Plica Syndrome is Back?

Back in the late 1990s, I had pain and swelling in my left knee during and after bicycling. Orthopedist after orthopedist told me it was tendinitis, but it never went away with physical therapy and rest. Finally I saw an orthopedist who thought it was something else: plica syndrome. Long story short: conservative treatments didn’t work, so in 1999, I had arthroscopic surgery to have the plica removed. I made a quick and full recovery, and I had no problems during my 2001 ride across America. Since then I’ve had the occasional ache and pain, but nothing more than stretching, ibuprofen, and on occasion a day or two of rest couldn’t handle.

Then one cool morning (45°F) last week, I went for a bicycle ride, and after only seven miles I felt the unmistakable pain and swelling of 15 years ago. My orthopedist had warned me that the plica could grow back. Many people have a medial plica, so it’s not the presence of such that is an issue, the concern is if it somehow becomes inflamed. And now it was back and inflamed with a vengeance.

The interesting thing is that back in 1999, very few people seemed to know about plica syndrome. Now in 2014, I see a ton of information and cyclist blog posts about it, almost to the point where it seems to be overused as a diagnosis when the true cause of knee pain can’t be found. Though in my case I have the video (a VHS tape!) from the procedure back in 1999 showing I did indeed have an inflamed plica.

Out of the last 15 years, the last few years were especially symptom free, even though within the last year I had added running to my exercise repertoire. And then it clicked: I’ve been at my new job working from my home office for about three years now. Although I wasn’t doing so for my knee, I took advantage of the flexibility of working from home to shift my rides from morning/evening to midday/afternoon, when it was at least 60°F outside. Recently I’ve been working back in an office again, forcing me back to morning/evening rides, and last week’s ride was the coldest I’ve done in a few years. I do cover my knees when riding below 70°F, but for me 45°F and covered isn’t quite the same as 70°F and uncovered.

I had hoped to back off on the running and ramp the cycling back up over the winter break. But the interesting thing is that cold weather running, especially doing so for a week in New England over Thanksgiving, don’t seem to irritate the plica. Even after the plica was already inflamed, the few easy runs I’ve done in the past week haven’t made it any worse. I’m guessing the range of motion that my knee goes through for cycling irritates the plica more than the pounding from running.

So although it wasn’t my original plan, going into the holiday season I’ll be targeting 3-4 short easy runs per week. Maybe I’ll get out for some easy rides if we have some warmer days. Also, I’ll be sure to do a better job of stretching so that tight muscles don’t provide additional stress at the knee joint. Furthermore, I’ve been thinking of getting one of those portable elliptical trainers, but I have no idea if they are junk or not. I’ve been thinking that maybe it’s time to add swimming as cross-training? (But I dread the additional overhead of commuting to a pool, etc.) Finally, I need to work on my race/ride calendar for 2015 – though that can wait until after the holiday!