Tour de Knees

Cycling has the Tour de France. Running has the Tour de Knees. What? You’ve never seen the Tour de Knees? It is a special athletic event. You only get to participate if you run your body hard, over a number of years. Then you have to endure multiple unanticipated traumas to your knees, resulting in vague symptoms that prompt your doctor to order MRI’s of both knees. Then one of your Sports Radiologist/Colleagues offers to sit with you during lunch and take you on a tour of your knees.

Seriously, I got to see my knees up close and personal a few Fridays ago. I haven’t had this much anatomic fun since my General Surgery attending in my third year of medical school allowed me to palpate all of the abdominal organs during an open hernia repair.

Let me give you some background. Last May, many of you remember my crash with a stationary concrete bench. As usual, I was socializing too much during a long run, and had my head turned, running straight into the edge of a concrete bench at a pretty fast clip. At the time, I couldn’t see the silver lining in this big ole giant thundercloud. All I knew is that when running finally was pain free, my pace group had built their long run up to 16 miles. After two months of persistent achiness, an MRI of the left knee revealed a bone contusion (bruise) of my femur and patella. I was cleared by my doctor to run, but out of respect for my body, I made a radical decision to give up running for 6 months and focus on building strength and losing fat. I celebrated the start of 2009 in the best shape of my life as a result of that bench.

Many of you might also remember my bike wreck of 3 months ago. I was providing course support to a 30K road race (running), and I was following the leader. Unfortunately, I forgot that some of the course is on sand, and I didn’t lower my tire pressure to off road levels. I was about halfway down the sandy path, about 200 yards behind the leader, no other runners anywhere near him (collegiate runner!). I didn’t notice the patch of thick sand and my rear tire fishtailed, taking me down hard, causing my new Terry seat to get up close and personal with my pelvis, and my right knee to become intimate with the road. It didn’t help that I had on my supercool Keen sandals with SPD clips—falling when you are clipped into your pedals doesn’t exactly allow you enough time to unclip and save your pelvis and knees from crash injuries. Naturally, I ignored the mild pain with kneeling, until my strength coach finally said to me that I should not still be having knee pain this far out. So enter MRI number two.

Tuesday after my MRI, I was driving to the track to run a series of fast quarter mile repeats. My family doctor called me on my cell with words that a runner never wants to hear, “Wendy, unfortunately, I think you are going to be taking a little time off.” My heart sank, I pulled over to fully concentrate on what he was saying. The radiologist had found a cartilage flap. Just a tiny one.

Of course I started bargaining with him, like I did the time I sprained my right ankle on a Tuesday and proceeded to run 10 miles on a Saturday without incident. I figured I could manipulate him again into giving me permission to go ahead and drive to the track anyhow, perhaps adjusting the intensity as necessary. No go. Bummer. He did say that he would defer to the Sports Medicine specialist that I would see on Thursday.

As I turned left onto my dirt road leading to my house, I was thankful that I was in my trusty Honda Element and not on my superfly Gary Fisher hybrid with my supercool Keen SPD clip-in sandals. Nope, I was just another dejected runner, wondering why I seemed to be such a crash magnet.

I decided to treat my body well over the next 72 hours. Lots of massage, foam rolling, stretching, good nutrition. I was well rested and in a good mood by the time I drove to the Sports Medicine doc. I was anxious as he prodded and palpated both of my knees. There was only one small spot that was tender, right underneath the kneecap on the right. All of my ligaments and tendons were strong and stable. He watched my gait as I walked, lunged and squatted. Both the fellow and attending were more than confident that the small cartilage flap had absolutely nothing to do with the bike wreck. And the mild pain was probably more of a strain than anything. Their advice? Don’t do sports that reproduce the pain, in my case, kneeling. So no more kneeling on the gravitron. No more kneeling so I can do pushups full range chest hitting floor. At least not until the pain stopped. And since running and lifting didn’t produce knee pain, I was all clear to run!

YEE and HAW! Naturally, I was tempted to run that night, but I decided to take yet another day off and wait until the radiologist saw me the next day. Usually, radiologists don’t sit with you and review films, but I earned my MD fair and square. And when he called me earlier in the week to go over my results, he offered to meet me over lunch hour on Friday to show me my knees. Hooray for professional courtesy!

The Tour de Knees was an eye-opening, and dare I say, knee-opening experience. The first thing that amazed me was how strong my muscles looked—the tip of the quadriceps as it wrapped around the knee joint from above, and the fibers of what would eventually become my calf muscles from below. And my legs looked so LEAN!! Like an athletes legs. Big strong muscles, not a lot of fat. So fun to see radiologic proof of my hard efforts!

He reviewed the cartilage flap while I pointed to the area of pain and described the pain. He agreed with my doctors, the superficial pain on palpation would not explain the deeper achy pain that I should be feeling with cartilage issues. His best guess? A patellar ligament strain. Same advice as my other docs, DON’T KNEEL.

But the most important part of this tour was the cartilage review. On both knees, I have some mild degenerative changes in my cartilage. We won’t ever know whether my history of obesity is the cause or my history of distance endurance sports—both cause cartilage stress. But none of my cartilage changes are career ending. In fact, he thought my knees looked really good for someone who has done all of the things that I have done. But as I sat and looked at the little divets of imperfection in my cartilage, I had one of those light bulb moments. I don’t want to be one of those middle aged, recreational athletes who runs themselves into a knee replacement at 55.

I suppose if I made my living as a professional endurance athlete, I might decide that it would be worth damaging my knees—just another day at the office right? But as far as I know, neither my employer nor my patients require that I run a specific marathon time and risk damaging my knee cartilage. But I know for sure that preserving my knee cartilage is essential to my functioning as I age. I want to be like the 82 year old woman at my last 5k, who ran a 31 minute 5k, clinching the 75 and over title by more than 15 minutes. And running for a lifetime is much less likely for me if I become like some of my friends and make marathoning a lifestyle. Maybe they are some of the lucky ones who have perfect knees? I now know that I don’t.

So I have one good final shot at a marathon personal best. And if my personal best is good enough to earn my ticket to the big show, the Boston Marathon, then, I guess I have two more marathons in me!!

But after the Tour de Knees, I have decided that if my best isn’t good enough on that day, I will celebrate anyway. I will celebrate, knowing that for one year, I gave everything I had in me and became the fittest, strongest, best runner I could be. I will celebrate, knowing that I am doing a good thing for my entire body by backing off on the distance running thing, and switching to distances that are less taxing on the cartilage.

Goals are wonderful things to have, but they can’t be so rigid that you are unable to adjust them when you acquire new data. I didn’t know that running into a concrete bench would ultimately result in the leanest, most muscular physique of my life. Just like I didn’t know that wrecking on my bike would result in changing my self concept from “marathoner is who I am as an athlete” to “marathoning is part of of who I am as an athlete”. Seeing potential damage and injury unfold right before your eyes in vivid anatomic detail is one of those data points that deserves to be recognized, and deserves an action plan.

My action plan is to respect my body and make this my last shot. Who knows what kind of silver lining lies around the corner? I just hope the corner is on a paved road, without concrete benches.