Anatomy of an Injury

Running Tips - Anatomy of an Injury,
     or how I learned about Baker's Cyst, Ultrasound, MRI, Weight-bearing X-ray, and Torn Meniscus

It may all have started with a fall. We were taking a walk along a grassy path after some rain when I decided to leap over a puddle. The grass on the other side was wet and so, instead of getting a foothold, the landing leg slipped, the other caught in the ground, and I fell, twisting one or both knees or ankles. It was hard to tell, so I just lay there, gathered myself, counted body parts, and got up slowly. No harm done, it seemed; we resumed the walk.

I reduced the lengths of my usual runs for a while, but then got back to my regular schedule. Two and a half weeks later, we were going to cape Cod for a couple of days, so I increased the running in the few days before that.

The day of the drive, the right knee and leg felt fairly stiff and sore. Even some slow walking didn't seem to loosen it much. Going up and down stairs was painful, and that night, knee pain didn't let me sleep well.

The next day, it was clear that the right knee and right leg were quite swollen. It meant limping around some; I thought of myself as Chester on Gunsmoke. One day later, with the leg still swollen, I was persuaded to go to a local health center to have someone look at it.

We were advised to go to a hospital immediately, the fear being DVT, or deep vein thrombosis. In DVT, a blood clot breaking loose and traveling to the lungs could have deadly consequences. The contra-indications were my healthy lifestyle and the fact that there had been no direct trauma like a blow to the leg.

In short, later that day I was sent to a hospital for an ultrasound scan. The technician found the actual problem, a ruptured Baker's cyst, rather than DVT. This cyst is an accumulation of fluid in a sac in the back of the knee; something had caused it to rupture (the fall, overuse?).

Rest, leg elevation, and an elastic stocking got the swelling down again during the next week, so that, toward the end, I was actually running a few miles again. Then a sequence of other injuries took over, all on the right knee and leg.

Five miles into a longer run, I developed a strain at the lower part of the calf muscle. Walking home was painful. It all meant more rest and a slow start to a combination of walking and running. Then, at the end of a walk/run, the ligament on the inside of the knee developed a strain. Even short walks were painful, and improvement was so slow that two weeks later I looked for medical advice again.

An x-ray showed nothing, and after another exam during which the physician's assistant suspected a torn meniscus, I was scheduled for an MRI scan. The scan took about a half hour, and at the end, I had the images to take to the orthopedist two weeks later.

With the images of sagittal, coronal and axial scans (!) in hand, what's one to do in the meantime but try to get educated about MRI's and torn meniscus, and to try to read the images oneself. What better place than the web! I found some great sites with information on MRI scans, and great pictures of damaged knees.
There's an excellent online book, The Basics of MRI, by Joseph Hornak, Ph. D., with as much technical detail as anyone might like.

See an Emory site for MRI images of the knee in various cross-sectional planes: "sagittal" refers to a front-back, top-bottom plane; "coronal" refers to a left-right, top-bottom plane; "axial" refers to a left-right, front-back plane.

There are  many sites with a discussion of torn meniscus, with diagrams and images.
By the time I saw the orthopedist, the knee had begun to improve, so that I was cautiously doing some running, insterspersed with short walks to recover. He took me on a guided tour through the MRI images, and confirmed a torn meniscus, apparently a partial extrusion. Then he ordered a weight-bearing x-ray, where an x-ray is taken with the patient standing. This checks the separation between the upper and lower leg bones, and their relative position. Despite all the running over all the years, the weight-bearing x-ray showed the joint to be in excellent shape.

The orthopedist offered three options: Anti-inflammation medication (Feldene) with no other intervention, steroid injection (no more than a few times a year), or arthroscopy. I chose the first, the most conservative, with the others available if that did not work, and scheduled an office visit for three weeks later.

After about three months, the ordeal seemed to be over, and I decided to cancel the scheduled office visit. My new regimen was to bring mileage back up slowly, and to run only every second day, using the alternate day for recovery. That's brought the run distance back up to nine miles once again, without ill effects. I can't tell whether the medication is making any difference; I use it after a long run, when I remember.

Last updated Oct. 4, 2017