Monday, January 28, 2008

Pes Anserine Bursitis

Just got back from the doctor. My knee has degenerated into a cauldron of pain. I stayed off my legs all day Sunday. Ditto as best I could today. Been taking max dosage of Aleve too. Knee feels ok upon first getting up, but any standing or walking quickly produces severe burning sensations just below the joint in front of the tibia. Researching various knee injuries and causes, I suspected pes anserine bursitis before visiting the doctor. I have never experienced an overuse injury before. I suspected ramping up running the last few weeks was probable cause, but the doctor suspects otherwise.

After waiting more than an hour, the doctor finally comes in. Asks couple questions, then touches my pes anserine bursa. It was puffy and he could immediately see I had bursitis. I gave him run down of my cycling and skiing history, 600+ hours per year training, then 20 minute run takes out my knee. He didn't think so. He said bursitis is an overuse injury, and I couldn't have done enough running (about 50 minutes lifetime total) to have caused the bursitis. He suspected the skiing, especially if I did any skating. That is only technique I do. You see, his son is a high school skate racer, so he's somewhat familiar with the technique and how that could cause an overuse injury with that tendon. I did happen to do a 50km ski the Saturday before my 20 minute run on Monday. My knees were slightly tender from the hard weekend. The run may have been just enough to put me over the edge.

So now I must recover. I still don't know how long this will take or how big of a training hit this will be. I've already lost about 8hrs training volume, a race last weekend, a race this coming weekend, and probably the race the weekend after that. I asked about that. The doctor said if I really must race weekend after next and the pain is not subsiding by this weekend, to call, and they'll set me up with an orthopedist for a cortisone injection. The doctor did say cycling shouldn't be too much of a problem in the mean time, but skiing is not a good idea. I do know after this past Saturday's 50 mile hilly ride, my knee was a wreck. It doesn't hurt too bad while riding, but I'm practically disabled afterwards.

He put me on Voltaren. We'll see if that does a better job controlling the inflammation than Aleve. In the meantime, I have business trip in NJ, so Wednesday will be soonest I can try any aerobic activity. I haven't recovered this much ever, not even for Mt Washington. I can see the belt buckle straining already. Unfortunately, the eating machinery doesn't shut down just because the powerplant stops burning fuel.

3 comments:

Peter W said...

Hi, my name is Peter Wilton and I'm a student at Carleton College in Northfield, MN. It sounds like I may also have pes anserine bursitis. I went to a physical therapist over my spring break and was told that I have hamstring tendonitis. I was just finishing up a ski season (like you, entirely skating) and purchased some rollerskis because I couldn't drop the skiing (still can't). Some time between my last few snow sessions and my first few sessions on rollerskis this problem came up. The pain I feel isn't so much painful as it is nagging. Right now I'm mainly running (which doesn't aggravate the nagging pain) with a little bit of skiing thrown in. Skiing seems to be what aggravates the condition.

My questions for you are: Did you try skiing again after your rest period? Was it painful?

Also, are you bowlegged? When my foot hits the ground, I land with the outside (lateral) part of my foot making contact with the ground well before the inside. I've noticed that with my ski boots on, when I stand upright, my left (my weak leg, and same leg as the knee pain) foot rests without the entire boot making contact with the ground. This probably means that I land on my left boot on a non-flat ski. Rollerskiing forces me to land on a flat boot, which forces my knee in a medial direction and seems to put strain on my knee. I guess what I'm saying is, does that sound familiar to you at all?

I understand you're not a physical therapist, but I was just wondering whether any of this rings a bell for you.

Hill Junkie said...

Peter,

Once I was diagnosed, I gave up running entirely (haven't run since) and backed off skiing for a week, but within two weeks, I was right back into 3+ hr skate ski sessions with thousands of feet of climbing. I had some minor lingering tenderness that slowly disappeared. The remainder of the ski season I had zero pain or issues with pes anserine bursitis.

I think it was poor running form that triggered the bursitis. I am not bowlegged, but I am somewhat splay footed (toes point outwards, especially riding a bike). I plant my feet plant differently than yours. I tend to ski on inside edges of both skis while skating. For me, this is just bad technique I'm sure.

I hope you sort out what's going on. For me, even the brief interruption in training was frustrating. My doctor said bursitis is an overuse injury, and you have to back way down until it heals. Taking NSAIDS helps too. Interestingly, Google Analytics tells me my bursitis post continues to draw visits. Pes Anserine Bursitis must be a fairly common problem.

Doug

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