems.....