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.

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.

1 Month, 27 Days

I had physiotherapy this Tuesday. We did some jogging again, but this time going for some 50-60 meters at a time. We also did some hopping from one foot to the other, side to side and forward and backward. Finally we did some reverse lunges, before going back inside. Back in the studio we did some squats to shoulder presses, then some deadlifts, both with 8 kg dumbbells. To finish, he had me do shallow single legged squats while holding an exercise ball between the knee of the opposite leg and the wall - quite difficult to coordinate everything while keeping the proper form.

He instructed me to include deadlifts in my gym work plus well as leg presses and leg extensions at the end of training sessions to really work the muscles and stimulate strengthening and growth. He also gave me a green light to increase the distances in my run/walk intervals and to adjust the dynamics as I feel suits me the best. In general, we are moving more and more toward self-guided training where he will just provide advice as an outside observer.

Yesterday I commuted to work by bike. It's very short, just 3 km one way, but it provided a more challenging dynamic than the previous weekend rides since I had to focus on the interaction with the traffic rather than on my interaction with the bike. Nevertheless, it felt good; I was able to relax and pedal without thinking with no complaints from the knee whatsoever. I was pushing harder than on the previous rides, naturally getting into a stronger rhythm. Judging from the sensations from the legs, I would have been able to forget I'm still in the very early stages of regaining my strength and endurance, but a quick check of the speedometer was quick to break that illusion. All in all, cycling feels good and I'm looking forward to increasing the mileage. I guess it's lucky the weather will be getting worse in the next months, so hopefully I won't be able to go too far too quickly.

Today I went to the gym. I warmed up for 12 minutes on the elliptical trainer, then did squats, leg press, leg extensions and some leg abductions, just to give those muscles some attention since all the others have been working a lot lately. I left deadlifts for the next session since the hamstrings still feel a bit fatigued from the PT session. Squats felt very good though, I was able to increase the weight to 25 kg.

I think I've approached the limit of how much the knee can take at this time. It feels a little sore now, the way it didn't last week. I'm icing it regularly and keeping an eye on it. Since the exercises are getting harder, I will be making longer rest breaks in between, and that will hopefully help to find the balance again.

1 Month, 16 Days

The idea to push the knee out of its comfort zone is working well so far. I went to the gym twice since the last post. The first time was more of a learning experience, while the one today was a harder workout (compared to how hard I was able to work as little as a week ago):

1. Warm up on the stationary bike, 5 minutes.
2. Elliptical trainer, ~75 RPM, ~155 BPM, 6 minutes (+ 1:30 cooldown).
3. Stationary bike, ~100 RMP, ~140 BMP, 8 minutes (+1:30 cooldown).
4. Squats, 3 x 6 repetitions with a 20 kg bar.

The knee is feeling better daily. I am now able to run with a normal gait with just a little tension and pain - about how walking felt like in the second week after the surgery. As usual, I just ran some fifteen-twenty meters as a test, but it was especially encouraging that the pain stopped immediately when I stopped running. I expect I'll start doing some actual running training with the physio the week after the next at the latest.

1 Month, 9 Days

Friday was the final PT session with this therapist, and from next week I'll be starting sessions with my old therapist. We did:

1. Stationary bike, 5 min, 106 RPM, 139 BPM, 141 W.
2. Leg raises, 2 x 15 repetitions.
3. Heel pulls, 2 x 10 repetitions.
4. Balance with opposite leg extensions on the foam pad, 2 x 6 repetitions.
5. Shallow single-legged squats on the foam pad, 1 x 10.
6. Leg abductions with the elastic band, 2 x 15.
7. Squats leaning on the Pilates ball, 2 x 15.
8. Massage.

Yesterday I went for a ride on a bike-share bike again; seven minutes around the block, light tempo but a little faster than last time - I even switched to second gear out of seven when I got some momentum going. The knee feels OK, there is no pain and it's tracking straight. However, I can feel that pushing harder with the other leg, sparing the bad one. I think that's to be expected, but I'll try to make sure it doesn't become a habit.

