My History
Where to begin...
I remember running in 7th grade and my knee bothering me ocasionally. My solution back then was to wrap it and keep running. It worked. By 9th grade, I was on the Varsity track team. I had minimal knee issues that were solved with a good pair of running shoes and a pair of orthotics to support my high arches. Proceeded to run all through high school and into my sophomore year of college without any knee pain.
One day I was with my sister in sister in southern California and we were out walking. I remember stepping off a curb and after that my knee bothering me. Nothing had happened when I stepped off the curb, so I was in complete shock when my knee swelled up and I couldn't walk--literally. I couldn't bend my knee. I immediately went to a local orthopaedic surgeon, one of the best in SoCal.
My visit with him ended with him telling me that he couldn't find anything wrong with my knee. There was no sign of a torn meniscus or torn anything. He had no idea why I was in pain. He offered to scope my knee, but said since he didn't know what was wrong with my knee, there was little chance that the operation would yield any new information. He gave me two options: surgery or exercises. I was 20 years old at the time, and had enough sense to say, "Thank you," but "No surgery. I'll take the exercises." The exercises consisted on putting a roll of toilet paper under the back of my knee while sitting on the ground and pressing my leg into the toilet paper roll. After a couple weeks of that without any change in my knee, I stopped doing the exercises and fell into the mindset that "things will just fix themselves like they always have."
Over the next few years, things didn't work themselves out. Instead, my knee remained the same--painful with any activity, even walks that were either brisk or longer than a few minutes. I went back to the good ol' standby of my junior high years--I started wearing a neoprene one-piece wrap over my knee. At the time I was in college and consequently sitting a lot. My knee would be in serious pain when it was bent in the 90 degree position for very long, including car rides. I took to wearing the neoprene wrap all the time. It was especially uncomfortable under jeans, but I did it. I didn't know why, but bending at that knee joint was really painful, and the wrap helped to keep my knee and leg straight.
Looking back, this is when I started to feel a serious loss in my life, as activities, one-by-one, were eliminated from my life. In the beginning of an long-term injury, you tell yourself that it will only be temporary, that it will heal. That things "will fix themselves like they have always done." But when they don't, it's devastating. I remember meeting my now husband of 11 years. We met in college and I remember running with him for the last time before my knee was "injured."
That's another element to my story. Doctors, friends, everyone always asked the question, "What happened?" When I tell them that there was not actual "injury," they are puzzled. I was puzzled. Doctors were beyond puzzled. Many times I wished that I had just torn my meniscus--at least then I would know what was wrong, how to fix it, and that I could get better. Of course no one wishes for a serious injury, but you can see just what this kind of conundrum puts you through.
The years came and went. I am not a quitter by nature, and I had a really hard time accepting that this was it, that I would never be able to run, hike, and in general be active again. Four years after my injury of sorts set in, I went to a chiropractor who was very well-known, still is, among the running community in Portland, Oregon. Years earlier when I was running in high school, when he was a chiropractic student and working as a massage therapist, I would go to him when my muscles would get super tight from clocking 25+ miles per week. This time I saw him for my knee issue. He said he suspected that I had a shorter leg, and sent me to have a standing x-ray of my pelvis. Results came back and he said that the head of my right femur was 1 1/2 inches higher than my left, as indicated by the x-ray, and that the solution to my problem was to wear 1 1/2 inch lift.
Finally, I thought, this is what is wrong with me! I was so happy to finally know what the cause was of my knee pain. Balance out the pelvis and the pain will go from my knee, right? So I commit to wearing this lift; I had a lift of this height added to all the shoes I could except high heals so as to follow doctors orders. I even had a lift put on my flip flop so that I could wear them around the house and not go barefooted. The only problem was that I still had pain in my knee when I rode the stationary bike, when I tried to run, etc. I had worn the lift thinking that maybe it would take time for my body to adjust to it, that maybe the knee pain would be there for a while until I gave my body the "time" it needed to get in alignment.
Four years after I first started wearing the lift, I went to another doctor since I still couldn't run. He insisted that I did NOT have a leg length discrepancy, that I should stop wearing the lift, that it was an "absolute crime" that was done to me and my body having me wear that lift. I really challenged him on this--I told him all about the x-ray, and how could x-rays lie? He said he didn't care what the x-ray said; he said that I did not have a leg length discrepancy. I did choose to stop wearing the lift, primarily because I felt like if the lift was really the solution, then I would be able to run/be active without pain in my knee, which wasn't the case. So I stopped wearing the lift and ditched all my shoes that I had had the lift added to them. Interestingly, I didn't notice any change in my body (aka feeling pain other places) and at the time was managing a retail store where I was standing on my feel 8+ hours per day. Surely, if I was going to feel something lacking from the absence of the lift, it would be in this environment. Nope.
Back to this doctor who said to stop wearing the lift. He said to stop the lift, but he didn't have a solution for the knee pain. All he really knew was that the lift was a mistake, but he still didn't know how to fix the knee. At one point, he maintained that my body would fix itself. Hadn't I heard that somewhere else...
