Knees knees knees

[betagirl]

Ok, so I have bad knees (thanks dad!). When I was 14, I had to have surgery on my left knee for a chronically dislocating kneecap. Probably some of the worst pain in my life. It went out on me 5 times before I got it fixed. I was on the same course as my father, who had surgery at 16 on the left and 35 on his right. Well, I hit 30 this year and my right knee is starting to show signs of the same crap I had before.

Apparently the technical term for what I have is Chondromalacia, where basically my kneecap doesn't track properly. Currently if I'm in too big of a gear, I feel the pain behind my kneecap as it rubs incorrectly in the joint. It's nothing horrible, but I'm slightly concerned about RAGBRAI this year. The route is about 18,000 feet of climb over the week. Basically lots of rolling hills. Considering my knee is bothering me on the Chicago flats sometimes, I can't wait to see what hills do to it. It's currently slightly swollen, which my boyfriend pointed out to me tonight. Swell.

I'm not sure what to do about it. I've read what the physical therapy is for it - basically strengthening your quads and such. One of the exercises recommended is riding a stationary bike :D I suppose I could strengthen the muscles more than they already are, but I'm not sure what good that would do.

Does anyone else have this problem? Apparently it's pretty common in us girls. If so, what do you do? Part of me says get the dang thing fixed in the winter like I did with the left. I'm secretly mortified of having it dislocate on me.

Thanks!

oh and I do take celebrex for longer rides. I'm not really keen on wearing one of those braces on the bike either. I can't imagine how sweaty and uncomfortable that would get!

[salsabike]

Yes, I have had it ever since my ballet days. Best exercise: what they call short-arc extensions. I sit on the floor with a soccer ball under my knee to raise it up, and four pounds of weights on my ankle, and raise and lower my lower leg. They call them short-arc extensions because you are really only raising and lowering your lower leg the last 20 degrees or so of the 90 degree arc you have when your knee is completely bent (like when you're sitting upright in your chair).

Link to an excellent article: http://www.youtube.com/watch?v=_pGtY6e3fVI

[Lise]

Sorry to hear about it, beta. I think SK has the same thing, and had a number of surgeries for it.

[Kathi]

I have it too. My x-rays are showing signs of cartiledge wear.

It's the reason I started cycling.

Correct crankarm length is very important as well as saddle height. I spin my gears, no mashing. I use Speedplay pedals, my ortho recommends them and they keep my knees happy.

I was also told by my PT not to do the same activity the same day in a row, ie. riding the bike. I do not jog or do high impact activities. My drs. told me not to do lunges and squats. One told me, this was in 1994, to quit exercising.

Fast forward to today. I tore my ACL in Jan. and had surgery in late Feb. Just about everything I've been told is out the window!

I do lunges and squats almost on a daily basis, I'm working on muscle endurance and will eventually back off. I do leg raises and bridging on my fit ball. I'm now doing plyometrics.

My physical therapy exercises incorporate quad, glute, hip, hamstring and core strength. Many things I do for strength are on the Pilates reformer.

Currently, I'm riding 100+ miles a week and have 3 tours scheduled for later this summer.

Before I tore my ACL I did a weight routine that included lunges, squats or leg press, leg lifts, step ups and calf raises with 12-20 weights.

Anyway, I recommend that you find a PT that knows how to work with this issue and get on a good program for strengthening the quads so the pain doesn't get worse.

[Trekhawk]

Ooohh we have quite the club going. I have Chondromalacia in both knees and have just finished PT. Make sure you ice your knee after riding. I recommend you buy Andy Pruitt's Complete Medical Guide for Cyclists. I know Im always raving over this book but it really is jammed full of great info. It has a section on Chondromalacia and a section of stretches to help the condition especially strengthening the Vastus Medialis.

Avoid pushing big gears and until you get the condition under control avoid lots of climbing.

Hope this helps and GET ANDY'S BOOK.

[Kathi]

For me, the Vastus Medialus is the one muscle that has not come back yet. My therapist says its the last muscle to come back and it takes a long time.

The uninjured leg looks great but the injured one, :eek: I shouldn't complain, it's come a long way since March.