Here's an overview of the current stage in my recovery:

• Finished the first block of physiotherapy where I had 9 sessions spread over two weeks; the next block will include 9 sessions with one session per week.
• I'm doing a combination of glute and quad exercises daily using an elastic band, balance board and exercise ball (with one rest day per week).
• I'm also doing hamstring and glute stretches daily; I occasionally try to do hip flexor and TFL stretches, but at the moment they still cause some pain in the left knee before I feel the stretch in the actual muscles I'm targeting.
• I can walk up stairs one and two steps at a time.
• I can walk and even run down stairs (not super fast though).
• I can walk at a fairly quick pace, around 7-8 minutes for a kilometer for a couple of kilometers or more.
• I can ride a stationary bike for five minutes about as hard as my current cardio conditioning allows me with no limitation from the knee.
• I can ride an actual bike outside at a fairly easy pace (no idea of the speed); if I push harder, I start loading the good leg more.
• I can swim breaststroke and crawl as long as I don't try to push too hard with the legs.
• I think the hematoma at the incision site is completely gone; some swelling appears if I spend a lot of time on my feet and disappears with rest, ice and/or NSAIDs.
• There is a hard bump in the area of the incision that feels different than the hematoma on touch; not sure what it is.
• I still can't really run - the last time I tried I did some ten-fifteen meters at a jogging pace and I could have gone further but it was with a pronounced hobble and each step hurt, not too much but enough that I was unwilling to push it further.

1 Month, 2 Days

We went for a day trip with friends yesterday, and I spent most of the day on my feet. It was leisurely pace walking, but nevertheless the knee felt sensitive and a little sore by the end of the day. I applied ice and the diclofenac gel, and decided to skip the exercises - today was meant to be a rest day anyway, so I just moved it a day ahead.

Today it's still a little sensitive, but better. I didn't walk as much during the day and I didn't have any problems when doing the exercises this evening. I went harder with the exercises targeting the hip abductors and skipped some of those that involve loading the knee, just in case.

I haven't mentioned it before, but in the last couple of weeks I've really made it a point not to sleep on my left side, to avoid putting pressure on the operated area. It doesn't feel bad when I first lie on the left,  but I've come to the conclusion that most of the time when the knee was swollen in the morning, it was because I'd spent most of the night on the left side. I think I've now come to the point where I avoid that side even in my sleep, and the knee is no longer swollen when I wake up.

Speaking of the swelling, I think the hematoma is really and truly gone and the red bump has disappeared. Left remaining is a general light swelling in the area that's most noticeable after I've spent done time on my feet, and that mostly disappears with rest and icing. But now that the swelling is mostly non-existent, a hard bump has become noticeable under the skin in the same area. I can't tell if it's some sort of deeper swelling, scar tissue, or something else; I'll see the doctor next week for a scheduled follow-up, so I'll ask him about it.

Day 28 (4 Weeks)

No physiotherapy in the last couple of days, and I took a rest day today. Well, it was rest from exercising, but I did go for a nice walk, leisurely pace but a good 2-3 km covered. The knee started hurting a little near the end, but I think I managed not to overdo it too much.

I've noticed that I can really feel the left glute medius, TFL and hamstrings working, and even straining a little, when I start walking a little faster. That's interesting, seeing as my left side now feels stronger than the right when doing the exercises targeting those muscles, yet the right side doesn't complain while walking. It could be a combination of many factors, but the top two I can think of is 1. that those muscles on the left side are now waking up and activating more than the on the right side thanks to all the exercises, and/or 2. that the left side is getting better at doing the exercises, but the functional strength in real world conditions is still not up there compared to the right.

Whichever is the case, I think the following course of action will be in order:

• increase work on the right side to bring it up to speed when it comes to exercise proficiency;
• start mixing it up with different exercises still targeting the same muscle groups in order to improve actual functional strength - so for example do leg abductions one day, side steps the next, and so on.

Regarding recovery in general, I have been able to do a few steps of something resembling a jog - the last time I tried, it a few days ago, it was still not at all doable. It still takes focus however, and when I tried to RN the last couple of stops across the street without really thinking about it, I reverted to a hobbling locked-knee gait.

The hematoma/swelling is mostly gone now, with just a pea-sized bump and some redness right around the middle of the scar. The redness doesn't look very good, but it responds well to icing, so I'm not too concerned yet. All in all, it seems to be getting better at an unchanging pace, which is perfectly fine with me.

