Old injuries are new again

My second season doing triathlon I started getting pain on the outside of my knee. I tried stretching and icing it, I started wearing a compression brace, and I cut back my training. But nothing seemed to work. Then one night, after some vigorous stretching, I awoke in the middle of the night to find my knee roughly the size of a cantaloupe (or rock melon, if that's your preference).

I went to the doc. They x-rayed it, they mri-ed it, and the verdict was to take some prescription NSAIDs and leave it alone for 6 weeks. It still hadn't recovered, so I went to 6 weeks of PT, which I was also not very impressed with. We did some very gentle exercises to strengthen the inside of my knee, and after 12 weeks, it seemed to have calmed down.

I know a lot more about the injury now, and I realize it was actually ITB syndrome which was putting pressure on my knee and causing it to rub. And with all the shin issues my running created over the last two years, I haven't really had to deal with it again.

Until about 4 weeks ago. I noticed after strength training that my ITB was tight, but after a few days of foam rolling it subsided. The following week it was back again, but this time, the following day I had the pain in my knee again. Bugger. More rolling.

And this is where I should probably establish that I am up for just about any sort of crazy treatment that the internet can throw at me. Since I started triathloning, I've submitted myself to being stabbed (accupuncture), having giant hickies (cupping), table-clutchingly painful massage directly into the injury, and essentially finding my funny-bone in my legs (fascial stretching from a man I usually refer to as "the witch doctor"). I've also tried nasal irrigation, but that's not related to my running injuries (though I really believe it works). Basically, if some one promised to make my leg injuries subside through massaging my aura or sitting in post-race porta potties on a warm day, I would do it (and probably pay $90 for the pleasure).

My coach suggested I go see the team chiropractor. So on a Thursday after another session of strength training, I went to see him for the first time. He does a combination of Active Release Therapy, which is targeted massage meant to break up the adhesions in and between muscles, and Graston Treatment, which is essentially ironing out the muscle with a butter knife. The Graston results in some pretty serious bruising. The first treatment goes well. I go back the following Tuesday after a strength workout of my own and before a track practice. My knee felt good going in, but on Wednesday I've got pain in the top outer part of my calf and stiffness on the inside of my knee. Thursday I go back to strength, and back to the chiro. This time we do some pretty serious work to the inside of my knee and it's the most painful treatment I've had and by Thursday night my knee is seriously stiff, like I can't bend it all the way. That night I was supposed to do a run, but upon putting on shorts I discovered my knee was swelling up again.

This is bad, and I start to panic a bit. I've only got 6 weeks til the half. Now is the time to be doing my best volume work. I can't have a swollen knee. I run my knee through the GameReady (a compression and icing machine, which Paul bought for his shoulder and is awesome), and it definitely helps some of the swelling. The following morning I go to swimming and the knee is still a little swollen, but it's better. I talk to my coach about it, she assures me that some localized swelling is normal after an intensive treatment. And this helps quell the fears.

By Saturday morning things are feeling better. Every now and then I take a step that just feels like my knee is not quite in the joint the right way, but for the most part it's better. I go ahead and do a brick with 2:20 of biking and 40 min of running, and things feel pretty good. Sunday I run my mother's day 5K and follow up with a 58 mile ride (in some serious wind).

I had a bit more Graston yesterday on the ITB, and on the inside of the knee as well. Still a little swelling, but I rode this morning and things seems to be ok.

But that's just it. I can't really tell what's been the culprit here. Is it the strength training that's causing the dramas in my knee, the increased volume or the treatment? And if it is the treatment, is the cure worse than the disease, or will it result in improvements in the long term.

I'm traveling this weekend, so I will only be able to get in a long run while I'm away, which I hope will give the knee the rest it needs to recover from all the stuff I've been throwing at it.