An Injury That Refuses To Get Better Or Worse
Living with a knee that won't break, won't heal, and won't leave
Today I got the results of my follow-up MRI for my knee injury. The conclusion was short and brutally neutral:
“No relevant change compared to August 2025.”
No better. No worse. Just… the exact f*cking same.
What surprised me, though, was my rather low emotional amplitude. It felt more like someone finally putting into words what my body had been telling me for months anyway.
Your knee is not really bad.
But also nowhere near healed.
Clinical stagnation. Or at least slow motion.
What “no change” really means
On paper, the situation is clear:
A stubborn patellar tendon injury.
A bone marrow edema in the tibia underneath it.
Both are notorious for being slow to heal. Anyone who has dealt with Achilles issues or tendon sheath problems in the wrist knows this painfully well. Six to twelve months is a realistic horizon for the edema alone. And often one doesn’t heal without the other.
Yet still that uncomfortable question:
Why did nothing move in the last half year? Especially when I stayed within the recommended load management, stuck meticulously to my rehab plan, and restructured my complete daily life around protecting this knee?
There are a few answers. None of them surprising but all of them honest.
Reason one: biology doesn’t care about your discipline
First, this is a tendon injury. Tendons are slow. They don’t respond to effort. They respond to time, blood flow, and a very narrow sweet spot of tension and stress. You can’t negotiate with them, impress them, or guilt-trip them into healing.
Same with bone marrow edema. It’s basically a stress reaction deep inside the bone. There’s no quick fix, no injection that magically resets it. It’s one of those injuries where the most powerful treatment is boring: patience and controlled, often frustratingly low load and impact. My last downhill was from the Osterfelderkopf down to the finish of the Zugspitz Ultratrail in Garmisch-Partenkirchen in June 2025.
So in a way, part of this stagnation is simply baked into the nature of the injury. That doesn’t make it less exhausting, but at least it’s not a mystery.
Reason two: I committed late to a real plan
The second reason is on me.
I did get medical opinions. I did talk to doctors. I did decide in November to start focused shockwave therapy, on the recommendation of one of them. But I wasn’t truly committed to a clear, step-by-step medical plan.
There was no: “We do A, then wait X weeks. If that fails, we move to B. If that fails, we do C.”
It was more like: collect smart opinions, then improvise around them. Physiotherapy here, shockwave there, a lot of self-management in between. Not reckless, but not exactly tightly guided either.
That has changed now. I’m finally in a setup where someone is looking at the big picture with me, defining sequences, building in waiting periods on purpose. Someone who keeps a tight rein.
The time between steps still feels endless, but at least there are steps. That alone calms something in me.
Reason three: I never gave the knee real rest
And then there’s the part I can’t gloss over: I never actually stopped.
Yes, I reduced.
Yes, I adjusted.
Yes, I skipped flat running when things felt too hot.
But complete rest? Zero load? Not once.
All summer I trained full vertical volume. A complete uphill season, including a race at the end that felt very much like a proper performance block. On top of that:
A three-day gravel bike trip (for some reason, cycling irritates the knee even though it’s technically low impact).
Running up the Zugspitze (In terms of elevation gain, it wasn’t a big deal for me, but the run also included 13 flat kilometers, the longest distance since ZUT).
Crewing a full week at TOR for our friend Juliane (long hours in the car, which is hell for this knee).
So if I’m honest, the tendon and the bone never got more than a few quiet days in a row.
The only exception?
Early November, when a brutal virus knocked me out of my life for two weeks. No sport. No gym. No nothing. And suddenly, the knee felt noticeably better.
That experience has been echoing in my head ever since.
The only experiment I haven’t really tried
Which brings me to where I am now.
I’m seriously considering stepping out of my already heavily reduced training for the next four weeks until my next doctor’s appointment, where we’ll decide on the next phase of treatment.
That would mean:
No treadmill, even though I only run uphill at 15% incline.
Possibly no Stairmaster.
Potentially even cutting strength training down to a true minimum.
From a load-management perspective I tolerate all of this very well. The knee felt totally alright for the last few weeks. The problem is: tolerating is not the same as healing.
Maybe what I need is a clear contrast. A completely new impulse. A phase that is fundamentally different from everything I’ve tried so far. Pure rest as the final experiment. The one I’ve avoided, because it’s the most uncomfortable one.
But even if this does not improve the knee, we at least know for sure that impact is not the main driver, and that we’re dealing with either a mechanical issue or a biological / inflammatory one.
The opposite side of the equation
There are reasons against extensive rest. Strong ones.
The reduction of my training already did damage in other areas: sleep, eating, stress levels, focus, mood. All compromised. No surprise. If you’re used to a high training volume for years and suddenly move a fraction of that, your system reacts.
And then there is the heartbreak aspect. I just started to feel a bit of flow again on the treadmill and Stairmaster. The gears were finally meshing. Sessions started to feel like training, not just rehab. And now I’m supposed to shut that down again?
But the bigger picture is bright and clear:
What good is this fitness, right now?
I can’t scale it. I can’t build on it. The corridor is narrow and probably stays narrow.
So the real question is: what price is higher? Losing a few weeks of carefully rebuilt fitness? Or dragging this half-healed injury yet another season into the future, hoping it will get better along the way?
I won’t answer that today. But I can feel the decision approaching.
What this really does to me
Medically, the MRI didn’t tell me anything I hadn’t already felt.