The bump is between the third and fourth suture marks; picture taken after icing, so it's not very noticeable

Most of the swelling is gone

Day 26

Physiotherapy yesterday:

1. Knee press, 2 x 15.
2. Heel pulls, 1 x 15.
3. Leg raises, 2 x 15.
4. Balancing on the foam pad.
5. Single-legged shallow squats on the foam pad, 2 x 12.
6. Balancing with opposite leg extensions, 2 x 8.
7. Squatting while leaning into an exercise ball against the wall, 1 x 15, focused on pushing off with the left leg.
8. Leg abductions with the elastic band, 2 x 15.

Next session will be Wednesday next week, and we'll be doing some exercises on the stationary bike. The next two weeks I'll be having two sessions per week, and after that my usual physio comes back from vacation, so I will switch to working with him. Most of the exercising will be done at home now, so I bought a Pilates ball and a balance board today.

I went to the swimming pool today, a light session of some twenty minutes in the water. I tried crawl and breaststroke and both are doable, but require careful and deliberate movement. For crawl I need to let the left leg mostly hang in the water, just a little stroke here and there. Breaststroke is OK as long as I go very slowly and I don't force the leg strokes.

In other news, I'm officially descending stairs without any pain. Well, I can make it hurt if I intentionally put the leg into an awkward position, but stepping normally is perfectly fine. I can't really pinpoint when exactly was the first time I descended with no pain, but I noticed it today. Encouraged by this, I tried to run a step or two as well, but that's not really happening yet, though it is better than the last time I tried to take a few quick steps. 

The hematoma is receding but not completely gone, it feels like a slight thickening of the skin now. It is still visible though, when I look at it from the right angle. The bone and the tendons underneath feel interesting, definitely different than the other leg. It will be interesting to see what it will be like once it's fully healed and settled down.

Day 24

Yesterday at physiotherapy:

1. Knee press, 2 x 10.
2. Heel pulls, 1 x 12.
3. Leg raises, 2 x 15.
4. Balance on the foam pad.
5. Shallow one-legged squats on the foam pad, 1 x 12.
6. Balance on the foam pad, extend the other leg forward, side, back, 2 x 5.
7. Leg abductions with the elastic band, 2 x 15.

The same as last time for homework, plus balancing with leg extensions (number 6 above) - no foam pad so it will be easier to do, but that's OK. Next week we are starting exercises on the stationary bike - first time on pedals after the operation, very excited to see how it will feel.

Today, the DOMS is subsiding, I can finally feel how the knee is doing (the signal was sort of getting lost in all the noise from the aching muscles). Nothing exciting to report, still the slow march of progress goes on. Standing in one spot for too long is still not very pleasant - after an hour in the kitchen the knee feels swollen and stiff. I was hoping this wouldn't be such a problem by now, but not too worried taking into account the overall improvement that's happening. I haven't gone swimming yet, we had some guests over for a few days so I didn't have too much time in the evenings.

Day 16

I had the first physio session today. This one consisted of an ultrasound treatment, followed by electro-stimulation of the quads and finished off with a massage. Starting from Friday, I will be having more active sessions with exercises, three times a week for nine sessions in total (including the one from today).

In regular news, after the previous somewhat doubt-filled update, I'm now positive that the knee is indeed improving steadily. The strength in the leg is improving and I can apply more power before it starts hurting. A lot of everyday activities still cause some pain, but that's because I naturally push to the limit where it starts to hurt. For example, going down stairs yesterday hurt the same as the days before, except that this time I was able to go straight and with no hop-skip for the first time - yay!

The scar from the incision is also looking better and better. There's still some scabbing, so I won't be going to the swimming pool just yet, but I expect it to be fine by the end of the week.

All in all, I'm happy with where I am at the moment and I'm looking forward to starting active rehabilitation on Friday. I hope I'll get an exercise program to do at home as well, but even if I don't, the three sessions a week will provide a very welcome change indeed.

Day 14 (2 Weeks)

Still improving, but still very slowly. It goes up and down during the day, so at times it feels like there hasn't been a change in a few days, and later it feels massively better. I guess it's also easy to forget that a particular move or position used to hurt before, once it no longer does. There are definitely no leaps and bounds though; it still hurts a little to go up stairs for example, and I still do the little hop-skip when descending them. The strange pulling feeling comes and goes too, so sometimes the most sensitive spot is there, while other times it's around the actual incision site.

