Monday, May 14, 2018
Mystery Solved - Baker's Cyst
After four days, last week, of indoor training on the Lemond direct drive trainer I
decided to hit the open road Saturday morning. Filled with trepidation.
Ten miles out I had to pull over because pain was so bad. I had a knee wrap
around the knee and I had a rolled up sock in the back of the knee to add
`compression' per R.I.C.E. I took the wrap and the sock off. I could barely
straighten my leg because the pain behind the knee was so bad.
I was thinking `O.K..Only one 16.2 mile lap today.' The `behind the knee'
pain was a good 8 out of 10.
I started to pedal carefully and slowly, a long hill coming up.
And then ... I became aware of no sensation of pain. None. None at all.
I concluded that this is just temporary, part of the `up and down' over the
past six months.
I geared down so as to not stress the right leg/knee. I crested the hill ... no
pain. Moved into a higher gear, carefully, slowly. No pain.
As the ride went on I continued to feel absolutely no pain.
Fatigue? Sure. I pushed it. Still no pain.
I pushed increasingly hard for the remaining 40 miles. Both legs and knees
were completely without pain. Sure, I felt the burn of the muscles with
increasing watts, the fatigue, etc. But absolutely NO pain.
I did an intense indoor training for a few hours the next day.
Again. No pain.
Back on the road again. What an ordeal!!!
Sunday, May 6, 2018
UPDATE re: The Knee and Tendonitis - May 6, 2018
Several months ago I began experiencing a growing ache in my right leg. At first I just racked it up to the usual temporary discomfort of sore muscles or something else that would work itself out. But then it limited my ability to stay on the bike at the November 2017 World Time Trials in Borrego Springs, CA. I got off the bike and elevated the right leg for about 90 minutes in total. That helped but it slowed me down for the rest of the event.
Over the next few months the discomfort continued and I found myself simply waiting it out and trying a few modifications to the bike. I decided that I pulled a tendon because I was extending my leg too far. I scooched the seat up closer to the crank to limit leg extension. That seemed to work for a while but when I was doing a lot of climbing in the local area the pain returned.
I waited it out.
The Pace Bend Ultra Race in Texas came in February 2018. I was hoping for minimal pain. It didn't happen. PBUR has several short and steep climbs that irritated the leg. I almost quit the event mid way but decided to simply ride as long as I could stand the discomfort and then stop and rest.
Returning home I consulted my primary care physician, had knee x-rays and then had a cortocosteroid injection in my right knee, making the assumption I had arthritic pain. That had no real effect. That is, after some rest and sedate cycling I started climbing the hills out here. The pain reappeared. In fact, through the process of elimination it became clear that I did have tendonitis and that the minimally present knee arthritis was not the problem.
Some time during late 2017 I must have injured the plantaris muscle/tendon. THIS is a link to a very helpful medical article, i.e., `The Plantaris Muscle: Anatomy, Injury, Imaging, and Treatment'.
Often called `tennis leg' the treatment is standard for tendonitis: RICE, i.e., rest, ice, compression and elevation.
First, I canceled participation in two ultra events in Texas taking place in early and late April. Second, I am training on the least challenging (i.e., flat) terrain in the area. Third, I moved the seat on my bikes up a few centimeters so as to extend my leg less, thus minimizing the irritation of the plantaris muscle. Fourth, I am using a corded (electric) hand held vibrator with a heated head on the plantaris muscle. And finally I am icing, compressing and elevating the leg after each training event.
I am not seeking chiropractic or physical therapy intervention. Given the location of the injury and the recommended treatment methods I believe that I am doing all that can be done on my own.
The most difficult aspect of treatment is `rest.' Minimizing intense training while still pedaling along at a sedate pace is as much rest as I'm willing to do at this time. I take two consecutive days a week off from training.
Practically and hopefully this treatment regimen will heal the plantaris muscle and allow me to return to more challenging riding.
Update: May 6, 2018
Over the past few weeks I've had good and not so good training experiences. In discussion with my primary care physician we agreed that an MRI would be in order. The MRI would show soft tissue (muscle and tendon) in clear relief.
On April 28th the MRI results came back. A completely severed ACL and a severely torn meniscus. No comment on Plantaris tendon muscle ... which I consider a failing of the radiologist completing the report. (Clearly, not a sports competent radiologist).
On May 2nd I met with a local orthopedist who confirmed the radiologists report. He had earlier commented that I was "a long way off from even thinking about a knee replacement." He still has that opinion.
The orthopedist casually noted that the completely severed ACL had probably been there for 8 or 9 years and the other ligaments (connecting the tibia to the femora) were strong and intact and the surrounding muscle was exceptionally good.
This supports my current thinking that the arthritis is of negligible consequence (i.e., no pain). It also supports my thinking that the Plantaris tendon remains the source of pain.
I have made an appointment (2nd opinion) with a highly regarded (and recommended) `sports' orthopedist in Phoenix in ten days. Among the treatment interventions he provides is stem cell injection into the tendon to hasten and strengthen repair and recovery. This and other issues will be discussed at our meeting.