[KnottedYet]

A good PT can teach you to strenthen your hip external rotators (to stabilize the femur) and the vastus medialis obliquus (to keep the kneecap tracking properly). They can also get you stretching the tight stuff and teach you how to do myofascial release to your ITB and the retinaculum around your knee. And will be able to tell if insoles/orthotics will help on the bike or walking.

Tibial tubercle transfers and lateral releases are really last resorts. And you do have time before RAGBRAI to make a difference. PT could tell you how to keep things happier on the ride, too.

[TxRider]

I'm cursed with bad knees as well. Same thing - chronic dislocations and I agree, some of the worst pain you have ever experienced. I had surgery on the right knee for the first time while in college (tried the conservative routes up until then) and ended up having it repeated about 5 years later when it started dislocating again (last time at work - how embarassing!). Fortunately, the left one never went out as often, so I've been able to avoid surgery on it. However, not sure if I overcompensate with it, but I experience problems with the IT Band from time to time.

For me, the dislocations occurred primarily when I was kneeling/squatting down or sitting with my leg(s) folded beneath me, so I've learned to be careful when doing either. And, I also got to where I could tell when it was going to happen ... I'd feel that pull and immediately I'd try to straighten it back out to prevent it from happening. Didn't always work, but certainly kept it from happening more often.

I second the opinions others have expressed ... find a knowledgeable PT that can help you strengthen the quad muscles and try to avoid that surgery for as long as possible. I do appreciate the fact that it has given me another 6 years without too much constant fear of dislocations, but I also know that I gave up some strength in that leg as well as some stability.

[SadieKate]

Yikes! Lunges and squats! :eek: :eek: :eek: :eek: No way, Jose. Not for me.:eek: Let me say that again.:eek:

Prescription orthotics. Worn them since 1976 for chronic chondromalacia and I don't leave home without 'em.

In 1980, I managed to fall straight through a snowbank with a fully loaded backpack and my right knee had nowhere to go. What was chronic was now acute with a big, old gigantic tear. Fortunately, I could walk out of the backcountry and I have a strong as an ox brother who doubled-packed everything out. I carried the fishing rods.:D

After an arthroscopic scraping didn't work because the gouge was just too big(I got to watch the little lawn mower rotor rooter around in there!), my right knee was re-aligned with a Macquet Maneuver (tibial tubercle elevation) which I understand is no longer performed. The Los Angeles Rams' orthopod did mine which may have been why it has been successful for me (he had lots of really big knees to practice on first). The lower attachment point for the patellar tendon is actually excised from your tibia and bolted to another spot. Bye-bye competitive volleyball (I'm too short anyway); hello, cycling (and a handsome hubby/riding partner).

My chronic chondromalacia is caused by a number of things, pronation being part of it. The orthotic rolls my foot outward so that my tibia tracks in a straight line in the patellar groove as I bend my knee. So, it does solve my chronic issues but, of course, couldn't protect against acute injury.

I'm hoping one of these days to get some new prescription insoles as mine are not as low volume as are used for cyclists these days. I've been very interested in eSoles which TsPoet bought. http://www.esoles.com

I did short arc extensions until I was blue in the face when I was recuperating. Yoga, cycling and orthotics for me. And, no hiking downhill.:eek: :eek: :eek: Let me add a few more on that one.:eek: :eek:

Adding one last thing: no extra weight. Easier said than done or I would be the indulgent dorky dough girl, but somebody has to keep those peppermint mochas from escaping.

[salsabike]

Andy Pruitt's book IS great, and I got it on Trekhawk's recommendation.

My understanding is that anyone with anterior knee pain should avoid squats, lunges, and any weight-bearing knee bend that places your kneecap beyond your toes. And, by the way, I changed my crank arms to 165 mm.--the ones that came with my first bike were 175s!

[SadieKate]

Ditto on Pruitt.

BTW, TrekHawk, what's up with the mtb cranks?

