Yesterday evening I received a call from my family physician and he said he had heard I wanted the results of my MRI. I told him, with no small amount of trepidation, “Yes, I would like those results.” And his reply...
You have a bone bruise. I was ecstatic! I was so worried that I had a tear of some kind and that I would require surgery and that I would not only be out for this season but possibly the very beginning of next season. My doc's original thought was that I had a torn meniscus but he couldn't rule out a torn or partially torn ACL. He told me how common it is for 40+ year old guys to get a torn meniscus especially the active ones. He said that they meniscus basically becomes increasingly brittle as you age and therefore more susceptible to injury. He said it may just require an orthopedic surgeon to just “go in and clean it up a bit.”
I was contemplating no running until surgery and then the long recovery and rebuilding period that could last up to seven months. I was also thinking about what all I would do with that time. I had to admit that I was at least happy that I may get an excuse to take a couple weeks sick leave from work post surgery and I thought that in relatively short order I could sign up for some Tai Chi classes to help with the knee rehab and maybe improve my balance and flexibility. When life hands you lemons...
Anyway, a bone bruise. I thought “Great!” but said “What exactly is a bone bruise and what are the implications?” My doc started off by telling that he was amazed I had not torn anything at all and that I had only bruised the bone. He said, “You must have really rubbery menisci or something. Most people don't get a bone bruise alone.” I asked how to care for it and he said, “You need to lay off a while, take it easy.” To which I replied, “You mean run at an easier pace, run on softer surfaces, things like that?” and he said, “no, I mean you probably shouldn't run for a couple months.”
Well, my thought is piss on that, it's a freakin' bruise. So, being honest I told him I was going to take it easy but I was still going to run and he said “I know, just keep your appointment with the orthopedic surgeon, have him look at the MRIs and you two can talk about it and see what he thinks.” So that is my plan. I see the knee guy on May 18th and I'll know more from there. In the mean time I am going to see what I can do and just take it easier, slower and pay close attention to how I feel. I did about 8 miles tonight at an 11 minute pace, about 3 minutes off where I had gotten to before the injury, and felt good but then after sitting for about a half hour I stood up and was limping slightly and there was some pain. I think the "see what I can do" part will not be nearly as much as I had hoped.
I also did a little research on knee bone bruising and there isn't actually good stuff out there that is relevant to my cause. I did discover that a knee bone bruise without any associated tearing of anything else only occurs about 19% of the time. I also read an article from the journal Clinical Radiology titled “Magnetic resonance imaging of bone bruising in the acutely injured knee--short-term outcome.” which basically found 10% of their population had bone bruising without associated ligamentous injuries (like me), that the bruise was still visible on MRI after 12 – 14 weeks and that the initial severity of the injury didn't really have any bearing on whether or not the bruise was still visible after 12 to 14 weeks.
I also discovered that it isn't really a bruise per-se it is really a micro fracturing of the head of the femur. The ends of living bones are covered in a fibrous material and in a bone bruise that is what gets smashed. I guess that is what that kind of sickening squish-like sound I heard was.
This all fits with some of the anecdotal evidence I unearthed, basically that a bone bruise heals slowly and continues to be painful until it heals. There is no apparent intervention that will make it better other than time. The enormously frustrating thing is that I didn't find anything about running with a bone bruise, whether it would make it worse or what. I did find one piece that briefly stated that it was important to maintain mobility of the knee during the healing process but that could be just about anything, stretching, walking, Tai Chi or doing knee bends while sitting in your arm chair.
So I guess the overall outcome is still equivocal, I really don't know where I stand. Things look much better than they could but they don't look as good as I had hoped. Leadville is definitely a big question mark and it looks as if everything else I had planned for my season between now and the end of July, which is everything by the way, is also seriously in question.
This is one seriously expensive fall.