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Author Topic: Chondromalacia - what seems to work  (Read 3372 times)

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Offline dri

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Chondromalacia - what seems to work
« on: August 14, 2011, 10:53:19 AM »
All,
I am a new member.  I am 51 and have been a long distance runner and biker for 35 years, competed in college and have finished 4 marathons.  This past April I was finishing an 8-mile run and suddenly felt a "pop" and sharp pain at the top of my right knee cap during a warm-down walk.  Then when I went to walk up stairs I had a shooting pain behind the knee cap.  After 4 weeks of pain going up and down stairs and after sitting, I had an MRI was diagnosed in late April with chondromalacia. The most frustrating thing about this injury is how elusive it is - one day I feel like I'm making great progress and I'm about to get back into a workout groove and then the next day the pain feels like I've gone backward 2 weeks. About 3 months ago I began to keep a daily journal to find the pattern of what works and what doesn't.  I have found this to be very effective.  For me, it has been a comprehensive set of PT to increase flexibility of the ITB and hamstrings, squats (single-leg, wall slides, and chair-pose with light moderate weights), and Bikram yoga.  I have just begun to use the exercise bike again but have found that the slightest differences in seat height, angle of seat-post, etc. has a huge impact. 

I would greatly appreciate anyone's experience or suggestions about using an exercise bike or spin-bike on the road to recovery.  Also, I have found that the eliptical trainer is very bad for my condition.

Thanks in advance for any help.

Offline Lottiefox

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Re: Chondromalacia - what seems to work
« Reply #1 on: August 14, 2011, 10:26:37 PM »
Patella wear and tear is one of the hardest to manage and to deal with, because as you say it can fluctuate so much. You sound well on the way to building the muscles around the kneecap to help the trauma settle down. The stretching of the ITB and hamstrings are very important, as is stretching the calf muscles frequently. I also find foam rolling the trigger points in these muscles helps. I use a spin bike 2-3 times a week. I also find the set up to be crucial. I triggered a major flare up last year using a different bike with the saddle too far forwards (I am tall!). Yikes. I now have the perfect set up and tend to go for intervals on it, with very little standing hill work in it, and lots of mixed RPM and resistance whilst sitting. Nothing too hard on the knees. I find 40 mins to be enough for me, and I worked up to that in 5 min chunks from 15 mins initially. Elipticals can force your legs into the wrong arc of movement and tighten the calf muscles, and that hurts the knees. Depends on your build and gait, they don't have much room for adjustment.

I also found a course of a strong COX-2 NSAID Celebrex settles down a flare up. I have also had 2 shots of Euflexxa into my left knee and one in my right. This is a visco supplement that aims to lubricate the joint. For me, they have REALLY helped. They allow me to train harder and I am currently still getting benefits from February's shots. I did also have 6 weeks of no real exercise in April/May as I had foot surgery and in a strange way that let the inflammation settle down too - but I lost all the muscle gains I had made in my legs! I am on the way to regaining them though.

Be careful with squats, especially single leg ones. They do place a lot of load on a poorly kneecap. Ditto any lunge action. You need to be creative with leg exercises to avoid annoying the kneecaps. I find things like the glute bridge helps my overall leg muscles and control, modifoed to be single leg, feet on BOSU etc to progress it. Also lots of balance work - cable machine wood chops, static squat cable pulls etc. They all load the legs without the repetition of movement that a squatting up and down action brings.

Don't get down if you feel yourself going backwards. It is the nature of kneecaps. Give them a little time to settle, work the upper body, do some core and balance work and then get back on the bike and you'll be forwards again with any luck. Diary is a great idea.  ;D

Good luck

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline LadyMTB

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Re: Chondromalacia - what seems to work
« Reply #2 on: August 15, 2011, 02:20:23 AM »
It sounds like we are a similar age and with the same condition. I am 53 and my first flare was in March after several weeks on leave – cycling competition (hills) and lots of heavy physical work on a small hobby farm. I now realise after research/reading I did way too much, and fell into the trap of ‘overuse’.  I had been doing 10 hour days on our property walking up and down hills and carrying and lifting heavy equipment for fencing etc. Because I was so fit and strong I felt invincible and didn’t realise I could simply wear my knees out. I feel like 20 but obviously some parts of my body don’t agree. I knew you had to be careful with running but it hadn’t occurred to me that just working hard and heavy lifting could be just as bad.  Where I live the term Chondromalacia does not seem to be used. An MRI of my left patella shows cartilage thinning and some fissuring on the apex.  After being very careful and trying to rehab I have only recently noticed some improvement after 5 months. Gradually the burning and aching has reduced and now I can walk on the flat and gentle gradients with no pain. I walk as much as possible, and I also use a stationery exercise bike for interval training with low load and high cadence. I’m gradually increasing the level.  After the flare I was only doing ‘quad sets’ . This is static contraction of your quadriceps with the legs straight. Then I progressed to straight leg lifts and am now doing those with 2kg weight on each ankle. Like you I noticed the elliptical trainer was not good for me initially. I have not tried it again since but stick to the exercise bike, walking and the leg lifts. I focus on the VMO muscle using the physio exercise of sitting with legs straight out in front and a towel under the knee and then contracting.

