Knee Injury Case Update: One Year Later

A year ago today I published two blog posts that had a profound impact on my life.

In Part 1 I described the chronic knee condition I suffered that had me recovering on crutches for 7+ months, nearly half of which kept me in my apartment on glorified bed rest. I detailed the chronological list of events that led me to that state, and the specific cocktail of remedies that helped me get better.

Part 2 was all about my reflections, and how going through the injury-recovery process affected me. The chronic case of synovitis and patello-femoral pain I suffered was only one part of the journey. What started as a physical symptom ballooned into a mind/body condition that required some deep internal exploration to dig my way out.

Hitting the publish button on these posts was therapeutic. I needed to get my story out into the world for myself as much as to share them with other people. There was so much pent up rage, frustration, anger, joy, and triumph that I had to document it all in one place.

So much has happened since then. I’ve been amazed at the reaction these posts received from friends, family, and acquaintances. People who had no idea what I was going through reached out with offers of support and encouragement. Others resonated with the core messages, revealing their own stories of struggle and ultimate triumph.

And yet others have reached out asking me for help. These are folks who are still in the thick of it, still struggling through some mysterious, chronic ailment or injury, wondering if, when, and how they will recover. 

It’s these people I think about whenever I feel like I might be ready to stop blogging on this site. The small trickle of emails I get from people wanting help, support, and advice as they recover from strange knee injuries tugs me at the core. If I can somehow be their one source of clarity through the mess they’re dealing with, I feel somewhat obligated to stick around and offer my story and experiences up for examination.

So with that, what follows is a chronological case update on my physical recovery since last November, 2013. I hope to follow up in the coming weeks with more posts about my continued recovery over the past year, and what I’ve learned.

November – December 2013

Even though I stopped using crutches to walk around back at the office in late October 2013, I was careful to avoid walking too far, or standing too long. My legs felt weak and fragile, almost like I was moving around on peg legs. A few co-workers mentioned I still had a slight limp when I walked, which made sense, given the crazy amount of muscle atrophy I suffered in my right leg.

Adding more time and distance was a slow process. But I was thankful to be walking again, able to participate in the world outside my apartment’s walls. For the first few weeks I limited myself to walking around the office and whatever room I was in, still taking cars and cabs everywhere I went. After I gained more confidence and stopped limping as much, I tried extending my walking to one block on flat land, then two.

At this time I had also graduated from water walking in the pool at CPMC to doing land-based physical therapy. My therapist, Jeremy, worked with me to slowly and steadily build up strength in my quads, glutes, and hips. We started every exercise with no weight at first, gradually building up to increasingly higher levels of resistance. These initial exercises included warming up for 5 minutes on a stationary bike, light leg presses on one of those sleds where you lie on your back and use resistance bands to increase the difficulty, quad and flute raises, and various medicine ball exercises on the floor. We also worked on light stabilization and balancing exercises as I progressed.

By the end of November I was able to walk several blocks, including the gradual incline up the hill to my apartment. I walked up this hill very slowly, since I was still weary of putting too much force on my knee.

January – June 2014

By this time I had started swimming laps in a pool by my apartment. I used a buoy between my legs to avoid having to kick, then eventually felt comfortable enough to start kicking lightly without using the buoy.

Once I felt strong enough (you’ll notice a theme here), I even started riding a bicycle trainer at work for longer periods of time, at greater levels of resistance. The first trainer ride I have documented was just 15 minutes of light spinning, but I soon started going for longer periods of time. About a month later, I even added a tabata workout to the mix!

That turned out to be a final test for me to see if I was ready for the real road. Later that week, on April 4, I took my bike out for a spin on mostly flat land (check out the ride here). It felt great to be moving my body faster than strolling speed! A couple weeks later, I commuted to work on bike my for the first time in a year and a half. Things were definitely looking up.

It’s worth pausing to take note of how I felt during these months. As you can probably tell, my criteria for deciding whether to add increasingly more difficult movements was based on how comfortable I felt at the time. While I was no longer experiencing the “old” pain deep inside my knee, nor was it getting swollen, hot, and red anymore, there were times it would feel sore after I pushed it too far. I would also commonly feel a slight pain/twinge in my knee whenever I stepped down from a step or sidewalk on my injured leg. This pain gradually went away as I got stronger, telling me I had built up enough muscular strength to support my knee, and that my envelope of function was increasing.

I can’t remember exactly when, but eventually I was able to walk up hills and stairs. For quite a while, I was still walking down stairs one step at a time, stepping with my injured leg to avoid the compression of bending my knee with each stair. After months of this approach, I was finally able to walk down stairs, which was the last “normal person” activity to come back.