[DrBee]

I had knee problems in both knees from my ballet days as well. I had my right knee dislocate 5 times in one afternoon of riding horses when I was 15. That was pretty much the end of my ballet days. I had surgery (lateral release) on both knees when I was an undergrad and it cured me. I have had no problems since. My knees will "talk" to me a bit when I start running, but by 5-10 minutes into it, they are fine. I haven't run into any problems on the bike. Strengthing the quads is not always the solution - that is what caused my problems. It's the other muscle on the inside of your leg (name escapes me at the moment). In women, the quad wraps across your leg above the knee. Over-strengthening of that will cause improper tracking. The jumping and other movements done in ballet accentuate this. Hence, the problem in women, especially dancers. When they did my lateral release, the doc said that he could see the patella pop back to where it was supposed to be.

[Nanci]

Beta, I'm sorry to hear about the knee problems. I think your only hope is to move to Florida. The brevet series here is much gentler and kinder, too.

Nanci

[betagirl]

Wow, thanks guys for all the tips. I've been mulling over seeing an orthopedic dude who I hope would refer me to a good PT. The surgery (lateral release) I had at 14 worked phenomenonally well (knock on wood). So I'm tempted to just have it done again. I know it sounds crazy to say that the surgery is the "easy" way out of this. But I tried the exercises when I was young. Grant it I probably wasn't that dedicated to doing them, so their efficacy was probably less than it could have been.

I did a pretty fast ride today, and had no problems. I was spinning a lot, no mashing, so I definitely think that's a big part of it. So I'll try to keep the cadence up. I've been better about that this year. I'll also check out that book.

Nanci - if they'd just do the Brevet's in Illinois, I'd be happy. I think the chicago area competes with FL for flatness. But noooooooooooo, we need to go to WI for them. RAGBRAI this year starts near Sioux City, and goes through some area called the Loess Hills. That should be painful. Guess Terry the triple will see a lot of action :D

[KnottedYet]

Fishdr- that's the VMO, vastus medialis obliquus. It's on the medial side of the whole quad complex and acts to pull the kneecap so that it stays centered in the groove. In those of us of a feminine persuasion, it gets inhibited and weak so it needs extra love. It acts to help straighten the knee in the last 10 or 15 degrees which is why everyone is running around doing short arc extensions. There are better ways to strengthen the VMO. If the VMO is already weak the larger quads can substitute in a short arc, so you end up in the same muscle imbalance you started with.

(i'm thinking externally rotated straight leg raises with feedback from just resting your fingers on the VMO, and functional activities like step-downs in front of a mirror and posture work)

[Kathi]

[QUOTE=SadieKate]Yikes! Lunges and squats! :eek: :eek: :eek: :eek: No way, Jose. Not for me.:eek: Let me say that again.:eek:

Prescription orthotics. Worn them since 1976 for chronic chondromalacia and I don't leave home without 'em.


I also wear prescription orthotics, shoes, ski boots, cycling.

And yes, squats and lunges. My first bout (when the ortho told me to quit exercising) with this the therapy was mostly straight leg raises with ankle weights. I did them until I was "blue in the face". But, I still had pain. I had been doing step aerobics, which I gave up, but had an instructor who was very strict about proper form (knee over toe) when doing squats and lunges.

One day, I decided my knees were going to hurt anyway so I started doing squats and lunges again. My knees felt so much better! A year or 2 later I tore my rotator cuff and for some reason got off the leg training. During that time I went hiking and jumped down an embankment and that started the right knee off again.

The ortho I saw said "no lunges or squats" but my therapist disagreed, most of my therapy was straight leg raises, again to ad nausum, weight machines and lunges and squats. To make a long story short I ended up working with an athletic trainer at my gym who set up a program using the weight machines. I followed her program for quite a long time.

When I moved here to the Denver area I didn't have a gym membership so, for ski conditioning, I started doing lunges and squats again. No problems. After I joined a gym I mixed the weight machines with lunges and squats.

Then every skiers fear, the dreaded ACL tear. Before my 1st therapy session for my torn acl/mcl I thought I was so smart because I just knew I'd have to do zillions of straight leg raises. Initially there were leg raises but the protocol is so different from what I did before. Strengthening was done on the pilates reformer, all leg muscles ( hip, core, etc.) were included. Many floor exercises were pilates based. Around 4 weeks I started doing single leg squats. Then I had acl surgery and started the protocol all over again. Around 6 weeks post op I began lunges, walking, sumo and side to side,l squats against a wall or fit ball. I also do the step down in front of a mirror that knottedyet spoke of.

