2021-04-03 - 3:48 p.m.
I stopped running in September 2019—about a year-and-a-half ago. I was noticing some pain in my knee when using stairs, which wasn't really familiar. I was used to sharp, acute onset pain coming and going, running through small stuff and taking time off when bigger stuff would come around.
I had taken six months or so off in Winter 2018 because of ITB flare-ups that would kick in on runs longer than a couple miles. I did a couple months of PT, which didn't seem to help, and got a bunch of weird diagnoses which amounted to “weak muscles.”
When I got to California in June 2018, I decided that if the flare-ups started at-or-around mile 2, it'd be better to just run a mile at a time and quit before the pain started, rather than not run at all.
After sticking to 2 miles or less for a month, I was able to push out gradually, getting back to 7-8 mile long runs at my regular pace. It felt great. I did a couple trail runs, and during the shorter, harder runs, I’d pushed it and managed one or two sub-6-minute miles. It was the best running shape I'd ever been in. I was waking up and catching the sunrise, exploring the area around my housing accommodations.
I can't pinpoint when exactly the knee pain started creeping in. Since 2010 or so I'd feel it whenever I sat for more than an hour or so. Driving long disctances and taking plane or bus trips were the only times when I had any issues. I’d been on my feet working retail since 2013, but whenever I spent significant time sitting recording music or doing freelance audio stuff, I'd notice the knee pain starting. Sure
Right before I stopped running in September 2019, I'd done one of those 14-mile trail runs, really going hard. On a plane trip back from Vegas the following week, I noted the knee pain was particularly searing. Incidentally, I came down with a UTI after that trip. The antibiotics the doctor put me on had been known to cause tendon ruptures, so I took it as an opportunity to take a break from running and let my knee cool down.
But I didn't factor in the amount of freelance audio work I'd been doing, and needed to continue doing, which meant that when I wasn't walking to work or running, I needed to be sitting in a shitty dining room chair trying to ignore my knee pain.
My last attempted run in California was during the seasonal fires in October. The knee was a minor nuisance, and I was more concerned with what the smoke might be doing to my lungs.
I moved back to NYC in November 2019 and did one or two runs that winter to see if anything was getting better, and it wasn’t.
I lost my amazing health insurance when I switched to a desk job at a smaller company, which kept me sitting more than I'd sat in ten years, and poor enough to want to avoid seeing a doctor. I had a standing desk in the office, which did help, but you can only stand so long before needing a break to sit, and more than 15 minutes of sitting in one position was uncomfortable.
Then the pandemic came. I was lucky to be able to work from home, but that meant no standing desk and the same amount of work to do. After I hit 12-months of no running in September 2020, I found a random sports medicine doc who diagnosed me with “pain.” Understandably, he sent me to physical therapy. Imaging was expensive, and PT was less so.
I did the PT, and tried to take more standing/walking breaks when working from home. At the end of Week 5 with no improvement, the therapist just scratched his head and said, "Huh. Yeah, you should probably see a doctor again and figure out why this isn't working."
He recommended a specialist, who I saw in December 2020. By that point I'd started registering hip pain when sitting, so the doc ordered a knee and hip MRI. "Get the knee done, at least, and if your insurance doesn't give you issues then get the hip imaged too. But definitely get the knee."
I dragged ass for a couple months. My new insurance was...garbage. MRI cost-estimates for both joints were going to cost 5x my monthly food budget, and past experience with imaging was always that nothing turned up—an inflamed tendon, or maybe some benign bone growth that wasn't big enough to cause an issue.
So I flip-flopped for a couple months, hoping I could just keep strengthening the leg and things would get better. I thought about scheduling the knee MRI and maybe getting the hip later if the knee was unremarkable. My mother told me, “You just need to consider the money well-spent whether they find anything or not. You’re paying to know.”
I justified getting MRIs for both joints in Feb 2021 by factoring in the pandemic stimulus checks. The actual cost of the imaging was better than the estimates. Still a lot of money, but fine.
