Not The Bee's Knees: My Running-related Injury

It's official. I have my first sports-related injury. Before I go any further, I want to preface this post with the following: While I am a physician who is licensed to practice in the state of New York, please do not use my comments in this post to make an attempt to diagnose or treat any knee pain you may be experiencing. Nothing can replace the value of a good clinical history and physical examination so please see your family physician, physiatrist, or physical therapist in order to be accurately evaluated.

Now that a disclaimer has been placed, back to me. Last week I wrote about the knee pain I experienced at the most recent race I ran, the UAE Healthy Kidney 10k. This was the fourth race I ran since taking a year off from running, and also corresponded with my fourth episode of sharp left-sided knee pain. In the previous three races, my pain started vaguely, around mile 2, and progressively became worse, especially when downhill segments of the race course were encountered. The pain resolved over the next 24 hours as I limited physical activity, iced my knee and intermittently wore a knee brace. Rapid flexion or extension of the knee, as occurs upon getting up to stand from a seated position, or vice versa, caused excruciating pain. It was all very debilitating, as you can imagine.

At the UAE Healthy Kidney 10k, pushing through, "I will complete this race. I will complete this race!"

At my last race, the pain started much sooner, within the first few minutes, in the early part of mile 1. Alarm bells started to ring, but the competitor in me wanted to complete the race. Although I did run/walk/limp the 6.2 miles to completion I decided that I could not keep doing this anymore, especially if I wanted to run the 9 New York road runner races to guarantee NYC Marathon eligibility for 2012, and so I made an appointment to see a physiatrist.

When you decide to go to a teaching hospital, as I did, you should be prepared to repeat your clinical history twice, and sometimes even three times, before you will be seen by your actual doctor. I was first seen by a nurse, then a resident (physician-in-training) with a medical student in tow, and finally by the physiatrist.

While some may find this system this annoying, I don't mind it. I have been on the other end, as both a medical student and a resident; nervous that the patient will see through my cool physician facade and realize that I am, in fact, merely, in-training; anxious about blanking out when quizzed about the diagnosis by the attending, and just overall apprehensive of making a fool of myself. The system serves a purpose, and that is to teach the residents and medical students the ability to autonomously and confidently make a diagnosis, and thus pass the threshold into becoming a real doctor.

The resident asked me many questions, which I answered as thoughtfully and accurately as I could. She then examined me. This did not yield much as my painful episode had subsided by this point. She just had to go by my description of where the pain was located, how bad it was on a scale of 1/10, and so on and so forth. Afterwards, she rubbed the side of her forehead and said "I really don't know what it could be..."

I knew she had to go and report her clinical impression to the physiatrist so I decided to cut her some slack and say, "I think its iliotibial band syndrome." (I had researched my symptoms beforehand and had a pretty good idea of what was going on with my knee). Her face lit up and she nodded, "Yes, that's probably what it is," and left the room, promising to return with the physiatrist.

When they returned, I repeated my story to the physiatrist. After he finished examining my knee, he turned to the resident, beaming, and said, "I completely agree with your diagnosis of iliotibial band syndrome."

I tried to catch the resident's eye to give her a conspiratorial wink but she did not look me. Well, at least she will always know how to diagnose an iliotibial band syndrome!

Source: www.sportsmd.com

Iliotibial band syndrome is a common cause of knee pain in runners. In this condtion, the iliotibial band, a thick band of fibrous tissue connecting the hip and knee joints (see above), for a variety of reasons, becomes inflamed, causing pain on the outside of the knee. The cause, in my case, was increasing my mileage too quickly. After taking a year off, I resumed running in the beginning of March, running short distances, never taking it beyond one or two miles. Since I ran regularly before the hiatus, I felt invincible enough to tackle a 10k in April, with no proper training. Bad idea apparently. So the take-home lesson is: Always train for your races! It is not worth getting injured.

Crossing the finish line (far, right, in the green t-shirt)

I start my 4-week treatment plan with a physical therapist this week. It is a bit disheartening not to be able to run especially now that the weather is getting nice. But hopefully I should be back, hitting the Central Park concrete, in July. Until then I shall live vicariously through the race recaps of all my favorite bloggers!

Have you ever had a running-related injury? Or dealt with iliotibial band syndrome?