At this point in my history, I started going to all different healthcare professionals--massage therapists, more physical therapist, more orthopaedic surgeons, all in the hope that they would know more that the previous ones I had gone to. I was given a wide range of diagnoses (see the Diagnoses page) and various exercise regimens that they believed would be the solution. I tried them. Each one aggravated my knee, and so the cycle continued. My favorite (kidding of course), was when I would go to a new PT, for example, and after the general evaluation, they would tell me to "go get the bike and warm up for 10 minutes." I began to realize this a sign of a bad therapist. If they truly understood my issue, why would they recommend aggravating it? Seriously.
As the years rolled on I was finally approaching acceptance on a few things. It had been 12 years and not one doctor/PT/health professional could help me. I was beginning to accept that I would really never run again. I began to accept things, like I probably shouldn't buy a two-story house because going up the stairs would present a long-term health issue with my knee. How could I carry my kids up the stairs to bed? I began to accept that the outdoor girl I had alway been would forever be gone, and on and on.
At different points of assessment of my injury life-cycle, I would go back and try to think about what worked. I remembered that I could run in high school without a lift, and surely if my alleged substantial leg length discrepancy (LLD) was present then, I would have had issues then. But there were people and information on the internet that argued that our bodies are very forgiving when we are young and in our twenties; when we are in our 30s and 40s is really when things start catching up with us and manifesting themselves. Still, I knew that I didn't need a a lift then and that the orthotics helped.
Three years after I stopped wearing the lift, I decided to go back to custom orthotics in the name of returning to things that once worked for me. I definitely believe that the orthodics helped support my body and that they still do. Only, my knee still hurt when I ran. Problem still here, issue not resolved.
Now there is a part of this story that I cannot leave out, so for those of you who aren't religious, brace yourself and/or read on because your are in search of a solution like I was. I happen to be religious and have always prayed. Over the years I prayed intermitently about my knee, thinking that perhaps I would find a solution. When I didn't, I prayed less about it, thinking that this part of my life that wasn't going to change, even if I still kept going doctors in the hope of finding a solution. A few years ago, I started praying really specifcally and regularly that I would be able to find someone who could help me with my knee. I prayed, prayed some more, and then some. As my husband and I were now having kids and wanting to settle down, I prayed that we would be able to settle down in a place where I could find someone who could help me. Call it crazy, but in a whirl of events and in a very short timeframe, our life completely changed and we moved to Nevada.
One day in Reno, Nevada, I went to running store. I still bought running shoes even if I couldn't run anymore; chalk it up to hope, but also to the fact that my orthodics fit in them and they offered me support that other shoes didn't, even if I was committing the cardinal sin of walking in running shoes. When I was paying for my shoes, I did what I had done a thousand times before, all in the name of hope: I asked the store clerk if there was a local physical therapist that he could recommend to me. I knew from experience that running stores often do know a PT, as they are runners themselves and suffer running injuries like everybody else. While I knew my injury wasn't from running per se, I figured that maybe they would be able to help me anyway with the gamet of knee injuries they see. He pulled out a tattered business card and told me that he didn't know this PT personally, but that the person who gave it to him "swears by him" for all his running injuries. I took the card, thanked him, and didn't think much of it. After all, I had already been to over 6 physical therapists. But, I had hope that a solution was out there.
I had my first appointment with Michael Spevak of Physical Therapy Partners in Reno, NV in February 2011. I took him through my history, explained the diagnoses I'd been given, told him my personal conclusions. At the time, I thought that my knee pain was a combination of diagnoses, only that any treatment I tried, aka strengthening exercises, created more pain in my knee, not less. Michael surprised me several times that day, first by telling me that we should be looking at the source of the problem, which seems so basic, but had provided no solutions before.
You see, after going around and around with this issue and everyone telling me the problem wasn't in my knee, I started to believe in the diagnoses surrounding my pelvis, my LLD, my weak core, etc. (See Diagnoses for more). I believed that my pain was resulting from a domino effect in my body. After examining me, Michael shot that one down. When I described the area where the pain occurred, when the pain happened, he told me that that area is where all of the ligaments connect. (Sorry Michael if I am not getting this verbatim!)
Plain and simple, Michael said that I had iliotibial band syndrome (ITBS), that it was very treatable, and that he could have me running in few weeks if his treatment plan went like he thought it would. Over, say, 13 years, can you imagine how many times I've heard doctors and PTs alike tell me, "oh, I can have you running in no time." But, I optimistically looked at Michael and was hopeful. Hesitant, but hopeful. Looking back, I think the reason I would even considered believing or hoping in him was because he turned everything I had heard/been told on its head. He was approaching my issue the complete opposite of any other doctor,PT, etc. that I had gone to. He also didn't have me get on the stationary bike to warm up...
After a few weeks, (see Treatment), I did start running, and with no pain in my knee! I had been running for a few weeks when I had some pain on the inner part of my knee, almost down on my shin but on the inside. I went back to Michael and he gave me some band exercises that he said usually resolve the tendonitus I was now having on the inside of my knees. The band exercises strengthened the hip muscles with simple resistance. Sure enough, the tendonitus is gone, as is the ITBS.
When I think back to my prayer to find someone who could help me, I don't doubt for a minute that it was answered! Thank you a million times over Michael! Here is his contact information for those of you who are interested:
Michael J. Spevak
Active Physical Therapy
775-786-2400
