Being Injured as a PT

Any runner knows what it’s like to want to push yourself, whether going for a PR, longest run, multiple races in a season or any other big goal. The more you push, however, the higher the risk of injury. Injuries happen to any of us, even the ones that know how to treat them.

This past August, I was in the middle of a speed workout around a loop near my house I have done a million times. On the final rep, with a minute left in the workout, my knee suddenly became really sharp with a pain I have never experienced before. I stopped the rep, thinking “that was weird,” (stupidly) tried completing the interval and immediately felt the sharp pain again. I called it, and gently limped over 2 miles back home. 

 The running part of my brain was cautiously optimistic, thinking it was a fluke and would feel better after some rest and mobility work. But the PT part of my brain was already diagnosing my knee. This injury could be my MCL, meniscus, cartilage damage…who knows. Once I got home, I began testing my knee with a battery of assessments I give any other patient who has knee pain. Hopping on it hurt a little, but the more time away from the run, the better hopping felt. Within 20 minutes of arriving home, I was able to perform a single-leg squat without pain. I was befuddled. I was in excruciating pain not a half hour ago and now I can do all these tests without eliciting pain?

I knew something was wrong because every time I tried running more than 20-30 minutes my knee experienced sharp pain again. I began treating it as though it was a meniscus tear. I had torn this same meniscus before, but with different symptoms, an injury which led to a surgical repair and extensive rehab before I could run marathons again. The symptoms also presented as a meniscus tear with the sharp pain being in my joint line. After trying to rehab it for a month with a strength routine I used from my previous surgery, I tried running again and the same pain occurred, at the same point in the run.

Puzzled and looking for answers, I needed an MRI to understand the extent of the injury and put together a rehab plan. The MRI not only revealed a meniscus tear, but a bone stress reaction in my medial tibial plateau, exactly where my pain was. These kinds of bone stress injuries are often misdiagnosed as meniscus injuries since having a BSI in that area is uncommon; mine most likely occurred due to having another tear in my meniscus leading to more bony breakdown without the proper shock absorption of a healthy meniscus. 

My symptoms are most likely coming from the bone stress; the meniscus tear is most likely not the immediate culprit of my pain as these kinds of tears can be asymptomatic, especially given that my knee never catches within range of motion or has ever gotten swollen since the injury. (Both of those signs occurred for my first meniscus injury that required surgery.)

This new diagnosis means I need to be more patient with the bone healing process, which unfortunately takes more time to remodel. I can keep up with strength exercises, biking, and even plyometrics as long as they don’t produce symptoms. I plan to return to running on the anti-gravity treadmill to get a sense of what my knee can tolerate with a lighter load to continuously allow for more healing and less stress.

It can be incredibly frustrating to bounce around diagnosis after diagnosis to figure out not only what’s wrong, but also how to fix it. The key is having to stick with it. A big part of PT patients never see is having to rule injuries out, as opposed to a “sure thing” that you know exactly what is wrong and how to heal it. A complicated injury like mine was nearly a sure thing, until I tried running again and just had to reassess. That doesn’t mean PT isn’t the answer, it just means having to try rehab differently to work on better outcomes.