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Author Topic: chondomalacia patella both knees  (Read 233 times)

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Online Ruby.P

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chondomalacia patella both knees
« on: January 09, 2020, 08:02:59 AM »
I'm a fit & healthy 51 year old with knees that 7 months ago decided to suddenly make my life hell.  Always had on and off pain but nothing that I couldn't work around for example if I ran they hurt, so I've always exercised
 with what I thought was care as already had various operations to shoulders, elbow, back injuries etc.  Had noticed over the past year or two more frequent sharp patella pain when kneeling & walking down slopes anyway in June 2019 I bought myself a cross trainer for the gym and after going on it several times I had a sudden acute pain in the medial side of the right knee which left me unable to weight bear - luckily I'm a nurse and work with a good orthopaedic surgeon, had an mri scan which showed early patellafemoral osteoarthritis and grade 2 to 3 chrondomalacia patella.  Sent me to a physio which unfortunately made the problem worse. To summarise I ended up on crutches, had to use a wheelchair to go on holiday,  had a brace, couldn't work - then my left knee "went" aswell.  Had a further Mri on right knee to check why it wasn't improving and got my left knee scanned - same problem there too.  So I've been religiously doing the physio exercises daily and I was convinced they were irritating my knees - it's like a double edged sword, they need to be done for strength but seem to be making it worse.  I decided over Xmas to see a chiropracter- said I have internally rotating patella, knock knees and all the physio I'd been doing was a waste of time (straight leg raises, wall squats - the usual textbook stuff). Gave me 4 specific  exercises to work my glutes, and quads, made me orthotics and within a week the acute pain has gone, it's the first time in months that I have true optimism that I'll get back to work - I tried but only lasted 3 weeks and was getting so scared that I may lose the career I love - I'm 2 weeks on now and still feel like my knees are made of wood with the most weird sensations which unless you have this problem are really hard to describe - and luckily for me as I live in the UK and we have the NHS I am waiting to have a course of PRP injections which (hopefully) will help with the damage already there.  It's going to take time to strengthen and rotate my knees into a better functional alignment but I just wish I could have seen someone months ago who knew what they were doing & looked at me as an individual and not as a textbook case with textbook exercises to match. Decided to write on here as I've read so many stories from people desperate for answers & although I'm not fixed by any means I know my body and know that I'm now doing exercises that are not irritating my knees but strenghening instead. (These are what I've been prescribed for 1st 4 weeks - side lying clam with resistance band, squats but I have to rotate my knees out and do them really carefully, crab sidewalk with band and step ups BUT all done in a specific way for MY knee alignment.  Don't give up.

Online Ruby.P

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Re: chondomalacia patella both knees
« Reply #1 on: January 11, 2020, 11:26:02 AM »
Spoke too soon &#128580; let my knees turn in a fraction during the squats and ended up with a whole day of pain, this condition is a bloody nightmare - 1 step forward and 5 back - is there anyone out there with a success story  who has got through this and how long did it take, I just want to walk without pain and get back to work (I think I've also got a bit obsessed with trawling through knee pain articles and forums but it helps to know there are loads of you out there suffering aswell) &#128549;

Offline Dave33

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Re: chondomalacia patella both knees
« Reply #2 on: January 11, 2020, 04:47:36 PM »
Sorry to hear your troubles.

I've been in your shoes, and your story is typical; being put in a carousel of activity modification, physio, and 2nd level medical (injections, chiropractic), and all of it extracts a heavy mental and emotional toll - booking your life around appointments, scouring the internet for solutions, depression when things aren't improving, and constantly obsessing over how it feels and what to do next.

At 51, you have a lot of options if you've given non-invasive treatment a solid attempt. Suggest you read through the threads in the Patellofemoral section on this site, as well as the Unicompartmental knee replacement section.. lots of great perspectives there!

Offline SuspectDevice

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Re: chondomalacia patella both knees
« Reply #3 on: January 13, 2020, 05:22:27 AM »
Wish I had a dollar for every time I've read 'physiotherapy made my patella femoral pain worse' !

I've had quite bad patella chondromalacia for decades, the severity comes and goes depending on what I've done.  It is very good atm.

Hip/glute/hamstring/core work (not quad work) also helped me a lot.

But your comment that your knees are made of wood & weird sensations got me thinking about synovial lining inflammation.  I'm sure that was my main problem, brought on by the chondromalacia, then a medial meniscus tear & subsequent surgery.