In the meantime I have decided to minimize the stressful training due to the back of the knee tendon concern. I'm backing off power pedaling (i.e., heavy watts). And my training terrain is as flat as I can find in the local area. My tentative expectation is that this year will be the year of `loping' on the bike.
There are a few serious problems with `loping.' First, it degrades my power, strength and endurance for challenging events (overall body `softening'.) Second, demanding and challenging physical activity is, and always has been, a healthy form of expression. Without it I become anxious, bored and tend toward depression. (Staying Sane)
Anticipating the downside of a year of `loping' I am doing some cross-training with the indoor rower, i.e., the Concept 2. I've been an off-and-on user of the Concept 2 over the years and found it an exceptionally challenging device, one that will allow me to `keep sane' and maintain an emotional and psychological balance.
Whatever happens in the near term with the knee (rest, surgery, stem cell injections, etc) I will have the Concept 2 to keep me fit and sane.
More to come as time and experience inform me.
Over the next few months the discomfort continued and I found myself simply waiting it out and trying a few modifications to the bike. I decided that I pulled a tendon because I was extending my leg too far. I scooched the seat up closer to the crank to limit leg extension. That seemed to work for a while but when I was doing a lot of climbing in the local area the pain returned.
I waited it out.
The Pace Bend Ultra Race in Texas came in February 2018. I was hoping for minimal pain. It didn't happen. PBUR has several short and steep climbs that irritated the leg. I almost quit the event mid way but decided to simply ride as long as I could stand the discomfort and then stop and rest.
Returning home I consulted my primary care physician, had knee x-rays and then had a cortocosteroid injection in my right knee, making the assumption I had arthritic pain. That had no real effect. That is, after some rest and sedate cycling I started climbing the hills out here. The pain reappeared. In fact, through the process of elimination it became clear that I did have tendonitis and that the minimally present knee arthritis was not the problem.
Some time during late 2017 I must have injured the plantaris muscle/tendon. THIS is a link to a very helpful medical article, i.e., `The Plantaris Muscle: Anatomy, Injury, Imaging, and Treatment'.
Often called `tennis leg' the treatment is standard for tendonitis: RICE, i.e., rest, ice, compression and elevation.
First, I canceled participation in two ultra events in Texas taking place in early and late April. Second, I am training on the least challenging (i.e., flat) terrain in the area. Third, I moved the seat on my bikes up a few centimeters so as to extend my leg less, thus minimizing the irritation of the plantaris muscle. Fourth, I am using a corded (electric) hand held vibrator with a heated head on the plantaris muscle. And finally I am icing, compressing and elevating the leg after each training event.
I am not seeking chiropractic or physical therapy intervention. Given the location of the injury and the recommended treatment methods I believe that I am doing all that can be done on my own.
The most difficult aspect of treatment is `rest.' Minimizing intense training while still pedaling along at a sedate pace is as much rest as I'm willing to do at this time. I take two consecutive days a week off from training.
Practically and hopefully this treatment regimen will heal the plantaris muscle and allow me to return to more challenging riding.
Update: May 6, 2018
Over the past few weeks I've had good and not so good training experiences. In discussion with my primary care physician we agreed that an MRI would be in order. The MRI would show soft tissue (muscle and tendon) in clear relief.
On April 28th the MRI results came back. A completely severed ACL and a severely torn meniscus. No comment on Plantaris tendon muscle ... which I consider a failing of the radiologist completing the report. (Clearly, not a sports competent radiologist).
On May 2nd I met with a local orthopedist who confirmed the radiologists report. He had earlier commented that I was "a long way off from even thinking about a knee replacement." He still has that opinion.
The orthopedist casually noted that the completely severed ACL had probably been there for 8 or 9 years and the other ligaments (connecting the tibia to the femora) were strong and intact and the surrounding muscle was exceptionally good.
This supports my current thinking that the arthritis is of negligible consequence (i.e., no pain). It also supports my thinking that the Plantaris tendon remains the source of pain.
I have made an appointment (2nd opinion) with a highly regarded (and recommended) `sports' orthopedist in Phoenix in ten days. Among the treatment interventions he provides is stem cell injection into the tendon to hasten and strengthen repair and recovery. This and other issues will be discussed at our meeting.
In the meantime I have decided to minimize the stressful training due to the back of the knee tendon concern. I'm backing off power pedaling (i.e., heavy watts). And my training terrain is as flat as I can find in the local area. My tentative expectation is that this year will be the year of `loping' on the bike.
There are a few serious problems with `loping.' First, it degrades my power, strength and endurance for challenging events (overall body `softening'.) Second, demanding and challenging physical activity is, and always has been, a healthy form of expression. Without it I become anxious, bored and tend toward depression. (Staying Sane)
Anticipating the downside of a year of `loping' I am doing some cross-training with the indoor rower, i.e., the Concept 2. I've been an off-and-on user of the Concept 2 over the years and found it an exceptionally challenging device, one that will allow me to `keep sane' and maintain an emotional and psychological balance.
Whatever happens in the near term with the knee (rest, surgery, stem cell injections, etc) I will have the Concept 2 to keep me fit and sane.
More to come as time and experience inform me.
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