6 Months

Now this was a long gap in posting. I just never felt like updating when I didn't really have anything new to post. My progress has been really slow recently due to the medial knee pain, and after a visit to the orthopedist this morning, I at least have the name for this new game: it's called synovial plica syndrome. The treatment is no different from what I've been doing so far, just keep working with the physiotherapist, doing the exercises at home and slowly be increasing the load all the time listening to the knee and how it feels. The long term plan is familiar too: if it doesn't improve, steroid shots are next, then arthroscopy as a worst case scenario.

On the bright side, the ortho has spent some time studying the old MRI scans of both of my knees, and he thinks the original diagnoses were a bit too eager to proclaim structural problems that would match the symptoms. In his opinion, there is no damage to the cartilage or the menisci in either of my knees, so that's a relief.

When it comes to cycling, as I said the progress has been slow lately. After several weeks of sporadic activity due to going on vacation etc, in the last month and a half I've been working on building a solid base of regular workouts and rides with intensity and volume that doesn't trigger pain in the knee. This means one solid gym or physio workout, including 25 minutes of run/walk intervals (still at 3:2 minute ratio), and one 20 km bike ride per week. At the moment this seems to be functioning well, with no pain in the knee, though I can still feel some irritation when cycling before it gets warmed up. The goal for the next few weeks is to introduce another, shorter ride in the week, and then work on bringing it up to the same distance as the longer one. If that works out well, I'll have built up a base of regular 40 km per week that I can then hopefully start extending into more serious distances.

Regarding the IT band, it is doing well, no complaints. The ligaments in the lateral knee area do feel bit strained and sore from time to time, but that's a sign that they are still adapting to the increased loads after the IT band release. I haven't had any pain from the IT band itself during cycling, running or walking (and I've had some long walks on consecutive days during the vacation a couple of months ago). It could be said that the focus of my recovery work in the last three months has shifted from the IT band to what I now know is the plica syndrome, so I consider the surgery to have been a success so far. There might be some doubt that the new issue is somehow related, but I have had some pain in the area even before the surgery. I'm thinking that it's just a combination of anatomical predisposition plus overuse, as is usually the case, and is something that would have probably happened anyway.

1 Month, 13 Days

I went to my standard physiotherapist yesterday. He put me through a set of exercises and he was quite pleased with my current condition. He suggested to start putting the left knee under more stress - not enough to feel sharp or burning pain, but enough to feel the load - this is something that I avoided so far, preferring to have a slower recovery rather than pushing too hard and causing new injury. Now that the knee is mostly healed, it's time to get it out of the comfort zone, and train it back to full strength.

We will be having one PT session per week, with exercises to do at home or gym in the mean time. He gave me the following set of exercises to begin with (to be done daily unless marked otherwise):

1. Balancing on the balance board or a BOSU with throw and catch. If I don't have anyone at hand, I throw and catch a throw pillow - the size, weight and shape make it more challenging than a ball from the balancing standpoint.
2. Leg abductions/raises laying on the side with an elastic band or ankle weights (we used 2 kg weights in the session).
3. Single legged supermans.
4. Hip bridges with feet on an exercise ball and an elastic band around the thighs.
5. Single legged bridges with the foot on an exercise ball.
6. Squats, five times a week. When possible, do them at the gym with a 20 kg bar, go for around 6 repetitions.
7. Elliptical trainer as often as I have the time to go to the gym. Build up the time, start with 5-10 minutes.
8. Cycling (normal and/or stationary bike) and swimming fit cardio when I have the time.

All exercises are to be done at a level that's challenging, but not all out painful. Along with the exercises, I am to continue the hamstring and glute stretching routine, plus a lighter hip flexor and TFL stretch, about as hard as I can stand for 20 seconds at a time, a few times during the exercise session.

Today I went for the second follow-up with the doctor. Regarding the hard bump around the incision site, he thinks it may be a combination of residual swelling and some scar tissue growth, but he is not sure about. He prescribed ultrasound to be done in about a month, to give it some more time to settle down and stabilise. In any case, he doesn't think it is something to be overly concerned about.

Other than that, he also recommended starting to push the knee harder, looking for that balance between a bad pain and a good strain. This pretty much settles the course for the following month or more, and I can say I'm looking forward to it.

Finally, this is what the operated area looks like now:

This is the hard bump, there is no swelling of the skin in these pictures

The scar is getting thicker and paler; I don't think it will be very noticeable in the long term