Speaking of the incision site, the one thing that really hasn't changed much is the swelling/hematoma. It decreases a little with icing, but it comes back if I spend too much time on my feet, whether walking or standing in one place. I'm still icing it daily as it does feel better.

Physiotherapy starts Wednesday. The physiotherapist I planned to go to will be on vacation until the end of August, so I had to make an appointment with another physio I found at the same hospital where I did the surgery. My idea is to work on basic strength and coordination of the muscles around the knee in the following month, and then start the specific cycling and running work with the original physio once he comes back from vacation.

Day 12

I've removed the final bandage today. The incision hasn't healed completely yet, there's some scabbing and light bruising there. The picture is here for those interested, but I don't think it's presentable enough to be displayed directly in the post just yet.

I've been icing twice a day since the sutures were removed. The swelling/hematoma decreases noticeably after icing. It would probably have been a good idea to use the ice during the time the old thick bandage was off for showers.

There is a new sensation from the knee. I feel a distinctive longitudinal line of tension midway between the lateral epicondyle and the patella, like there is a thin band stretched there that gets tight when I bend the knee under load. Could be that they had cut the IT band away from the fascia along that line during the operation, or it could be some scar tissue. We'll see how it develops.

The functionality is still slowly improving, though maybe not as quickly as in the first week. It's good that I'm about to start physiotherapy soon, it should help to kick start the recovery and keep it on the right track so I don't develop bad patterns of movement.

Day 6

The knee felt sorry of bloated and tight in the morning, and there was a distinctive feeling of pressure all around the incision site when fully flexed. It also gets sore quicker when standing for a while or when having it fully flexed for a period of time. I took a paracetamol to calm it down a little.

The useful range of motion (with some load, not just passive) seems to be improving, and I am becoming able to apply more force with the quads.

The area around the incision started itching in the evening. It stopped when I removed the adhesive bandage - guess it's just the hair growing back and not a sign of an infection.

Day 5

No big change since yesterday, improving slowly and steadily. I've been more active today - I've climbed the three floors to my apartment three times today, and while it did hurt a little, it did not feel like a bad pain. Still not using the bad leg when descending stairs though. I'm starting to activate the quads a little when walking and climbing stairs.

I also climbed and walked on the arm and back rests of the sofa to check something around the window frame. It probably looked precarious but I felt quite stable. I was sparing the bad leg and it worked fine.

I feel like at least some of the tension on the knee when extending under load comes from the sutures. Looking forward to getting them removed next week.

Day 3

I have a full range of motion today, from fully extended to fully flexed. However, I'm still not able to exert any force throughout the range without pain. I am capable of taking a few steps up and down stairs using the affected leg, but it still hurts.

I went outside in the afternoon, spent some time with friends in a park and walking around. It was nice, but I overdid it a little, so it feels a bit tender and inflamed in the evening. 

I've taken two paracetamol in total - one morning, one evening - and no ibuprofen. It helps settle things down a little, but I don't have any major pain that would need constant medication. No sign of a visible hematoma appearing, just the little, very localised swelling that's not changing. The swelling around the ankle is still there, but it is receding.

Day 1

Didn't sleep very well this night. I would get into an position that's uncomfortable to the left knee and the pain would wake me up. Some of the pain came distinctively from the patella region for some reason; it wasn't from somewhere inside the joint, but from the outer edges of the patella.

The pain is not too bad during the day. In total I've taken one aspirine (in the morning before picking up the prescribed medication), two paracetamol (one at the end of the day before going to bed) and one ibuprofen during the course of the day.

Knee flexion has improved since yesterday, I can do 40+ degrees from straight now. This is just passive flexion, no weight on the leg, no pressure on the knee. When not moving I'm keeping leg extended and elevated most of the time.

I'm able to walk slowly and carefully. Bearing weight is no problem, but the part where I need to bend the knee and bring the foot forward can be tricky. When stepping forward I can't really use the stabilising muscles around the knee because that puts strain on the IT band; instead I just lock out the leg and put weight on it completely straight and that seems to work fine at the speed that I'm going. I go up and down stairs using the right leg only to do the work. I've had two walks of 15-20 minutes to keep the leg moving and to stimulate circulation.

I've noticed some swelling in the ankle and foot in the evening. Can't tell if it was there before, I wasn't really looking. I'm guessing it's a light swelling that started in the knee area and then the fluid descended to the foot. It's not big or painful so I'm not really worried.

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.