This is the first of two posts explaining my one and a half year recovery from a chronic knee injury, and reflecting on the experience. You can read post two here. This post explains the onset and recovery of my injury in detail. 

Part of what kept me going was knowing I could share my story and hopefully help other people. I view these posts as part of my healing process. 

This is for anyone who has been diagnosed with patellofemoral pain syndrome (PFPS), synovitis, or a chronic injury of any kind. My hope is to provide the specific, detailed information I found so hard to find as I recovered from my injury. I’m still not 100% recovered yet (physically, mentally, and emotionally), but feel well enough to share what has worked for me.

Last week was my first without using crutches in over 7 months, and over a year and a half since my initial injury. If you’re going through anything what I went through, it’s important to know you can get better. You will get better. Never forget that.

Below is a condensed timeline of my injury and recovery, as well as the healing formula that worked for me. It’s important to recognize there was no magic bullet that helped me heal – it was a combination of everything together that ended up working.

I’ve also included a list of articles and resources I found helpful. Please leave a comment if you have any questions or feedback, and I’ll try to address it in an updated post.

Injury and Recovery Timeline

• I injured my right knee running up a steep incline on February 12, 2012. I thought nothing of it, so kept on running. After completing a 5 mile race, my knee was swollen and in pain. I knew something wasn’t right.

• I “rested” on and off for the next few months. I was still active and could do things, but felt pain when I pushed too far. With the assistance of a chiropractor, I continued to lift weights and even ran three races in May. The chiropractor said there was nothing structurally wrong, and it was just inflammation due to improper patella tracking and muscle imbalance. I used KT tape and Advil to get through the races.

• In June I saw two doctors who specialized in sports knee injuries. Both diagnosed my injury as “Patellofemoral Pain Syndrome.” I took an x-ray, which showed a faulty Q-angle, but no MRI. One doctor used a step-down test as part of his diagnosis, having me perform a partial one-legged squat with my injured leg as I stepped down with my left leg. I didn’t quite understand how fixing this maneuver would decrease the inflammation in my knee, but I went along with it. He prescribed physical therapy to strengthen my muscles, improve my balance, and correct my patella tracking issues.

• From mid-June through December 2012, I went to two separate physical therapists, with no progress in relieving my symptoms. At various points this therapy included: balancing exercises, lunges, one-legged step ups, stepping sideways with a band around my legs, balancing on a BOSU ball, riding a stationary bike, deadlifts, quad strengthening on a sled, using a Stair Master, heel slides, quad sets, bridges, air squats, and stretching. At one point my doctor told me I needed to “start running again,” to test the upper bounds of my pain threshold. When I switched physical therapists in November they told me to stop doing that, but this should give you a picture of the kind of advice I received.

• During this time I also took an oral anti-inflammtory medication for ~2 months. I stopped taking it after a while, as I wasn’t seeing any benefit.

• I finally got an MRI taken in December. Just like the x-ray, the results showed nothing conclusively wrong. The doctor told me I had inflammation within the knee joint (which we already knew), as well as “bone marrow edema” in my patella (which means general inflammation in my patella).

• I researched patellofemoral pain syndrome online, and found an ebook titled Save Yourself from Patellofemoral Pain Syndrome by Paul Ingraham. Looking back, the $20 I spent on this ebook was the best decision I made throughout my entire recovery.

• At this time, the pain I felt was primarily limited to the outer side of my knee, as well as “inside” my knee underneath my patella when it was bent in all the way. It hurt when I overtaxed it by walking too much, picked up weights at the gym, and walked up and down hills (especially down hills). The pain felt like a dull ache most of the time, but would become sharp when overloaded. I hadn’t experienced swelling since my initial injury back in February.

• In January 2013, as a last-ditch effort to relieve my symptoms, I received a cortisone injection in my right knee. The initial swelling from the injection went away after a few days, but I started to notice my knee would swell even after just walking around at work, which it had never done before. I completely stopped physical therapy at this point, seeing if resting my knee even more would help. After about a month of pure rest, it didn’t get any better, and my knee continued to swell and get red hot every day.

• I finally found and reached out to Dr. Scott Dye, who was referenced throughout Paul Ingraham’s ebook (I had been seeing a different doctor previously). He ordered a bone scan (showed nothing wrong!), x-ray (showed nothing wrong!), and MRI (showed slight fluid build-up in my knee, but nothing severe). Dr. Dye diagnosed me with a chronic case of synovitis, which was likely exacerbated by the months and months of weight bearing physical therapy I had performed over the past year.

• Thinking back, it was clear I had never truly “rested” my knee, allowing it to heal on its own. Dr. Dye made it clear that once the knee joint’s synovium becomes irritated to a chronic degree, it takes true dedication to rest in order for healing to occur. Recovery was no longer as simple as not running for 4 weeks. I would have to find out how much activity I could tolerate without any symptoms, which it turns out was not very much activity at this stage in my recovery. After all, simply walking around the office for a few hours caused it to become swollen and inflamed.

• Taking Dr. Dye’s advice to stay within my envelope of function, I purchased crutches in March 2013 (a full year after my initial injury). He also prescribed an oral anti-inflammatory, and told me to ice my knee often.

• I continued using crutches for the next four months. Around the end of June, my knee was still swelling up after just taking a cab to work and returning home at the end of every day (even on crutches). Dr. Dye and I decided to experiment with me working from home, which my work graciously allowed.

• During this time, I was confined to my apartment for most of the time. I only left on rare occasions, including physical therapy with Julie Wong’s Proactive Clinic (my third physical therapist), and visits to the doctor.