Do you get any hot burning symptoms around/under your kneecaps?  That was a big symptom for me, which led me to the conclusion of chronic synovial inflammation.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Online Ruby.P

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Re: chondomalacia patella both knees
« Reply #4 on: January 13, 2020, 12:07:14 PM »
Thanks for your reply, i have followed your story Suspectdevice which led me to check out Dr Dye theory and I read Richard Bedards book in one sitting, so much rang true.  In answer to your knees burning question, yes they have  recently had a burning/ache sensation in both knees along with a tingling sensation which has lessened as the burning has increased.  Symptoms seem to vary on a daily basis.  One thing that has changed since I visited my new chiropractor (I am not going back to my PT) is that the acute catching pain seems to have stopped and the knees are not clicking as much, I think this may be due to orthotics that he made for me, or maybe just stopping the original exercises did it, who knows and I think this is the most frustrating part of this puzzle.
There are reports of effusion on my mri scan within the bursa, I have early osteoarthritis and grade 2 to 3 chondomalacia patella so I have made to decision to go completely against the traditional advice as I have tried this religiously  for 6 months and it is not having any effect. 
The only time I have felt a real difference was when I went on holiday  to Orlando, having saved and worked extra shifts in a knee orthopedic clinic (ironic) for 6 years it was a real bummer to have to take a wheelchair as I could literally only walk a few hundred steps. Anyway by the end of the second week I walked pushing the chair just in case it 'went' around the whole of animal kingdom park - 23000 steps on my fitbit watch -I was elated, came home and begged to go back to my main nursing job promising I would take it easy.  The only thing I did differently on holiday was that I didnt do my physio exercises but believing that the exercises had to be done I restarted them again and they were not hard, we are talking straight leg raises, wall slides etc  - I was back to square one and lasted 3 weeks at work - it dosnt look good when a nurse is literally hobbling round wearing knee braces.
I am a naturally optimistic person and will fight to the end with this condition but it has really got me down especially reading so many posts with no end in sight - so once I read your story it gave me some hope again (thanks).  Yesterday I started my new plan, I am not doing the quad strengthening (yet), I am going to work within this envelope of function theory and I think the only thing which will stop me will be my own impatience and then over doing it if I get a few good days - I am lucky to still have a few months left of full pay and then half pay but if I want to get back to work I need to commit to this fully, at least I can truly say I have tried everything. 

From a medical background this goes against the grain of everything that is taught but I truly think that until you are in this nightmare situation it is impossible to understand, I have seen so many patients come in and been told to work on your quads, weirdly enough looking back the majority already have a good set of quads and normally are the fit kind who work out and keep themselves healthy and now I totally understand the look of despair on their faces when they find surgery isnt the answer and they are told to just carry on.  Obviously im not talking about the patients that end up needing knee replacements etc, just this cp diagnosis.

I will update regularly with any positive progress, just off to watch tv now with my legs propped up high (found this definitely relieved the burning sensations a bit last night). Onwards and upwards
« Last Edit: January 13, 2020, 01:44:55 PM by Ruby.P, Reason: spelling correction »

Online Vickster

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Re: chondomalacia patella both knees
« Reply #5 on: January 13, 2020, 01:18:46 PM »
Osteoporosis or osteoarthritis?
Are you taking supplements? Vit D, omega 3, may help.
If your kneecaps are maltracking, taping may help and is rather more subtle than a big brace (not that any of those are really useful for PF only issues, more arthritis, ligament laxity)

Some physios are expert in knees,  even PF issues (there's one in SW London for example), but most are more used to rehabbing ACL reconstructions, knee replacements etc
« Last Edit: January 13, 2020, 01:20:34 PM by Vickster »
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Online Ruby.P

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Re: chondomalacia patella both knees
« Reply #6 on: January 13, 2020, 02:00:58 PM »
thanks for pointing that out - I've changed it (autocorrection :D) yes I think there are some great physios out there and finding one can be hit and miss, I've got a great chiropractor who I really trust, used them for a longstanding back injury which had amazing results - I'm going to discuss with him what I'm doing (don't know what his reaction will be) as it feels totally alien to me backing off everything this much but feel like I'm permanently hitting a brick wall and need to explore another direction.

