Patellar what?

Nearly four years ago, I spent my first New Year’s at Camp Harmony. Afterwards, I wrote

Unfortunately between all the dancing and some steep hills at the camp site, my right knee got sort of wonky and I had to take it easier the second half of camp.

It seemed simple enough: my knee was aggravated, and resting was enough to recover. As the year wore by, however, I noticed my knee hurting more often. After I hiked down Squaw Valley in July, my knee was killing me. I resolved to do something about it, and went to see a doctor on August 24, 2009. I was told that I had “jumper’s knee” and was prescribed rest, ibuprofen, and physical therapy. A week later, a physical therapist gave me a regimen of strengthening exercises and suggested that I might feel better in 8-10 weeks.

I mostly tell people I have patellar tendinitis, because that was my earliest diagnosis, and tendinitis is a term familiar to a lot of people. Here’s what patellar tendinitis entails:

  • Pain at the bottom and front of the kneecap
  • Caused by overuse, especially jumping-heavy sports like basketball
  • Inflammation of the tendon

When I looked it up online, I learned that

Initially the pain might be present only during the start or after completing the sport or work out which then worsens to becoming more constant in nature. Everyday activities such as climbing up and down stairs might be painful too. [source]

which seemed apt enough, especially the part about going down stairs. My pain was clearly not caused by sports activities, but I thought maybe my dancing was a factor, or possibly poor seat adjustment on my bicycle. As time went on, however, my pain persisted despite a (reluctant) hiatus from dancing and reasonable diligence with my exercises.

The next term I heard to describe my knee was patellar tendinosis. Where -itis means inflammation, -osis, according to Wikipedia, “implies a pathology of chronic degeneration without inflammation.” Degeneration? Yikes! Damage to a tendon at a cellular level? Double yikes!! Fortunately, I was told that exercises which focused on eccentric loading — some of which I was already doing in physical therapy — had been shown to be very helpful in recovery [ref]. So I continued with my squats and clamshells and quad sets. By the time I went to Ireland in March 2010, I’d been assigned about an hour’s worth of exercises a day. Let me tell you that it is bloody hard to motivate oneself to do any boring and/or uncomfortable exercises without seeing positive effects, much less an hour of them.

Around that time, I expanded my medical vocabulary yet again with patellar tendinopathy. Time for more etymology! -opathy comes from the Greek p├ítheia meaning suffering (cf. pathos). In medicine, however, it really just means disease. That’s right, I had a disease of (or more accurately, problem with) my tendon. Good to know.

The next phrase I heard spiced up my growing vocabulary by leaving out the tendon altogether. On the surface, patellofemoral syndrome seems even more useless than tendinopathy; no fooling I have a syndrome that relates to my patella. Back to the internet went I and found this page, which clarified matters somewhat:

  • “a syndrome is a set of symptoms that tend to occur together rather than an actual diagnosis of the cause of the symptoms” (ohhh)
  • “patients may complain that there is discomfort on descending or ascending stairs, or walking downhill or on uneven surfaces” (check!)
  • “The knee may become stiff and uncomfortable after sitting for a long time” (check!)
  • causes including hip weakness, IT band tightness, quads/hamstrings imbalance, and arch abnormalities, especially flat-footedness (aha!)

This certainly wasn’t the first time my feet had been brought up; the first orthopedist I saw watched me walk and suggested I get new orthotics to replace the ones I’d had for almost 10 years. However, what was emerging was a picture that suggested that the dysfunction in my knee wasn’t caused by particular activities or injury, but rather by biomechanical issues above and below (i.e. in my hips and my feet), probably ones which had been developing over some time.

It’s past my bedtime, but stay tuned for the rest this riveting saga, featuring needles, a detour to cartilage, and yet more etymology.

Comments 2

  1. Rachel wrote:

    I actually Am riveted. I have suspected biomechanical issues (remember the Alexander Technique e-mails?), but is that not it either? Write again soon…

    Posted 01 Oct 2012 at 23:55
  2. Rachel wrote:

    Rowyn, you never posted the follow-up!…

    Posted 30 Apr 2013 at 12:14

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