Acknowledge your ignorance: an open letter

Dear doctor,

If you are not a sports doctor/trainer and are not listening to my explanation of my pain, do not pass off my pain/discomfort as a mere “overuse injury”. Explain to me why my injury has the pattern it does if it is a mere overuse injury. Do not shrug helplessly at my limited alternatives for healing (no anti-inflamatories) and insist on using the old, so-in-the-box RICE method… with the anti-inflamatories I can’t take.

If you refuse to think outside the box, at least admit your fucking ignorance and refer me to someone who might know more. Not an orthopedic surgeon, but maybe someone who can differentiate what kind of “overuse injury” I might have on a more useful granularity than, “Well, you biked, so it must be because you weren’t in shape. Being new to exercise causes muscle soreness.”

Um, no. That is not the case here. You are not listening to me.

I want an insightful analysis, not an anecdote about your mother’s expensive-as-hell herbal anti-inflammatory or help finding my quads. I told you that I’m fairly up on my anatomy.

When I ask for a referral to the sports trainers after 30 minutes of haggling with you, don’t belittle my request and tell me what you think they’ll tell me. I’m already done trusting that what comes out of your mouth will be intelligent. Acklowedge your lack of expertise and gracefully pass me on.

Having a degree (bachelors, PhD, whatever) does not in and of itself garner respect from me. There are too many stupid people with doctorates that, despite the fact that I may someday have one, I don’t have a lot of faith in the process. A willingness to acknowledge the boundaries of your knowledge and to act to compensate for that will gain my respect.

In the meantime, I believe it may be time for more research on what this problem could be. *frown*

Update: A description of the problem

So I started biking about a month ago, right? After doing running, Pilates, weight-lifting, etc., for months. About a week or so into biking, I started having this weird feeling just above my right kneecap–like a pressure was building. It didn’t feel muscular, per se, since my whole quad wasn’t feeling weird, but just a very localized area. Not really a pain, but an intense discomfort.

I stopped biking, and kept up the rest of my routine, although more sporatically. The pain/pressure didn’t come up unless I tried to bike.

Fast forward a week, the week before Spring Break: I’m exercising very sporatically (hey, it was the week before spring break!), and the pressure builds in my knees (both knees now, although less in the left) when I sit for longer than about ten minutes and is constant by the end of the day (after a lot of walking and sitting). At this point, I’m icing and applying warmth via WO’s cornbag regularly. I don’t take painkillers, though, because I don’t want to ignore the problem. The pain/pressure is steadily getting worse, and I’m occasionally wearing a knee brace on my right knee.

During Spring Break, there was the hiking. At this point, my knees felt janky within a handful of hours of waking, so WO and I actually kept things pretty light on the trip. I’d have pushed much, much harder had I been in full health.

The end of the break (once the trip was over) and now, I’m in nearly constant discomfort and pain. Tylenol offers negligible relief, and the application of warmth or cold doesn’t seem to change much. I can’t sit still in class for more than about five minutes, although propping my legs up on a nearby chair is a little better. There are the typical side effects of enduring a chronic pain–little appetite, little sleep, grumpiness, blah blah.

Some internet research last night (especially this) suggests it might be quad tendonitis based on the location of the pain–there’s no lateral pain, no pain beneath the knee cap, etc. It’s all above the kneecap. WO and I tested for runner’s knee, since suddenly working the quads so hard in biking might have quickly created an imbalance, but there was no pain. I’ve checked out Patello-Femoral Syndrome, but there’s enough deviation in symptoms from site to site that some match and others are opposite from what I have.

That’s assuming it is overuse in some form (which I think it might be), and nothing rheumatic (arthritic) that has suddenly decided to develop. That’s not impossible, but is unlikely. Several members of my family have arthritic knee problems, but I don’t know if that sort of thing runs in the family.


  • Dulin

    A year or so ago a Student Health pseudo-doctor told me that I had Patello-Femoral Syndrome and gave me exercises to do. When he told me about it, he suggested biking instead of running, though, so I’m not really sure. Anyway the exercises he told me to do:

    1) Leg Extensions on the machine

    2) Sit down with your leg extended so that your knee cap can be moved around. Push your knee cap down, right, left, and up for ten seconds and repeat for five minutes. I have no idea what this actually does, but I did it…

    3) Sit with one leg bent and one leg extended and lift your leg like 8 inches off the ground, hold for 5-10 seconds and then let it down, do three sets of ten for each leg. It’s best to do that with your back to a wall, I have found.

    4) Sit with one leg bent and the other leg extended and with the extended leg, press down on the floor so that your quadriceps are tightened. Hold for 5 – 10 seconds. Three sets of ten for each leg.

    Anyway, I did those for a while and I remember it working… I’ve been doing them recently because I’m back up to three miles. It might be your shoes too, I know I need to get some new ones. I think your supposed to change them every couple of hundred miles, but since you are on a bike, that probably won’t make much of a difference.

    Here’s the disclaimer. I am not a doctor, I know a little about this issue through personal experience and research a long time ago. I admit that I do not know enough to effectively diagnose your problem . Good luck figuring it out and I hope it is something simple rather than a chronic degenerative anything.