Knee Update: I Know My Enemy

On Monday lunchtime I met with the knee doctor – who surprisingly was a bit more compassionate this visit (I suspect it is because he had a medical student shadowing him…) The result were not unexpected – clearly I am not doing my knees any favours by running, yes there is something wrong with my left knee, and yes I do need to seriously reconsider if I continue running weighed with the risks associated with doing so.

The Results

I admit it – I am a pictures junky.  Nothing helps me to understand a situation like a little visual.  And the photos show very well what is going on with my knees.


Patellafemoral Dysplasia

What does this mean?  Basically, both my knee caps and the groove in which they sit are too shallow, like saucers rather than triangular sat in a deep valley.

Source: random search on google images landed me here

The good thing about this image is that it shows that my kneecap is in alignment with my knee joint – which for my entire life people had suspected was not the case. This means that one of the scarier surgeries the doctor had mentioned during my first meeting – realignment – was completely off the table.  He seemed pleasantly surprised by this alignment, as I just don’t look very aligned when observed without images. 

The image also goes a little way to explain why my knees so easily dislocate – the groove for the kneecap is just not deep, it is easier for it to slide.  Also, great finally knowing – years after my release surgery but still, information is always welcome!

Patella Alta

What does this mean?  Basically, my kneecap sits too high.  The numbers on the image are distances.  The ratio of the cross section of the knee cap to the distance from base of kneecap to tibial head should be 80%.  Mine measures 60%. 

The consequence of a kneecap too high in the joint is that during impactful or intense exercise (squats, lunges, heavy weights, running) the upward force from the thigh coupled with the downward motion of the lower leg pushes the kneecap backwards.  In a “normal” joint this is backwards into the joint, the natural gap between tibia and femur.  But when the kneecap is high, this is back into the head of the femur.

The consequence of this is damage to the cartilege on both the back of the kneecap and the head of the femur.  And in the case of my MRI you can also see a white spot – which is a bone bruise, probably reason why I am now feeling discomfort in my leg. It is also nice to know that I am not going completely insane or tending toward hypochondriac or over-reactive when I sent my physio Ellis an email exclaiming “oh my god what if I have a stress fracture” – comfirmation that the bone does indeed show signs of hurt.

A Binary Diagnosis, Creating a Soft Landing

There is something about visiting a doctor that always scares me.  It is like they have some sort of power with their words to somehow immediately and profoundly change the course of your life.  Something so final about a diagnosis.

I guess, all things considered, it is not a surprise that the doctor said to me “Stop Running. Now.”  I have always known that I have bad knees.

And there is something so deeply depressing about seeing the world in such a binary way – yes or no, right or wrong, good or bad.

I gave myself a day to wallow (which randomly coincided with a day where I also was feeling sick… Related?) and woke up this morning with a much clearer head.

Now it is time to create a soft landing for myself – the end to this chapter.  I have a few more appointments to see to – a second opinion from a knee specialist, a sports physician appointment.

But if I am honest with myself – has anything really changed from my first running steps in 2009—besides my thinking?

The answer is a resounding “No.”  Except for the clear evidence of bone bruising, and how that exactly happened I do not know – was it too much loading at bootcamp with weighted squats?  Was it an intense run technique session?  Was it random wear and tear?  Who knows.

And now I know my enemy – I know the medical names for what is wrong with my knees, I know how these things contribute to my history of knee dislocations, I know how they have led to the knee swelling and pain I now have.  And I know the risk of continuing down a path of longer and more intense running – further degradation to my knee joint, increasing the need for a knee replacement in the future.

What I don’t know at the moment is how my actions are likely to increase my risks.  I don’t know yet if there are other people managing similar situations and running.  I haven’t begun to do the research. I haven’t begun the process of informing myself beyond the binary diagnosis.

So that is what I am going to do. I’ll be seeking more information.

But mentally I am treating this season as the final season I will be running. I have to pay attention to how my knee feels.  No more stubborn completions of races like I did at the Paratriathlon Nationals. No more denial that running has been anything but hard for me – because of my knee issues.

I am in the process of accepting a change of direction – but there is no way that a change in direction means giving up an active lifestyle, or that a change of direction means defeat. It is just A CHANGE.

So… My participation in the British 10k for the Hypermobility Syndrome Association will be one of my swansong running events.  So appropriate – my diagnosis and decline from Charcot Marie Tooth disease is what go me involved in the multisport lifestyle, Hypermobility Ehlers Danlos Type 3 is what will be shaping the future directions I take.

Note: I’d like to thank everyone who commented thoughtfully on my Facebook posting about “retiring” from triathlon. When I took up triathlon in 2007 it was a way for me to manage my health and my CMT.  When I embraced the multisport lifestyle in 2009 I discovered that a regular active life helped me to be a better me – to do what I had never even dreamed was within my realm of physical capability. To hear that I would have to stop one of the three components of triathlon was hard – it is through sport that I have discovered a way to be healthy, to live a balanced energetic and adrenaline filled life.  I’d especially like to thank my friend Hilary for her post.  Little does she know but in 8th grade at Camp Mokuleia the way she treated me – as a friend, without cliques getting in the way, telling me to try things I was scared of, cheering for me on the zip wire – those memories are a big part of what I draw on today when I face the unknown.  And right now it all seems a little unknown… By no means do I intend to give up the active healthy life I have built for myself. Facing my fears, challenging myself, pushing my limits – that is in my DNA. 2013 is the year I continue to challenge my limits with triathlon – and the future? There are still many paths to travel, many limits to discover, and beat.

3 responses to “Knee Update: I Know My Enemy”

  1. Well…I am so sorry to read all of this. What is it about life that sometimes forces us to give up the one thing we love most?

    I hope that you will find that there are ways to manage this diagnosis and still run (even if at shorter distances).

  2. Donna, I’ve been inspired by your attitude and outlook for several years (and there is no doubt your positive and frank perspective encouraged me to take up triathlon). I look forward to “watchin” where the next adventure/challenge takes you!

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