Offline SuspectDevice

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Re: chondomalacia patella both knees
« Reply #7 on: January 13, 2020, 09:22:14 PM »
Thanks for your reply, i have followed your story Suspectdevice which led me to check out Dr Dye theory and I read Richard Bedards book in one sitting, so much rang true.  In answer to your knees burning question, yes they have  recently had a burning/ache sensation in both knees along with a tingling sensation which has lessened as the burning has increased.  Symptoms seem to vary on a daily basis.  One thing that has changed since I visited my new chiropractor (I am not going back to my PT) is that the acute catching pain seems to have stopped and the knees are not clicking as much, I think this may be due to orthotics that he made for me, or maybe just stopping the original exercises did it, who knows and I think this is the most frustrating part of this puzzle.
There are reports of effusion on my mri scan within the bursa, I have early osteoarthritis and grade 2 to 3 chondomalacia patella so I have made to decision to go completely against the traditional advice as I have tried this religiously  for 6 months and it is not having any effect. 
The only time I have felt a real difference was when I went on holiday  to Orlando, having saved and worked extra shifts in a knee orthopedic clinic (ironic) for 6 years it was a real bummer to have to take a wheelchair as I could literally only walk a few hundred steps. Anyway by the end of the second week I walked pushing the chair just in case it 'went' around the whole of animal kingdom park - 23000 steps on my fitbit watch -I was elated, came home and begged to go back to my main nursing job promising I would take it easy.  The only thing I did differently on holiday was that I didnt do my physio exercises but believing that the exercises had to be done I restarted them again and they were not hard, we are talking straight leg raises, wall slides etc  - I was back to square one and lasted 3 weeks at work - it dosnt look good when a nurse is literally hobbling round wearing knee braces.
I am a naturally optimistic person and will fight to the end with this condition but it has really got me down especially reading so many posts with no end in sight - so once I read your story it gave me some hope again (thanks).  Yesterday I started my new plan, I am not doing the quad strengthening (yet), I am going to work within this envelope of function theory and I think the only thing which will stop me will be my own impatience and then over doing it if I get a few good days - I am lucky to still have a few months left of full pay and then half pay but if I want to get back to work I need to commit to this fully, at least I can truly say I have tried everything. 

From a medical background this goes against the grain of everything that is taught but I truly think that until you are in this nightmare situation it is impossible to understand, I have seen so many patients come in and been told to work on your quads, weirdly enough looking back the majority already have a good set of quads and normally are the fit kind who work out and keep themselves healthy and now I totally understand the look of despair on their faces when they find surgery isnt the answer and they are told to just carry on.  Obviously im not talking about the patients that end up needing knee replacements etc, just this cp diagnosis.

I will update regularly with any positive progress, just off to watch tv now with my legs propped up high (found this definitely relieved the burning sensations a bit last night). Onwards and upwards

Burning/ache/tingling sounds exactly like my symptoms.

Propping my legs up also works for me.

The strengthen quad theory needs a complete overhaul, it is so wrong for people with our symptoms, like pouring petrol on a fire.

You've probably read from my rantings on various forums, the only thing that broke the cycle for me after about 5yrs of misery was 5-6mths on the anti-inflammatory Celebrex (an idea I got from reading Dr Dye's protocols).  I also went on the Anti-depressant Celepram which helped deal with the mental side of things (I still take a very small half-dose every day, but have not needed Celebrex for about 2yrs now).

To be honest, I probably still pushed my knees too hard while on Celebrex compared to what Dr Dye would recommend, but still got incredible results.

There seems to be a major aversion to anti-inflam meds on various forums, but as I've said before, they were the only thing that broke the cycle for me, and allowed me to eventually resume the hip/glute/hammy/core exercises that took the load off my knees & moved me along the recovery track faster.

And here is a weird thing.  Unlike Richard, I actually found high load/low rep exercises like deadlifts & kettlebell swings tend to improve my knees when they feel twitchy, whereas high rep/low load activities like cycling do the opposite?  The other day, I'd overdone it with jogging & cycling, so the next day just did strength work & my knees felt better ?????
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons

Offline Froglet

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Re: chondomalacia patella both knees
« Reply #8 on: January 18, 2020, 09:35:34 AM »
Hi Ruby P,

I too have joined the CP stage 2-3 club following a ski injury last February but most likely due to physio ie. I don't believe the CP was a result of the initial injury as my CP symptoms came much later after a too-keen physio's attempt to -wait for it- "build up my quads"!  My problem now is a little more complicated as I now know I damaged my femoral nerve in ski fall so my quad muscles are not receiving motor signals (mainly my VMO).

