Heeelp! Chondromalacia (aka knee pain)

[freshwater_pr0n]

Last month, I went to an orthopedist who specializes in sports medicine. He's revered in the running community because he's a great doc who has a top notch PT staff.

I did a month of weekly PT sessions and have been fanatical about working the at-home exercises. Most of the exercises my PT gave me focus on the VMO, one of the quadricep muscles. My VMO now ripples when I look at it in the mirror.

Despite all of this, I've seen very little improvement in my condition. I still can't even ride to the grocery store without severe pain. He wants me to continue PT for another month, and then come in to discuss surgery.

Has anyone out there overcome chondromalacia without surgery? Tell me your story, cite sources, name names. I really don't want to go under the knife!

[Zen]

Chondromalacia patella is such a vague diagnosis they just had to give it a fancy name
And strengthening the VMO seems to be the go-to rx for pt's.
What does the orthopaedist want to do? Does he suspect tracking issues?Remove and scrape the patella? Eeeesh.
Scope just to see? not so eeesh
Does he need a new boat?
Have you had an MRI?
Have you done a lot (a lot) of research?

[surgtech1956]

Hello, I have patella chondromalacia - Grade 3 - that I have been dealing with since May 2006 as a result of a fall at work. I had a knee scope done in January. Had 3 rounds of PT, now on Celebrex. Chondromalacia can take some time to resolve itself. You can also seek another opinion. Yes, did you have an MRI? Surgery should be a last result. Do lots of research - there is an excellent web site - forum --- www.kneegeeks.com It was the most help for me. Good luck and keep us updated.

[freshwater_pr0n]

Well, the very next step is this week's meeting with my PT. He's going to teach me how to tape my knee.

If that doesn't help things, he's going to anesthaetize my knee and do a bunch of diagnostic tests on it.

What worries him is that even with several weeks of rest and PT, the inflammation in my knees hasn't gone down much.

This Dr. is pretty conservative and probably already has a nice boat. I'm just looking for anecdotes!

[salsabike]

Have you had a bike fit? Your saddle may be too low.

Here's one of the better summaries on the web about cycling and knee pain, including chondromalicia (I've had mild chrondro. for many years):

http://www.cptips.com/knee.htm

I keep my saddle fairly high, and also switched down to 165 mm. crank length.

[KnottedYet]

How about insoles/orthotics posted with a 2-6 degree wedge at the medial forefoot?

Patellar pain on the bike is pretty classic for a forefoot that needs some medial posting, especially for women. (I assume your PT addressed any other potential issues. VMO and taping is all peachy for walking/running/general knee health, but continuous weightbearing thru the forefoot has a very different effect on the kinetic chain and knee mechanics.)

Knot-beat-chondromalacia-thru-better-footwear.

[Velobambina]

Or better yet "Superfeet Knot!!" Thank you for recommending them, by the way. Both my podiatrist and my PT were impressed that I was using the green ones.

[short cut sally]

I had right knee pain that developed last year, only while riding bike, Went to a bike shop (not where I purchased my bike) who did the whole walk this line, walk that way, hop here and there, squat. Just so happened to have my bike and shoes with me. He kinda did a fit, off the bike, on the bike again, keep peddling, and he ended up moving ever so slightly my spd clip on my right shoe. That made the world of difference to me. I had pain to the outer aspect of my knee, and he said it would take a little bit of time for it to resolve, and so happened I was off the bike d/t weather and Ive not been bothered since. Just a suggestion.

[gingergin]

I have had right knee chondromalacia - no cartilage behind my kneecap, for 2 1/2 years, as seen on an MRI. The worst part for me was pain with bending the knee and lack of range of motion. After 7 months of PT and 6 weeks of accupuncture it wasn't much better. About a year a half ago I decided to try clinical massage therapy and was lucky enough to find someone great. After only a couple treatments my range of motion improved. Though it is still not 100% it is way better than it was. He also works on my back and hip as they get cranky too. It is not an inexpensive treatment, but you can use Flexible Spending Account if you get that. I would recommend to anyone!
When I bough my bike last year I didn't know how my knee would handle it, but I am sure cycling is helping as well as the massage therapy.
If anyone in the Boston area wants to know who my therapist is just email me!