The radiology clinic had a patient portal, which allowed me to get to the report before my doctor. The knee MRI was completely normal. Nothing had changed since my last knee MRI in May 2019.
The hip, though. According to the report, there was "an extensive labral tear," along with slight femoroacetabular impingement and a few other minor complications. No arthritis anywhere.
By the time I saw my doctor again, I’d spent way too much time researching the tear online, watching videos of surgeries and looking and prognoses. The doctor, when I saw him, took a conservative approach. He’d know if surgery was right for me after I got a cortisone injection into my hip. If it relieved the pain, then I’d be a better candidate.
I got the injection—no dragging ass this time—and it didn't really do anything. Knee still hurt, lower back still hurt. From the perspective of a month removed from the shot, I do think it helped the hip a little. I've been reading that referred pain from the hip is the last pain to disappear, so the shot not helping the knee and back isn't surprising, in retrospect.
I wasn't sure if I should bother with more PT, since the shot didn’t seem to have worked. Spending more money on 6 weeks of therapy seemed like a waste, since nothing was really different from my last round. The most likely outcome was having to do more PT after surgery.
When I eventually spoke to my doctor on the phone—a strong effort by me to not have to pay a $50 copayment to get yes/no answer—he said that even though the shot didn’t work, the next step would be surgery. “But if it was my leg, I’d try another round of physical therapy.”
So I started PT this week at a new place, to see if a different therapist would have a more targeted approach. They didn’t. There was some insurance miscommunication and after the second visit they told me I needed to go to a different office if I wanted to stay in-network. The therapist didn’t offer much insight into what they were asking me to do, and was also working with three or four people at once.
Last Thursday I saw a second orthopedic surgeon, this time a hip specialist. He was wheelin’ and dealin’, sort of steamrolling my the physical examination, pointing out inflexibility that I really couldn’t perceive. Seemed like a typical surgeon: confident, eager to cut, all-but promising wild success.
But he took more time to explain why surgery was the right move for someone in my position. Showed me his instagram, full of success stories and videos of the surgery. Bragged about how aggressive his post-op PT regimen is, and how I could expect to return to running after three months—which is…insane. Any generous estimates I’d looked up had said 4-6 months was the soonest I could expect to be doing anything remotely demanding.
“But I thought the cortisone shot not working indicated that surgery wasn’t a great option?” I asked.
He asked me what I’d done directly after the shot, to which I responded that I took it easy, didn’t do much if any desk work that day. Within a few days I still felt pain in the lower back and knee.
“I usually ask patients to try stuff that normally makes their symptoms worse,” he said. The shot was really only effective for a week-and-a-half on average in hip patients, he went on, so if there was any improvement it would have been fleeting.
I asked him doctor if there’s anything else we should rule out before jumping to surgery. He said that if I’d seen him one or two months after my issue started, he probably would have advised something conservative. But I’d gone so long with nothing else working—rest, therapy, cortisone, I’d tried everything.
“At a certain point,” he said, “a mechanical problem requires a mechanical solution.” We sat there in silence for a moment after that.
We left it at “Take some time to think on it and call the office to schedule the surgery.”
I want so badly to believe this is the answer. That the thousands I’d spend would be worth it, that I’d be able to run again without worrying about fucking up my joints worse than before. That I’ll be able to sit at a desk for more than 15 minutes without pain in one leg.
And of course, like a goddamn idiot, I’ve been on the internet, looking for success stories and getting tripped up by the cases where surgery did nothing. People swearing that you can get better by just doing the right PT course. That there’s no coming back from bad surgery, you’ll just need a hip replacement further down the line.
I’m going to try the new PT place I was transferred to. See if they have any insight, and maybe if it’s where I’d want to spend post-op.
I need to decide, though. I’m just overwhelmed with the idea that this pain is all there is from now on.