3 Months, 10 Days

Tuesday was PT day. I told the physio about the medial patello-femoral pain but he couldn't find anything wrong that would stand out on manual investigation. He approved of my plan to keep cycling with decreased intensity and on platform pedals and see if it improves. After that we did a quite intensive exercise session, the theme being balance and coordination taken up a level. This means all the one-legged exercises (touch the opposite leg, extend the opposite leg in different directions, supermans...) but done on a BOSU and with addition of light dumbbells just to make it even harder. Finally he had me balance on one leg, side jump onto a step on the other leg and jump off back into starting position. The physio was positively impressed with my ability to do all the exercises he came up with, and with very good form too. However, we came to the conclusion that I have noticeably better coordination on my right leg, while the left leg is stronger and has more stamina.

Even though I've been regular with gym work and it has shown during this PT session, I have been lagging on these exercises hitting the side glutes and other hip musculature. I know this because for good two days after the session all those muscles were really fatigued and sore. Luckily I will be away for the next three weeks, so I'll have to do more of these types of exercises instead of gym work anyway.

I went for a short and easy ride this Saturday, around 15 km at an easy tempo. The knee still felt a little strange, almost like there's something in between the patella and the femur head that gets irritated on every flexion and extension. I feel this only on the bike, and even then it's not a constant feeling but sort of comes and goes. Not really stressing about it yet, I will monitor it further and only think about going to the ortho if it doesn't improve by the end of next month or so.

It's funny that the IT band is almost being forgotten, even though that's what I'm supposed to be recovering from. It's doing fine, but still letting itself be heard from time to time. At the moment, some of the ligaments toward the front of the IT band and toward the outside edge of the patella are feeling a little sore, like they are now learning to take the increased loads after the band itself was released. It's a new sensation, unrelated to the tension I used to feel in the same general area - the tension has been gone for at least a couple of weeks now. It doesn't feel worrying, I won't be surprised to still be getting phantom aches in the area months from now.

3 Months

It's been two weeks and then some of the new regime with one gym session per week. It's all good so far, seems like a programme that will be sustainable in the long term, providing the benefits but at the same time not too taxing. I've expanded the gym sessions into more of a full body workout with dumbbell shoulser presses, bench presses, bicep curls and one-arm rows in addition to the leg exercises and treadmill work.

Speaking of the treadmill, running is improving nicely. I've come up with a combination that seems to work well for my current ability: 2 min walking, 1 min jogging, 2 min light to medium speed running, repeat 5-6 times. No knee pain, no shin splints any more, cardio seems to be the limit to going much harder at the moment. I'll be slowly increasing the run-to-walk ratio, but there's no hurry.

Cycling is not going as well unfortunately. I've kept the rides to around 20 km, but it seems I've been riding a little too often, not giving the body enough time to adjust and re-adapt after the long break I had before and right after the surgery. As a result, I've developed some knee pain - not around the IT band, but the inside (medial) side of the patellas, both knees but more on the left one. Pain in this area is not new to me, and I've had MRI done on both knees at different times to see what's going on inside: meniscus damage in the right knee and some lesions in the cartilage of the left knee.

The damage on both sides wasn't deemed bad enough to warrant anything more drastic than some rest and rehabilitation at the time, and I'm hoping to get away with same now. The pain only appears when cycling, so I'm taking a week off and I'm switching to platform pedals for a while to let my legs re-discover the most comfortable position for pedalling after the break. Of course, I'll also ask the PT about it the next session.

The IT band itself is doing fine, further along the way back to full strength. As usual, there are occasional aches and pains, tension, or just feeling of something being not quite right, but it's getting less intense and less frequent all the time. There hasn't been any swelling that I could detect at any time in a few weeks now, and it just gets a little more sensitive to pressure if I've been working it a bit too much. No surprises overall, it's right about where I'd expect it to be at this time.

2 Months, 3 Weeks

It was good having the two weeks to settle into a workout schedule and really see what the effects would be. I did gym sessions every three days on average, alternating the focus between squats and deadlifts, with leg press and knee extension added at the end of each session plus the full complement of stretches. As a warm-up, I'd spend 20-30 minutes on the treadmill doing walk-jog-run combinations. In between the gym days I did some home exercises, mainly elastic band work for the gluteus medius and some balance work, but not frequently. These were the results.

The good:

• I improved noticeably at doing squats and deadlifts.
• I improved a little at running.
• I no longer get the feeling of tension and pulling in the area halfway between the kneecap and the incision site - I used to get it while walking at first, and later while running ever since the surgery.

The not so good:

• It takes me time to recover properly from the gym workouts, three to four days at least. In the days between sessions the muscles would feel tight and a little sore and the legs would feel heavy. I wasn't able to push myself on the bicycle and I never really felt like running or doing any exercises other than on gym days.
• The muscles improve faster than the joints. I started feeling some soreness under the kneecaps when crouching or kneeling if I wasn't warmed up. It wasn't a major pain, just a warning that I was starting to work them more than they could recover from.
• The area around where the IT band inserts into the top of the tibia started feeling sensitive under my fingers (I got into the habit to poke and prod the area every morning to see how it's doing, if there's any swelling etc.).

The obvious conclusion was that I should ease off on the gym work and replace it with more exercise for balance, coordination and proper muscle activation. The PT agreed with my conclusions and additionally suggested to decrease the loads on all exercises that strain the knees, so squats, leg press and knee extensions. 

The PT recently started training as an ultrasound technician and he acquired a machine for the office, so we used the opportunity to take a look under the skin during this week's session. Everything looks like it has healed up fine and there seem to be no residual swelling in the tissues. He noticed that the surgery was done very cleanly and neatly without any unnecessary damage. The hard bump looks like normal bone under ultrasound. The PT thinks it's most likely the normal epicondyle being more prominent since it's no longer being hidden by the IT band, but to me it still seems like it's slightly enlarged compared to how it was before the surgery. I still need to make an appointment at the hospital for the ultrasound that my doctor prescribed, so we'll see if they have anything interesting to add.

The bump is definitely smaller than before, but is nevertheless still prominent

The next PT appointment is in three weeks from now, so I'll have plenty of time to develop a new exercise routine. So far I've been a bit lazy this week - I've done just one workout session at home, but I did ride the bike more. I've upped the ride distance to over 20 km and so far all is good. I won't be increasing the distance next week since I've made quite a jump, but I will try to do some running outside. That't the plan at least, we'll see how it goes.