The other things I had commenced 2 weeks prior to my flare were deep squats and walking lunges as I was trying to strengthen and condition my legs to take up running again. I believe these contributed to the damage (the final straw)!  If I were you I would be very careful with any squats. Later for rehab I was trying wall slides just to 45 degrees but that still seemed to cause pain the next day.  I think your idea of keeping a journal is great. I also do this so I can identify anything that causes me to go backwards. I am very careful about not doing anything that makes it worse next day!

You could also do a search on Richard Bedard and read his blog. He has chondromalacia and also kept a journal to help with his recovery.

Keep us posted on your progress  :)

Offline amoler

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Re: Chondromalacia - what seems to work
« Reply #3 on: August 15, 2011, 01:45:47 PM »


I also found a course of a strong COX-2 NSAID Celebrex settles down a flare up. 

Lottie

Lottie, I take it you mean you thought Celebrex was helpful? It might as well have been tic-tacs, because it did absolutely nothing for my pain. How long did you take it?
'77- Rt knee menicus tear
'90 -2nd menscus tear
'91 -failed arthroscopy/partial menisectomy
patella dislocation 10/ 2010
Dx = grade 4 chondromalacia + synovitis + Meniscus tear + lax strained medial ligaments
Fall down the stairs 7/20/11 - mcl sprain + 2 meniscus tears

Offline Lottiefox

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Re: Chondromalacia - what seems to work
« Reply #4 on: August 15, 2011, 03:14:07 PM »
I took my first course for 2.5 months. 100mg in morning and 100mg at night. I had tried Naproxen previously and that did nothing except make me sick and constipated. Within 2 weeks my knees felt better on the Celebrex and after 2 months I reduced the dose over about 10 days and spent 2 months free of it. I then overdid things on the spinner and started it again, this time for a month before again reducing. I now have it in the cupboard but am not taking it at the moment. My GP said it works wonders for some folks and nothing for others, even if their condition is very similar. I figured it was worth a go and it was far easier on my guts.  :D

I don't think it was the only factor in my improvement but it did help settle the burning, inflammation type sensation I had.

Lottie
Bilateral patella OA since 2009, no surgeries.
Euflexxa working well x3 to current
Right forefoot CRPS post fusion surgery 2011
Refusing to let the ailing parts stop me....

Offline dri

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Re: Chondromalacia - what seems to work
« Reply #5 on: August 15, 2011, 03:58:11 PM »
Lottiefox and LadyMTB,
Thank you very much.  Just hearing your feedback with similar experiences and good advice is very heartening.  I also thank you for your advice regarding squats.  This seems to be on of the most controversial issues in connection with physical therapy and conditioning to aid healing.  Everything that I have researched suggests that you have to allow the knees to settle down to the point of almost no pain and only then proceed with caution.  I go on the basis of my personal "pain meter" - anything more than a 2 or 3 on a scale of 1 (least) to 10 (greatest) I stop immediately.  Gradually, I have begun to seem improvement.

One other exercise I forgot to mention that really works well for me is walking briskly on a treadmill with the incline set to 12 degrees.  This was recommended to me by a terrific knee surgeon who studied in Vail Colorado and discovered it was a great exercise for skiers recovering from knee surgery.  I wish that I had learned about it years ago.  I am hooked on aerobic exercise and I am working up to 20 minutes at a very fast pace at 12 to 15 degrees elevation.  I can achieve an elevated heart rate (160 bpm) and feel that it helps to strengthen my quads as well.  I combine this with 20 to 25 minutes of spin bike and get at least a 40 minute workout....enough to keep my mood positive on this bumpy road to full recovery.

Thank you again for your great feedback.

DRI















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