Hello, it’s been awhile and it’s because I have been managing a knee injury, more specifically chondromalacia patella. I drafted a post very similar to this one at the beginning of December and well…I never pressed publish. Probably because it was just a bunch of ranting with no answers. I can actually write this today with answers….slightly.
If you missed it…
If you missed it, my knee started to bother me during my 14th week of a 16 week half marathon training cycle back in September. I was devastated. When you put that much into something and it just falls apart can really just bum you out. I didn’t think it was anything major, so I hoped just taking the last two weeks off would leave me feeling up to par on race day. It didn’t. I managed to make it to about mile 8 before I had to walk. Which when you know it started bothering me during the first half mile, should say a lot about how it’s not a pain that keeps you from running. After 8 miles, it was a bit nastier. But then with some walk/jog it held up okay.
It was quite angry with me afterwards and a few days afterwards, like any body is after a half marathon. I tried to do a few more runs here and there because I really wanted to do the Tunnel Hill 10 mile race. I had been wanting to do this race since we moved to Southern Illinois. The day before the race I decided to meet with my primary care provider since the Ortho in town said I had to do that first. (Side note: lots of insurance irritations within the system happened to me throughout this process and I may do just a snippet of that in case anyone finds themselves in the same boat.)
Imaging and Results
X-ray was clean – ortho referral was sent and I went and did my race. Doc approved based on x-ray. Race went awesome. My knee was taped. I just ran for fun and had a blast. Didn’t bother me too much during the run. was also on pretty smooth trail and not any crazy elevation.
Finally got into the local ortho, he wrote a bunch of possible diagnosis’s down and prescribed PT. I’m sure anyone can feel my struggle when I already was rehabbing during all of this time and I did not want to pay a co-pay 2x/week for 6-8 weeks before finding out what was wrong or doing the things I was doing already at home. I went to one appointment and canceled the rest. I was then told that I would not be able to get an MRI without going to the rest of the appointments. (Another insurance grumble.)
I found out the Ortho who diagnosed and performed surgery on my bi-lateral compartment syndrome in my legs during high school had actually joined a location about 45 minutes from me. He was also in network with my insurance. They got me in right away, along with new x-rays and an MRI, same day. He said I had chondromalacia and that the next nonoperative measure would be a corticosteroid injection. I normally shy away from these, but I trusted him. He said not to run for 4 more weeks until the follow up and keep doing my at home exercises.
Diagnosis: Chondromalacia Patella
I googled chondromalacia when I got into the car and then hoped the injection worked. I then asked for the office notes to be sent to me because he talks so fast and I really wanted to figure out what was going on and what else to do. Fast forward to the week before my appointment and I email to see if I should test running before my follow up, since that’s when I notice it most. They said yes. I made a chiro appt to make sure everything is intact before I try to run. She mentioned that most inner knee issues are from the SI joint and also weak adductors. I continued rehabbing.
The day before my appt I get a phone call that my ortho is no longer in network because after the new year they switched companies. So my follow up was canceled. I had a cry and then asked myself why was I upset. It wasn’t because of the appointment, it was just the realization that it was 3 months later and I still wasn’t running. Well, I went running. Walk/jogging to be exact and I went 2 miles and it felt fine.
I went back to read the office notes again because I just felt helpless. Thinking that maybe I had something else. But when I saw the exact diagnosis mild chondromalacia of the medial facet
of the patella and that is exactly where it is. While I didn’t have the follow up, I at least got an answer and diagnosis.
I rehab specifically for chondromalacia patella now and I am easing into running with walk/jog combos that feel good and will progress until I can run fully without any trouble. Right now I am just doing what I can with the resources I have.
Insurance Headaches
The insurance pieces that frustrated me, which I am sure the locations just do this to protect you but:
- my insurance says I do not need a referral from my primary to see ortho (maybe this was that location specifically and their rule?)
- A pre-cert was not needed for an MRI, so the threat of me not attending my PT appts would not get my insurance to approve my MRI was not great. The other location that did it same day, my insurance covered. It has already processed.
I know it always feels like you are having to jump through hoops, and that was what was so frustrating about this. Not only could I not do the thing I wanted to do, but I felt like everyone was just robbing me and taking advantage of me. Once again, I get this is probably protocol, but it still never feels good to someone who has the tools and is just looking to get a diagnosis.
That’s the injury recap. Basically a “time will tell” feeling is what I have. I will continue to put in the work and balance with biking and hope I can make it to the start line of the Christie Clinic Half Marathon, or at least bump down to the 10k.
I’ll be bringing back my training blogs, but they won’t be as exciting as I put in some base work.