Before I read the latest posts I was about to recommend Robert Bedale and Doug Kelsey books which are both truly 'lightbulb moment' reads! And have read Dr Dye's envelope of function theories too.

It really is very debilitating isn't it!? I can walk for around 1km then I get pains in both knees.  I work from home and find sitting at a desk for anything longer than 2 hrs really brings on symptoms, tingling, stiffness and swelling so I've had to just cut my hours down and make sure I get up and move around every hour.  Considered a standing desk but standing for too long also starts to really hurt (how many times have I been in queue at supermarket in agony!?)

I have a static cycle trainer that I was using daily on low resistance but I'm still not convinced that doesn't aggravate my knees.  For the last month I have been going to the swimming pool every couple of days where I walk forwards and backwards, do leg raises etc in the pool which I am finding is helping massively.  The joy of non weight-bearing!

I'm also dealing with the mental side of things (which I realised I badly needed to do in December!) with hypnosis downloads and muscle relaxation techniques (as I am holding so much tension in my body because of this!) Can highly recommend the website https://injuredathletesclub.com/ and they also have a book 'Rebound' and a Facebook group for support. I even went to a yin yoga, singing bowl therapy and reiki drumming session, which I can highly recommend!

This forum has also been immensely helpful.

Hope things start to go better for you, let us know how you get on!

Online Ruby.P

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Re: chondomalacia patella both knees
« Reply #9 on: January 18, 2020, 04:37:23 PM »
thank for those tips, I'm definately going to try the relaxation exercises.
My Richard Bedard experiment continues, unfortunately though the burning and aching pains started increasing to the point of being unbearable, couldnt even get up the stairs without crutches then 2 nights ago I suddenly wondered if my new orthotics could be causing these new problems as I have worn them every minute of the day unless I'm in bed or the shower - did a bit of research and read that they should be worn for half an hour and slowly build the time up over a couple of weeks!!  I'm so annoyed with myself, anyway taken them out and today the burning pain has completely gone, just got a bit of residual tingling - what I call my bone pain has come back a bit but I'd rather have that any day over that awful burning ache sensation. Top tip of the day - break orthotics in gradually!! This whole process seems to one big learning curve. I should get to 4000 steps today (cant believe i have to even write that as I used to daily hit 15 to 20000 every day. Setting an alarm just like he did in his book and walking round the house, thank God for Netflix and prime - hope you find some answers for your nerve problem, it only takes one person on here to have gone through the same thing and recovered to give you that hope which is the only thing that keeps me going.

Online Vickster

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Re: chondomalacia patella both knees
« Reply #10 on: January 18, 2020, 05:28:59 PM »
Are they custom orthotics? The fitter really should have explained about breaking in...also use across different shoes while doing so  :)
Came off bike onto concrete 9/9/09
LK arthroscopy 8/2/10
2nd scope on 16/12/10
RK arthroscopy on 5/2/15
Lateral meniscus trim, excision of hoffa's fat pad, chondral stabilisation
LK scope 10.1.19 medial menisectomy, trochlea microfracture, general tidy up

Online Ruby.P

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Re: chondomalacia patella both knees
« Reply #11 on: January 18, 2020, 10:05:17 PM »
yes custom orthotics, he said just to go easy and watch out for any problems although I presumed he meant foot problems so I've gone full steam ahead and worn them continuously not realising the link

Offline SuspectDevice

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Re: chondomalacia patella both knees
« Reply #12 on: January 21, 2020, 04:00:59 AM »
I don't believe the CP was a result of the initial injury as my CP symptoms came much later after a too-keen physio's attempt to -wait for it- "build up my quads"! 

It's almost worth a mal-practice suit on the entire physio profession isn't it - or at least a TV doco about how bad this advice really is.  In the 50's some doctors recommended smoking for your health  ::)  but it seems all physios recommend quad strengthening for PF pain  :o

I suddenly wondered if my new orthotics could be causing these new problems as I have worn them every minute of the day unless I'm in bed or the shower - did a bit of research and read that they should be worn for half an hour and slowly build the time up over a couple of weeks!!  I'm so annoyed with myself, anyway taken them out and today the burning pain has completely gone, just got a bit of residual tingling - what I call my bone pain has come back a bit but I'd rather have that any day over that awful burning ache sensation.

Very interesting that the orthotics caused such a problem!

Yes, the burning is unbearable isn't it, but IMO, a clear sign of synovial inflammation.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2020 - ride 3x/week, swim 2x/week, gym 2x/week, aiming to get back to short triathlons















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