The therapy this time around is much more "whole body" based and functional. Every exercise I do incorporates a variety of muscles, including my upper body. When I finish formal PT next week, I will start a "maintance program" at the physical therapist office, so there will be continual guidance with the knees.

I still have a lot of work to do to bring back the muscles in the injured leg but I've learned so much about keeping my knees strong. I guess that's the positive side of this acl tear.

[run it, ride it]

Oh boy, so I crashed my bike early Sunday morning. Aside from a monstrous black bruise on my thigh, I was fine--I did 75 minutes on the elliptical at its highest ramp setting later that day, and spent a good ten minutes crouched down brushing mud off my horse's legs after that. No problem.

Skip to Monday afternoon; my right knee is tracking a little funny. Monday night, if I try to straighten it after it's been bent more than ninety degrees it sticks, sticks, sticks, CRACKS into place and sets me off cursing in pain.

Tuesday morning, the whole inside of the knee is tender where I must have hit it in the crash, and any un-bending procedure involves me relaxing the leg completely and carefully manually manipulating the patella to minimize that jolt of pain.

I have bad knee genetics--shallow patellofemoral grooves, pronation. I took an impact to the other knee when I was fourteen and it never recovered. I've seen every sort of specialist and heard everything from "patellofemoral syndrome" to "bone bruise" to "huh.. pretty crunchy cartiledge there, eh? (to the nurse) FEEL this!" to "it would have happened on its own later anyway." I was advised to use orthotics in all my shoes (not just my running trainers), and to wear a brace for any activity.

Of course, the brace didn't last long. I preferred to build up my muscle and NOT have a weaker, more dependent leg. When it gets sore, rather than favour it I push it harder, push it through, and most of the time I work through the pain. I've managed the injury well, but its unpredictable incapacitating moments are what ultimately ended my running career and got me into cycling.

Well, now my old injury seems a walk in the park compared to what my right knee is up to! I just tossed the ole brace on it and already feel a difference, but UGH, what an awful feeling when it grinds out of place.

In less than an hour I have an opportunity to go mountain biking for the first time EVER. I can scarcely walk on my right leg, but I'm brought back to track races where I was too injured to walk and still got the adrenaline up enough for something resembling a dynamic warmup, staggered to the line and waited for the gun not knowing if my legs would support me. They miraculously worked every time.

So um... here's hoping that technique works again! I've got the ice pack handy, and the guy taking me on this trip has already insisted we're not going to do more than a few roots given the state I'm in (says he just can't stand the thought of the extra weight of the spatula he'd have to bring along to scrape me off the trail otherwise). YAY MTBING!

[run it, ride it]

w00 still in one piece! Knee started tracking fine once I was on the bike. I have switched over to the dark side and am in love with MTBing.

[carolp]

If there's a way to fix it without surgery I would think that's the way to go. Every time you have surgery you get scar tissue which in the end can cause so many problems.
I have a new left knee-- it will be a year old in another month== and it's the best thing I could have done. I'm doing the ALC AIDS ride in June. But without a good physical therapist, I would never have been able to.

[surgtech1956]

I have patella chondromalacia, grade III(right knee). Mine is from a fall at work - May 2006, my OS said it is like a 'dashboard injury' and can take up to 2 years for the pain to go away. My real job is standing 99.9% of the time, I've been on 'seated work restrictions' since the injury. I just had a scope done in January now in PT(my 3rd time since 5/06). I'm still not working. I see my OS on 4/30. My OS is talking about a possible Faulkerson's Procedure or Patella Femoral Joint Replacement. Anyone been through either or these procedures????? My pain is anterior - behind the patella and medial pain. The pain is definitely getting old. I just bought a new bike - to try to get in shape. I have the seat up. Biking is suppose to be good - building up the quads too. I'm not suppose to do any kneeling, no squats. I can relate.

[run it, ride it]

Okay, day three and this tracking thing is not letting up. If I brace the patella in tight and go through some pain it will track alright on the bike, but I can't bend it to walk up stairs, and lord knows without the brace I'm no good on a bicycle either (I just pedaled up the big hill to school -on one leg,- and you know I was really hurtin' 'cause I was late for a final and still couldn't push the injury!)