• I had stopped taking the oral anti-inflammatories (since the effectiveness was again questionable), but began tinkering with my diet. I stripped away all foods linked to inflammation throughout the body (refined sugar, processed food, grains, legumes, nightshades, and alcohol), and added foods I found to be anti-inflammatory, regenerative, and healing. These foods included ginger, turmeric, pumpkin seeds, macadamia nuts, coconut oil, and grass-fed beef collagen in warm water.

• I was extremely stressed and in despair, so I reached out to two other Dr. Dye patients who were going through similar recoveries. One of them recommended I read The Mindbody Prescription by Dr. John Sarno. That also led me to The Healer Within by Roger Jahnke. Both books exposed me to how healing is a holistic process, one that includes the mind as much as the body. I started applying some of their principles and practices for stress relief and mindbody healing, including deep meditative breathing and positive affirmation.

• In August, I went completely non-weight bearing on my right leg. Dr. Dye said at my previous visit that if I wasn’t making more progress by September, he’d want to “go inside,” and potentially perform a synovectomy. Scared of surgery without a definitive solution, I wanted to push Dr. Dye’s theory of rest to the extreme by not engaging in any behaviors that could possibly irritate my my synovial lining.

• After about 4-6 weeks of this, I started developing early signs of Complex Regional Pain Syndrome (CRPS), as diagnosed by Dr. Leslie Schofferman and Dr. Ben Ma (see pictures of my symptoms here). If I didn’t start moving and using my leg again, I risked developing full-blown CRPS, which can be a far worse condition than chronic synovitis. Dr. Schofferman also said there were about two dozen things he would recommend I try before having surgery, which I was extremely relieved to hear.

• I started pool therapy, which slowly retrained my brain to use my leg again. I also began shifting more weight onto my leg at home, and found that I was able to tolerate limited weight-bearing loads. I was encouraged by this, so I began standing on both legs more frequently, slowly building up to taking a few steps, and finally to the point where I could walk around my apartment without crutches.

• I went back to the office on October 28, 2013, and was able to complete a full week of work without crutches. I had spent 7 months, 11 days on crutches, and it had been over 1 year and 6 months since my initial injury.

• Today I can get around without crutches, but still haven’t built up the strength to walk up and down hills. I’m slowly building up the muscles that have severely atrophied in my right leg, but feel confident I’m heading in the right direction. Progress is the name of the game, and I’m happy to be out in the world again.

What Worked For Me

• True rest (staying within my envelope of function, which after a year of weight-bearing physical therapy and a negative reaction to the cortisone injection meant crutches and laying on the couch for several months)
• Limited icing, on top and underneath my patella. There were times when I over-iced, which may have stalled the healing process and brought on the early signs of CRPS that I developed. What ended up working was limiting my icing to once in the morning and once at night, for 20 minutes each. I used two bags of frozen peas, and made sure to place a towel or several paper towels between the bags and my skin
• A healing diet. This included organic spinach, kale, broccoli, onions, mushrooms, avocado, macadamia nuts, pumpkin seeds, olive oil, coconut oil, pastured organic eggs, grass-fed beef, organic free-range chicken, ginger, turmeric, pineapple, papaya, and grass-fed beef collagen in warm water
• Topical Voltaren anti-inflammatory gel
• Light physical therapy that took into account my true envelope of function
• Pool therapy when my knee showed reduced symptoms of synovitis
• Mindful meditation through deep breathing and relaxation
• Making sure to get 7-8 hours of sleep every night
• Positive affirmation by writing down five people I’m thankful to have in my life in a notebook every night before bed
• Practicing the Flowing Motion exercise from Chigung (described in detail in The Healer Within)
• Talking to others who were going through similar struggles and recoveries
• Reaching out to a therapist with a background in psychosomatic therapy, and seeing her once a week

Resources

Academic papers by Dr. Dye (especially this paper, which describes a study where Dr. Dye performs a knee arthroscopy on himself in order to diagnose the source of anterior knee pain)

KNEEguru.com thread on patellofemoral pain

Knee synovitis articles:

• Synovitis (definition)
• Current Concepts of Synovial Tissue of the Knee Joint
• Synovial fluid analysis
• Decline after immobilization and recovery after remobilization of synovial fluid IL1, TIMP, and chondroitin sulphate levels in young beagle dogs
• Diagnostic and therapeutic value of early synovectomy of the knee join (An analysis of 60 cases)
• PVNS: Experience and causes
• An interview on when synovectomy is used, with Dr. Mark Figgie and Dr. Daniel Green
• Synovial fluid (“Synovial fluid is made of hyaluronic acid and lubricin, proteinases, and collagenases.” )
• The Synovium, Synovitis, Inflammation and Joint Pain
• Synovium & Synovial Fluid
• Wikipedia: Synovial membrane
• Pathology of the Synovium  (Author: John X. O’Connell, MB, FRCPC)
• The Role of Synovitis in Osteoarthritis

Study on the healing properties of icing

Study on the topic of application of Voltaren on knee synovitis (used Voltaren 4% spray in the study; I was prescribed 1% topical gel)

Article about an author who changed his mind in favor of topical NSAIDs

Dr. Charles Y Ho – mentioned in a Kneeguru.com post about recognizing synovitis on an MRI

Anti-inflammatory and healing foods:

• Turmeric
• Arnica Montana (relieves muscle pain and swelling)
• Bromelain (pineapple enzyme)
• Ginger
• Foods high in vitamin C

Hyaluronic acid supplements (I didn’t take these, but thought about it)

Herbs for back pain

Books:

• The Mindbody Prescription – Dr. John Sarno
• The Healer Within – Roger Jahnke
• Power Sleep – Dr. James B. Maas
• Spontaneous Healing – Andrew Weil, M.D.