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.

Prologue

Hello!

This is a blog where I will be presenting the progress of my recovery from the surgery that I had to fix the IT band issues in my left knee. I presume people reading this blog already know that the Iliotibial Band Syndrome is and probably have some experience with it, so I won't be going into the subject here.

At the time of my surgery, I've been able to find very few blog or forum posts from people who had similar surgery done with more details than "Had surgery X months/years ago. Ran a PB X months later." In fact, the only detailed account I know of is this one, though it describes a more complicated intervention than my own. (I've no affiliation with that blog, I found it through Google and the only parts of it I read are the ones related to the author's surgery and recovery.) I hope to make this blog a useful resource for anyone facing a similar surgical procedure for their ITBS.

I'm a recreational road cyclist, and my ITBS started while cycling, though an ill-advised run was probably a factor as well. This is a short history:

• The pain first started midway into a 130 km ride in February of 2015. The ride was unusually long for me at the time, but I was well used to rides of around 90 km, so having the pain start at 60 km was unexpected. The best guess was that it was caused by a combination of factors: first I made made my first attempt at running just a few days before the ride, where I ran far beyond my capabilities at the time; then, I went for a long ride before fully recovering from the run; finally, I had raised my saddle as an experiment right before the long ride.
• During the spring of 2015, I made some attempts of taking a break and then gradually getting back into riding, but pain would invariably come back after a while.
• During the summer I didn't ride at all, but I did experience some pain on easy hikes a couple of times.
• In September I finally found an orthopedist with some experience with ITBS. Under his orders I did some passive physiotherapy during the autumn including stretching, massage, ultrasound and ESWT (link), followed by a gradual return to cycling during the winter. I had gotten back to 90 km long rides with no pain until it returned again in February 2016.
• Had a couple of cortisone shots and did a round of self-guided hip and glute strengthening exercises during the spring of 2016 with no success.
• Finally had a surgical procedure done on the 18th of July 2016.

The procedure done on my knee is resection of the posterior portion of the IT band, also known as open surgical release. This type of surgery typically includes removal of a piece of the IT band where it presses against the lateral femoral epicondyle, but in my case just a straight, perpendicular cut was done form the rear edge and about halfway across the band. I asked about the option of an arthroscopic technique to remove some of the synovial tissue under the IT band, but my orthopedist opted for the more conventional approach after consultation with one of the doctors who originally developed the arthroscopic procedure.