The low down on the knee

So... Knee problem - not fixed, but in repair. Here's the blow-by-blow of the past 2 weeks. Please disregard my sarcasm. I'm a horrible and ungrateful patient.

1) After the MRI was reported, I got a call from my Ortho. He tells me the MRI is "clean" except for "beginning chondromalacia" and I'm welcome to run if I want and it doesn't hurt. Maybe some physio to make the clicking go away.

So... his job is done and I never need to see him again. Pro: No surgery. Surgery is a bad thing, right? Con: This doesn't explain the pain pattern (being quite consistent with a medial meniscus tear) or the fact that he could pop my meniscus back and forth during exam (something he ignored when we spoke about the MRI)

2) I schedule an appointment for physio therapy and make a call to get my own copy of the MRI (you know, just in case something happens when I'm in Dublin... then I'll have a baseline, right).

MRI Report (gist): Changes of chondromalacia along mid patellar apex and medial and lateral patellar facets, surface irregularity and tiny shallow chondral fissures (no instability). Small knee joint effusion with mild synovitis [NB: no mention of this in the phone call?]. No evidence of meniscal tear.

... Ok, so this still doesn't explain the pain. Does explain the clicking and grinding and small swelling.

3) Went to physio today. I like the woman I'm working with. She's sound. Her assessment is that the chondromalacia and pain is a byproduct of running a lot (well... duh), the injury to my left foot, and my built-in body mechanics. Apparently I have ridiculously high arches in my feet (this I knew, but it's surprising to other people). But those in conjunction with little to no internal rotation from my R hip (it's like 10* on the R and 25* on the L) and the bigger sacrolumbral lordosis... This stresses the knee.

She agrees that the pain and the instability I've had is a meniscal problem, and w/dye injection, it could be picked up on scan... but I'm not sure I'm willing to risk my kidneys and knee to confirm what we already know (plus, there's be little change to management) - that I have damage to my medial meniscus that's not a full blown tear (yet).

So... new plan... I'm working with a trainer tomorrow at the gym to put together a lifting/cardio routine (must emphasize glutes/core/hamstrings). I have a series of stability exercises I'll be doing to help with the hip and chondromalacia bit. I'll keep doing alternate yoga - gym days (for my own sanity). And I'll not be running...

I dunno how long I'll be able to keep off running. I miss it, even if I'm doing other things to stay in shape. But... BUT if the pain goes away (for a consistent amount of time), a little light running should be ok. I interpret this as no races or running-training until after new years at the ABSOLUTE earliest. I dunno if I'll train for something in 2010, but the option is there. Running once or twice a week over "short" distances (which I feel is about 3 miles) when I'm back in Dublin (provided I'm pain free) is ok. And I'll need to find a yoga studio in Dublin. Any suggestions?

I have two more scheduled physio appts in August to add to the stability exercises and make sure I'm actually doing it right (cause let's face it, I'll probably cheat). I can add another before heading back to Dublin if I want, wait and do one when I'm home in Oct for the wedding, wait till I'm home for Christmas, or just not go back... We'll see. But I do like my Physio, so it won't be because of a personality clash.

So... that's the story. Chondromalacia + effusion + synovitis + meniscal damage (but no discrete tear). ... so no Dublin Marathon 2009 :(

C'est la vie.