Emotionally, it does something else: it confronts me with the fact that the Levelhead inside of me has not been in charge for the past six months.
If he had been leading, this whole process would have looked more structured. Earlier commitment to a clear plan. Earlier push for proper rest. Less improvisation. More boundaries.
Instead, I’ve been negotiating constantly with my inner Punk, the part of me that wants to do something at all times. Any stimulus feels better than sitting still with not-knowing.
How did I even end up here?
Sometimes I feel regret when I trace back how I got injured in the first place. That long chain of small yeses that led to an overloaded knee. That’s another story for another Das Z Letter. Spoiler: no, it wasn’t the ZUT alone.
Despite all this, my outlook for 2026 is strangely hopeful. That might sound naïve, but it’s real. I do have dark days where I want to quit running altogether. But they’re not the majority. Most days are full of intent and a quiet kind of stubborn optimism.
But….
The hardest part is not the injury itself.
It’s the uncertainty.
If someone came to me today and said, “Ten more months, and then it’s over for good,” I’d probably have the most relaxed ten months of my life. I can handle long timelines. What eats me alive is not knowing whether this is a ten-month thing, a two-year thing, or something I’ll carry forever at a low hum.
This could be the phase where I have to learn something I’ve successfully avoided my whole life:
That progress sometimes looks like not doing. That success can occasionally mean stepping back instead of pushing through.
I’m not there yet. I’m thinking about it. I’m uncomfortable with it. And I’m trying to stay honest while I decide. I’ll keep you posted.
Everything Not Running
The timing is almost suspiciously good: today, of all days, Lisa and I started our Anti-Inflammatory Los Wochos.
For a few weeks we’re cutting out everything that tends to fan the flames: sugar, white flour, highly processed food (yes, even the suspiciously good vegan chicken pieces from the fridge section). It sounds like self-punishment, but honestly, we’re actually excited about it.
For us, the step isn’t that huge. We already eat pretty well and cook all our meals at home. But this time, it’s more intentional. Driven by curiosity. Yes, we both deal with inflammatory stuff from time to time (see above), but this is not a medical protocol. It’s an experiment.
How do we feel without the usual inflammatory background noise? What happens to energy, sleep, and mood when we remove the most obvious irritants for a while?
Today we had carrot-sweet potato-soup with ginger, turmeric, and chili. Simple, warm, wholesome, and sharp in all the right ways. A good start.
On Repeat
The late 2000s may have been the decade with the most underrated hardcore bands. It was somewhat of a transitional phase, overshadowed by the metalcore hype and nostalgia for the legendary 90s. And yet there were quite a few bands that released insanely great music in the years from 2000 to 2010. For me, REIGN SUPREME is one of them.
REIGN SUPREME was never particularly innovative or unique. They simply mixed the basic ingredients of the hardcore genre together perfectly. With only one album and a handful of EPs, they didn’t leave an overly large footprint on the scene. However, the fact that their songs still sound incredibly powerful and authentic 15 years later suggests that they did something very right.
Oh dear! I‘m really sorry to read all this, but can fully relate to the frustration. But I can assure you that you can lead a very healthy life for at least a few months without engaging what we commonly define as sports. I‘ve been observing myself over the past years the impact of aging on my physical state although I‘m not that old actually with just a bit above 50. It is a inconvenient truth that our body’s ability to heal itself decreases constantly from the age of 30 onwards. Initially it‘s hard to notice and shows rather in there being no more quick physical wins. Performance progress is only gained by tough training work. At same time recovery takes longer and longer. Our bodies are dealing with tons of microinflammations which are increasingly harder to deal with. At least dealing with it takes longer. Cell growth isn’t what it used to be and balance between new „healthy“ and used „trash“ cells starts to lean towards the latter. This is just the natural way of things and cannot be changed, but we can help to decrease the load on our bodies to deal with all these challenges. The steps are easy and all well known. We need to eat and drink well and right. Even going vegan is not a solution if you don’t know where the food actually came from and how it’s been produced. So eating well is a bit of a theoretical concept if you don’t just rely on your own produce. Sugar doesn’t need to be cut out because it’s everywhere and we need it - at the right dose though, which is a fraction of what we typically consume even if we are on zero candy. I‘d go slightly paranoid about what I feed my body with. In the medieval ages people would have been afraid of being poisoned when that ate something they didn’t know the origin of. We however developed a strange attitude of stuffing things in our body without really thinking about what it actually is and what it does. At the same much more important than sports is actual moving ourselves. I walk whenever I can and that means not just leaving the car parked but also not using the bike if I can walk. Even while sitting I move. Moving makes me feel so much better and it doesn’t have to be running. I’m sure if you take it easy things will get back to normal sooner than you may think right now. Just my 5 cents (actually turned out to be a couple of cents more…)!
Ah man Chris this is so frustrating. I have been dealing with nerve tingling in my hamstring and leg since July. I can’t really predict when it would flare (during a 50k but not during a 100M????) so finally got an MRI hoping to get some answers. Nope. Clean MRI. Still unsure what’s going on, especially how it comes and goes. Full rest is really hard, especially being in the running space and writing a popular newsletter about it. But rest is part of life. When things like this happen to me, though it’s super hard, one thing I tell myself is that by letting this go (for now) I am making space for something that could be even better. That helped me get over my last break up ironically. I hope you are able to find something else that you enjoy that also allows healing for your body. You deserve it.
I also loved your first point. In my field (biomedical) we often say “biology gonna do what it do. it don’t care what you want”