Shortly thereafter, I started lifting weights again. Prior to this point I had been reluctant to perform even upper body exercises, since that would have required carrying weights around to load the machines and bars; I wasn’t sure if my knee could support that load yet. I started with mainly upper body lifts, and took things very very slowly with my lower body, with the guidance of my physical therapist (I was now going only once every few weeks). These exercises consisted of mostly hip hinges (a very modified version of an air squat), leg raises, balancing exercises, and extremely light leg press machine work.

The key was to take things slowly when I felt soreness and patello-femoral compression coming on. Even though I would get sore from time to time, it was a distinctly different kind of pain/soreness than what I used to experience at its worst. The discomfort I felt during this part my recovery was more of a general compression-based soreness, as opposed to the heat-and-swelling-inside-my-knee pain. I had confidence the discomfort was just a result of not having built up the necessary muscle strength yet to support my knee, since the pain went away, my knee didn’t swell, and as I got stronger I was able to do more without inducing that pain again.

June-August 2014

The slow, upward trajectory continued, and I was gaining more confidence each week. My assess and test approach was working beautiful, and I was pleased with my progress, if not entirely satisfied. I still couldn’t run and lift heavy weights, but those were small complaints given what I had been through.

In early July I downloaded an app called Bodyweight Training, since I wanted to vary my workouts and increase my heart rate. The app is set up tabata-style, with the ability to set the duration of your workout, as well as the difficulty level. I started at the “Novice” level, slowly building my way up to “Intermediate.” As I eased into the workouts, I was pleasantly surprised I was able to perform leg-centric exercises like 4-count bodybuilders (modified burpees), mountain climbers, and even lunges.

Soon I was biking to work more often, and riding around San Francisco on the weekends. On July 26, my confidence grew enough to attempt a ride up Hawk Hill, a notoriously difficult but scenic route on the other side of the Golden Gate Bridge. The ride was tough (check out my performance here), but when I got home I felt great! My knee wasn’t sore, and it felt amazing to push myself athletically again.

However, here’s where I got a little cocky. In the gym that same week, I decided to add more weight to the extremely light leg pressing I had been doing. The next day I also went an inch or two lower on the air squats I had added to my regimen as well. While my knee didn’t scream during those activities, I felt a twinge of pain deep in my knee as I walked to work mid-week.

Oh shit, I thought. I hope I didn’t just F things up.

It was a pain I hadn’t experienced in many months, more similar to the “old” pain deep inside my knee than the more superficial “compression” I had been experiencing throughout PT. I hoped it would go away by the next day, but it didn’t. It soon became apparent that I had reset my envelope of function back a few months, and was no longer able to perform certain activities without causing the deep, aching pain.

While that sucked, here’s the crucial piece – I knew how to handle it. I reverted back to what worked for me a year ago, first assessing everything I could do without causing my pain to get worse, then limiting myself to only those activities. I stopped going to the gym and biking to work, I returned to walking up and down stairs one step at a time, and I stayed in on the weekends to reduce the amount of walking I had to do. I also iced my knee once or twice a day for 10-20 minutes at a time, and added back turmeric, garlic, ginger, and collagen to my diet to provide joint and anti-inflammatory support.

I was still nervous though. A long-anticipated vacation was approaching in mid-August. It was a two-week trip to Croatia, a place that had long been on my must-see destination list. I really wanted my pain to go away before I left, but unfortunately that didn’t quite happen. I felt well enough to travel, but definitely not where I was one month prior. Upon arriving at my hostel after a long flight and carrying my bags through several airports, my knee was killing me. I worried my vacation would be drastically altered, and was kicking myself for pushing my recovery too far in late July.

But then something crazy happened… My pain dramatically decreased three days later, even though my activity level increased. What happened to achieve that result? I have a few theories.

For one thing, I was eating some amazing, nutrient-dense food known to reduce inflammation and support tissue healing. This included fresh oysters, fish, and seafood, as well as local figs and berries. The water in Croatia is some of the cleanest in the world, which may have also played a role.

Secondly, I used two “traditional medicine” interventions that I found effective a year earlier. These were (1) applying Voltaren gel to my knee a couple times a day, and (2) using the McConnell taping method to reduce compression on my patello-femoral joint.

The third part of my theory involves a day trip to a waterfall in Bosnia and Herzegovina. I spent almost an hour with other travelers swimming in 50 degree water beneath some beautiful waterfalls. This essentially served as an extended ice bath, and my knee felt better immediately after I stepped out of the water. Add in all the vitamin D I was getting from being out in the sun all day, and it appears Croatia was just the elixir I needed to get over the biggest setback I’ve experienced during my recovery. My pain gradually decreased throughout the trip, despite the extensive walking, hiking, and swimming I would take part in over the next two weeks.

