chondromalacia patellae and continuing to workout

[laurawd]

Hi,
After a recent fall while trail running, I was diagnosed with "chondromalacia patellae", which refers to gradual thinning of the cartilige below the kneecap, and poor alignment of the knee-cap over the cartilige. (I am considering a diagnostic artherscopic surgery to determine whether there is still something going on in there beyond this basic degenerative issue, since my knee pain became much worse after the fall).

My doctor - and everything I've read - suggests that this problem is difficult to treat, implying that I may never be able to run again. As it is, I have a hard time hiking or walking for a long time.

I've been biking and weight lifting, mostly without pain. But I wonder whether anyone here has been able to recover enough from this problem to run again? I really miss it. I'm also concerned that I won't be able to do other types of exercise in future - such as plyometrics, step, etc... (I do a bit of plyos now, but can feel it in the knee).

Thoughts welcome!

[Kaiser]

I've had chondromalacia on both of my knees, which caused a patellar scraping when they went in to clean up meniscal tears. The problem with CP is that surgically all they can do is scrape it, and I have been told that the rate of success on any individual procedure in relieving pain is only about 50% (which is why they usually do it when they are in for something else rather than by itself).

Couple of things for you to look into:

-biomechanics. an imbalance in your quadriceps muscles can be a prime cause of a misalignment, as can less than optimal conditions in your footbed bringing you to a true neutral. Find this and correct for it and you may cure your problem. A good orthopedist or podatrist with a sports background (who is also a runner, in you case) can help in this step.

-glucosamine + chondroitin - I've been on this for 8 years now with amazing results in managing OA. However, it takes months to work, and you cannot take it if you are allergic to shellfish (one of the components is derived from shellfish). The initial clinical trials show conflicting evidence for its efficacy, but there is little downside to taking the product that it may be worth looking into. Check out http://www.drtheo.com/ for more info.

Running, plyos, and other jarring activities: I've had mixed success incorporating these. Sometime, I can do them with no problem (well, except running, but that is a lack of meniscus issue), other times, they cause pain (and I don't do them). My personal experience with CP is that it is a manageable type of arthritis, but you need to know when you cannot push it and need to let it rest. Cycling causes no discomfort at all, and I have become a regular and serious cyclist and spin instructor now - it is a good substitute for running if you are unable to return.

Why are they unable to determine what is wrong via non-invasive diagnostics (e.g. MRI) instead of surgery?

[dos]

Try a vegan glucosamine if you have the shellfish allergies.
http://www.wholesalesupplementstore....e=pp&sptype=gg

I have one of the worst cases of chondromalacia on the planet. While it doesn't cause me much pain, you can hear me coming from about 50 ft. away as it sounds like someone muching on rice crispies with their mouth open. The glucosamine has seemed to help me but you need to be diligent about it as it will be part of your life for the duration.

I have had my knees scraped and this seemed to lessen the noise but it eventually came back even greater.

[Keith Scott]

I am always hestitant to answer questions on chondromalacia because it is such a tricky prognosis. I have treated MANY cases of this with great success and treated many with no success. Working with athletes, I measure success in their ability to resume activity at a high level without any more damage. Working with regular ole' clients I measure success by the ability to function throughout life in a normal pain free way.

Both are different. Since you are asking about being active and running, I have to put you in the first catagory and this is important because the prognosis is different and more tricky.

It is also tough to say without seeing and examining you up close. But based on what you said, it seems like you have it pretty badly.

First thing you need to do is get the inflammation under control. NSAIDS, Ice, and REST are your biggest things here. How long? As long as it takes. You are on the shelf for a while. When you are pain free, things can start to move along.

Once that gets under control, you need to do as was said above...get your quad under control, both by strengthening, stretching, and soft tissue work. Don't neglect your hamstrings and calves either. All are important in this. But the quad needs to allow the patella to track the right way.

Are your hip flexors tight? Rectus tight? Are your calves tight? Where are you the weakest? Where does your patella sit on your knee when you are relaxed.

Get some answers to these questions first.

Will you be able to run again?

I dont know. It all depends.

First thing is to get the inflammation under control.

Good luck.

[laurawd]

Hi and THANKS ALL for your replies. Very helpful! I should have mentioned that I take glucosamine and chondroitin regularly. I also saw a physical therapist for about 3 months to reduce inflammation (massage and ultrasound), and check out my biomechanics.

They had a hard time checking out my biomechanics since, with the knee in pain, I was walking and running abnormally anyway, so they couldn't see the fundamental problem. It seemed to them, though, that one hip is a tiny bit higher than the other, which causes one knee to turn out more...

My quads are very strong - and the doc thinks there is no problem there. ...

I also had an MRI that showed cartilige damage. The doctor said that he believes it is CP, but would have to do a keyhole surgery to find out more (he's reluctant to do that for all the reasons you mentioned in your reply (no guaranteed success, invasive surgery, cost, etc.)

Well, I guess I should rest it more. I've not been so kind to my knee. I expect it to perform, particularly for squats and lunges. But I'll be more conservative and wait another month or so before I consider the surgery.

I suppose stretching more should help? THe funny thing is, when I walk for long periods of time, and try to keep my knee aligned properly, I start to feel pain in the hip flexor.

[UConnJulie]

See if you can find a PT who is trained in Jenny McConnell's taping techniques ... they can be used successfully to reduce the pain to allow return to activity and proper training ... http://www.mcconnell-institute.com/kneearticle.html