[Tri Girl]

Everyone has given great advice. I, too, suffer from a serverly underdeveloped VMO. It's practially non-existent in my left quad- despite all the specific lifting and exercises I do to strengthen it.
My problem with my knees is my feet. Figured out that the severe overpronation leads the knee to track wrong, causing the chrondomalacia. I just got orthoitics (after two years of taping my foot), and hope that helps.

From my two running friends that have had knee surgery- avoid it at all costs until it's absolutely the last remaining option. Get a second (or third) opinion. Just because he's the most revered doesn't mean his opinion of treatment is the gospel truth and the only way. See someone else in your area. Austin is a cycling mecca, and you KNOW there's got to be lots of other docs out there.

Probably didn't help much, but good luck and let us know how it all goes!

[freshwater_pr0n]

Thanks for all the good advice. Salsabike, that's a great article.

Before I go under the knife, I'll definitely ask for a second or third opinion. I also just started working with a massage therapist who has about 30 years of experience under her belt and does myofascial release work.

Shelling out the money for a professional bike fit also seems like a great idea. And yes, my doctor recommended Superfeet insoles, and I'm pretty happy with them. Working with a massage therapist who has 30 years of experience under her belt has also helped.

Getting back on my bike, pain-free, is my new goal, and I'm as excited about my recovery as I would be about winning a big race. Gooo, knees!

[KnottedYet]

And yes, my doctor recommended Superfeet insoles, and I'm pretty happy with them.

If you have a seperate pair for biking only, see if you can get someone at a good shoe store to post the medial forefeet. Shouldn't cost you more than $15, tops. Your PT probably has posting wedges and can post your insoles for free (and get the specific angle wedge for you).

If he's not familiar with posting for cyclists, tell him to look up Andy Pruitt's Complete Medical Guide for Cyclists. (He'll still have to determine the angle of the wedge on his own based on your mechanics, but Pruitt's book is a huge help.)

Specialized Body Geometry (Andy Pruitt worked on these) shoes have the forefoot posting built into the shoe itself, so if you are wearing those you won't need to post your insoles unless the BG posting is too low for your needs.

[BabyBlueNTulsa]

Salsa,
Thanks for the article link! I was about to make a new post to get help about my new knee pain just to zero-in on what I did and how I did it.

I've been to the sports medicine doctor so often in my running past that I'm familiar with runners knee, stress fractures, LCL injuries and meniscal (sp?) tears... sigh. Still..what I'd zeroed in on was some kind of tendonitis.

Bingo...that article pinned it down. Patellar tendonitis... I've already been doing all the things that article talks about (the 1st things - R.I.C.E.)... If that doesn't take care of it with the reduced training, higher cadence, and (sigh) no hill climbing... I'll take the walk of shame to my doctor. :P I just hate to shell out $150 for someone to tell me what I already know before they make me come back for another $150. LOL Gotta love those docs.

Not to hijack this post from freshwater (thank you, btw, for posting the inital question and getting the excellent posts back from the other members)... just wanted to thank everyone here for being so open and sharing!!!

This has really helped me! LOVE YOU TE GALS!!

[Wahine]

So several people here have mentioned tracking problems and these are the core issue with chondromalacia patella. Other peeps have touched on the orthotic thing, I agree with the above. VMO strength is important but so is flexibility. All my CP pts get an eval for overall muscle flexibilty in the lower extremity. Typically they end up stretching the following muscle groups:

Tensor fascia lata (TFL)
Hip flexors
Piriformis
Calves (both the gastroc and soleus)

Sometimes:

Glute max and hamstrings

Apart from VMO, you may need to strengthen:

Hip adductors
Hip external rotators
Deep abdomenal/core muscles and pelvic floor

Manual therapy can be helpfu:

Muscle stripping of the Vastus Lateralis (this hurts like he!! but works)
Pelvis balancing
Assisted stretching of TFL and hip flexors

And if that doesn't work:

You may need have someone look at your back and do a manipulation of the pelvis and or lumbar spine.

Patellar alignment is about the whole lower extremity and not just the knee. Most often conservative treatment falls short because issues at the hip are not addressed. The nice thing about treating the hip is that it helps and you don't have to go anywhere near that nasty swollen knee.