My ability to bounce back this quickly gave me a ton of confidence, and validated the formula I previously used to recover initially. While maintaining an activity level in line with your envelope of function is a crucial piece of healing and recovery, there are other factors in play as well, including diet, icing, medicine, and mental state/stress. I fought through a big setback successfully, and was more confident than ever I would reach 100% health again.

September – November 2014

Since returning from vacation, I’m hitting the gym again, but have eased away from lower body exercises. Instead, I hopped back on the bike and started swimming more frequently. I also had a check-up visit with Dr. Dye recently, and he confirmed that leg presses and squats put way more pressure on the knee joint than activities like biking and walking up hills. So there’s no need to test myself beyond what’s proven to work at this point. I’ll stick with my basic formula, and slowly build up my strength through other means.

Overall, I’m still pleased with the progress I’ve made. While I’m not running, jumping, and participating in sports yet, I’m thankful I can move and do all the things that let me participate in life’s adventures.

It’s all onward and upward from here.

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5 thoughts on “Knee Injury Case Update: One Year Later

  1. Thanks for putting together this insightful blog, I really appreciate it. I have experienced a similar type of setback, except dual knees, and have seen many of the same practitioners you describe, Dr. Dye, and Dr. Ma. My injury occurred 15 months ago and I have been in PT for most of that time and also over the past summer added Bikram yoga and swimming. Not seeing any real improvement, this past Thursday, I went back to Dr. Dye. Dr. Dye believes I have a bad case of synovitis, and for now has couseled me to rest to ensure I am able to get back to a no pain state and then as my envelope of function increases, slowing add the stationary bike at home. Dr. Dye will do an X-ray and do a bone scan in a few weeks to ensure nothing else is causing this problem. I’m icing two to three times per day, and also taking Piroxicam( a one a day anti-inflammatory). After one week of rest I am noticing some improvement. I’ve eliminated most activities, driving, stairs, walking, and I am generally in my lounge chair at home with my legs up and only walking for bathroom breaks. I am crawling, not walking, upstairs to go to bed. I’m fortunate I can work from home and have a partner who is helping with meals. I’m generally on a nutrient rich diet and like you have eliminated the grains, do pasture raised/organic veges and meat and wild/fresh seafood(when possible). I’m also doing collagen and Vitamin C supplements. So thank you again for taking the time to put your blog together..any other advice, I’ve read all your blogs, would be appreciated. Take Care, David

    1. David,

      My apologies for the severely late reply; somehow your note got lost in the shuffle of my inbox!

      I’m curious – how are you doing these days? What were the results of the bone scan, rest, and anti-inflammatory meds?

      I hope things have played out for the better, and look forward to hearing back from you.


  2. Thanks for the wonderfully insightful posts on PFP and your journey, Bryan.

    I’ve been wondering for some time if chronic / severe PFP-related injuries are as much to do with the mind as the body. Despite PFP being common, there seem to be relatively few online accounts of struggles as involved as yours (and perhaps mine). The theme among those accounts? Seemingly anxious, type-A personalities.

    You have clearly made this connection too; however, it strikes me as odd that you attribute your acute recovery in Croatia to nutrition, topical NSAIDs, etc.

    Did you ever question how your state of mind, on vacation, a million miles from home in a wonderful location, altered your condition? I suspect more than you’ll know and certainly more than the oyster you were downing ;)

    You’re probably fed up with this subject matter but if ever you’d like to chew the fat – please drop me a line. Either way, all the best.

    1. Hey Thomas,

      Thanks for the note! I actually agree with you entirely – chronic pain is definitely a mind-body phenomenon. My initial posts allude to as much. Regarding the Croatia trip, I just wanted to explain what I did, along with the outcomes I observed. You’re correct in asserting that reduced stress may have had something to do with my quick recovery; though at the time of feeling a recurrence of pain on the first day of that trip, I was anything but stress-free!

      All this to say that I believe chronic pain is a mind-body condition, meaning the recovery formula requires a mind and body approach for most people. At least that was the case for me :-)

      Happy to chat anytime about this, so don’t ever hesitate to shoot me a note.


      1. Thanks, Bryan.

        May I ask – as it has now been some time since your post – how are you faring? Are things back to normal? I sure hope so.

        I reckon I’m currently where you were in about March 2013. Almost a year post-injury, and a heck of PT later, sees my knees in their worst shape yet. I have been implementing ‘relative rest’ (no lower-body exercise, limited walking, stairs, etc.) with little improvement. Admittedly, I could still rest a whole lot more. I will start on Celecoxib (oral NSAID) next week prior to taking some time off work if necessary. I’m just concerned that immobilisation has some dangers too (I note you unfortunately developed CRPS along the way).

        With the power of even more hindsight, if you had any tips or advice over and above what you’ve already written, I’m all ears! Cheers.

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