I recently described biking to my wife as akin to having an itch in the center of my back that I can only reach with the slightest tip of a finger. Sure, a little bit of relief comes from scratching with the tiniest surface area of my nail, but it's not really enough to make the itch go away. More dramatically and perhaps more poetically, I think of running as the only activity that silences the demons in my head, the voices that tell me how shitty I am and that I'm a fraud and that I'm wasting my short little life here on this planet. A good run, or even just the run I should be doing that day, will shut those guys up for good. But biking, at least, turns the volume down on their microphone.
This has not been the start to 2025 that I envisioned for myself. After running a fun, local race early in January, I got started building up to a solid training volume for the new year and quickly found my right knee irritated (see my last blog post). I was pretty convinced, and still am, that the source is patellofemoral irritation, commonly called Runner's Knee. On the date of my last post, January 22, I was confident that I'd be able to rid myself of the issue quickly and return to running in a relatively swift and efficient fashion. After all, I've experienced this issue before, and the previous two times taking about 4 days off from running allowed me to jump back into training without much of a hitch.
Lo and behold, it is exactly three weeks later and I still find myself saddled with this incredibly frustrating issue. Part of the problem is that I assumed this case would be roughly analogous to those I have experienced previously. That didn't seem like a ridiculous assumption at the time. But obviously, whatever I did to irritate that apparently very sensitive tissue around my kneecap this time has created a much more stubborn problem. The first 4 days off didn't solve the issue, and I probably returned to trail running a bit too early on in that part of the process. At this point I texted my PT for guidance. She generously spent some time with me on the phone giving me some exercises to do and helping to establish a more intelligent way to progress back to running.
Every morning before I walk my dog, I've started doing quad hurdlers to warm up those muscles. I've been rolling out every night and trying to increase a bit of mobility by doing yoga. I've been doing red light therapy a couple times a day (who knows right?). And some days it feels like some of this stuff works and other days it feels like nothing does.
I made the mistake last week of trying to accelerate my progression in order to try to be ready for a running trip I had planned with friends at the end of February. No luck. I'm now up to three cancelled trips because of this case of Runner's Knee. There's a lot that is frustrating about this situation, but what irks me the most is that I'm not exactly sure what my issue is here. It seems so unlikely that with my focus on strength training this winter my quads are somehow too weak. I've been following the normally prescribed protocol of running at an acceptable pain threshold (1-3 out of 10) and then judging whether it was too much based on my baseline level of discomfort after 24 hours. But so far, this just doesn't seem to be resolving itself the way I am so desperate for it to do so.
My PT described coming back from injury as being like a dimmer switch, the pain won't just all of a sudden go away but we are ultimately looking for a gradual decrease in discomfort. For picturing the process, it's a helpful simile. But it is still such a struggle for me moment to moment to figure out exactly how my knee is even feeling. For instance, today I woke up and did my quad hurdlers before walking my dog for a little over a mile. I did a short strength session that included plyometrics, nordic curls, and wall sits, all completed with no noticeable knee irritation. Then I started a flat road run, keeping everything feeling very easy thinking I would be out for 7-10 miles depending on how things felt. For about two miles I would describe the discomfort in my knee as hovering around a 1 or a 2, and then any kind of sensation completely disappeared for the next 8 miles. I kept my pace mellow, my average heart rate for the run was 109, and enjoyed a relatively anxiety free hour and twenty minutes. But after finishing that run, I made breakfast and sat down for about 10 minutes to eat and discovered to my dismay that my knee was hurting while just walking around! This hasn't been the case since I initially irritated it about 3 weeks ago. One step forward, 3 weeks worth of steps back.
It's baffling! I don't actually know how to moderate activity based on feeling when the feeling in my knee seems to be deceiving me. It's so confusing and frustrating. I would, in normal times, describe myself as a low-anxiety individual. But these past few weeks I've been plagued by anxiety, finding myself thinking basically all the time about whether or not my knee feels okay at any given instance. I write in my journal every day, and literally every entry since January 22 mentions my knee. I know how to meditate and I am doing my best to cope mentally without my normal outlet but apparently it's just not quite adequate. On top of being worried about my knee and catastrophizing about how this could affect my 2025 overall, the little demons keep telling me that I'm a fraud. "You're a coach, shouldn't you know something about how to fix this?" "Who is going to want to work with you if you are just constantly injured?" "You shouldn't have run on snow you big, giant idiot." There's a little bit more profanity involved in my actual inner dialogue with these monsters, but you get the picture.
For now, the logical part of my brain is still winning and I am not really all that worried at this point about how this minor issue could affect my races this year. I have been able to bike and ski without any pain, so at least I've been able to be outside and enjoy some of the unseasonably nice weather we have been having. But like I said at the beginning, running is the only thing that silences all this mental garbage I've got roiling in my head. So for now, I'm going to try to enjoy these other activities while slowly getting myself back into running and hoping that one of these days, fairly soon, I might wake up and not notice any kind of untoward feeling in my right knee. It is unbelievably exhausting to be hyper-fixated on this tiny corner of my right patella. I want to think about anything else!
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