Has anyone had trouble tracking after an impact to the inside of the knee, and will it really go away in a few days like I've been led to believe? Ahh well, at least my 'bad' knee is getting some serious muscle built compensating, but I'm tired of the embarassment of trying to walk up a flight of stairs in public and yelling out in pain, falling against the railing and cursing up a storm when my kneecap CRACKS into place!

[ace]

Yikes, sorry to hear about your accident. I slipped an fell on some water at the gym in November, impact was on the inside edge of my kneecap. I was on crutches for a month, and am still dealing with pain and knee tracking issues. I'd been told that I had chondromalacia before that, but it hadn't ever bothered me much.

What's helped me has been getting adjustments from my chiropracter, plus some good physical therapy that worked on loosening my IT band- when that gets tight, my kneecap almost points sideways. Also taping my knee is really helpful as far as pain goes.

It really sounds like you need to try to stay off it, take anti-inflammatories, and ice it for the next couple of days. You are really pushing yourself, and that's risky.

Also, if you had an impact injury and have swelling under your knee cap, I hope you're not using a compression brace. You shouldn't be putting any pressure on your knee cap while it's swollen.


Good luck!

[run it, ride it]

Ouch, that slipping accident sounds painful and frustrating!

As for staying off my injuries... but, but, the weather JUST started getting road-bike worthy, and the MTB trails JUST dried up, and I gotta move back to a flat ole place with nowhere to ride next week!

No worries, my brace collection is all open-patella and intended to aid tracking. I got the black brace with extra straps, the summery Tensor sleeve (all open patella, ow-ow), and of course, the under-the-knee strap. Oh, I am fully equipped and have the residual tan lines to prove it!

I should probably switch the kneely-stool for the yoga ball (chair? What is chair?)... and I guess (-GUESS-) stay off my feet so a) the good-but-worse-for-now knee can heal and b) the bad-but-better-than-the-usually-good knee doesn't recess into any of its old habits.

Can't afford the chiro anymore--horse's chiro bit into those funds and he's worse off than me. Always wearing the orthotics and running/cycling have helped the correct muscles develop, though. I haven't ever regressed back to the state I was in when I first started seeing the chiro.

Thank you for the advice--I am about to start a hot date with some Ibuprofen and an ice pack

[Wahine]

It is really helpful to stretch all the muscles that join in and around the knee, for this type of problem. You won't be able to stretch your quads for awhile (too much flexion and too much pressure on the patella). But you should start with calves and IT band complex stretches right away. Hams helps too.

Try these:

http://www.dcdoctor.com/pages/rightpages_wellnesscenter/homeexercises/back/stretches/exer_back_st_calf.html

http://www.easyvigour.net.nz/fitness/h_TFL_StrSt.htm

And I like this one for the hammies:

[Wahine]

Oh, I forgot to mention that it helps to squeeze something, (a ball about 6 inches in diameter will work), between your knees whiel you're lying on your back with the knees bent comfortably. This starts to strengthen the inner thigh (adductors and part of the quad - VMO), in a nice gentle way. I tell my clients to squeeze for 5 seconds and do 3 sets of 10 to 30 depending on how it feels.

[run it, ride it]

yep, those are all the stretches my physiotherapist had me doing when I wrecked the first knee! I love stretches! Thanks for the refresher

[run it, ride it]

This morning it's really swollen and I've lost a lot of mobility. I can't even walk without a limp.

Starting to get a little worried. Why is it getting worse?

[ace]

Layperson speaking, but I think that can happen with inflammation. When I had my fall, I was almost fine that day, slighly worse the next day, and on crutches by day 3. Not sure why it took a while to swell up, but it did. I'd strongly advise really taking care of yourself and limiting activity and seeing if that kicks it into healing mode.

I would say do ice and anti-inflammatories religiously for a few days, no biking, no KNEE CHAIR, elevate it, try to stay off it, and see if that helps. If not, maybe it's go to the doctor time, kiddo.

Hope you feel better- let us knoe how you're doing.

-Amy