My HS physiology is seriously weak…I have a friend who is getting into tris after a long career in running. Apparently she suffers from the aforementioned problem but hasn’t gotten any help from doctors on treatments or ways to prevent it from getting better/worse. Any people out there that can point her in the right direction it would be very appreciated. And yes I did google it but I figure the collective running experience of a forum like this would be infitiely more valuable a resource.
When I first started marathon training, I suffered a long painful battle with chondromalacia. What did the recovery trick for me was a daily, isometric strengthening exercise of the quadriceps muscles. Sitting in a chair, I’d hang a ten pound weight plate from a shoe string over the end of my foot, extending my leg out straight, contracting the quads for a count of ten-12 seconds. I do this six times on each leg. Helps even the strength in the quads and the balance pull on the patella tendon. It took a week or two before relief arrived, but doing this simple exercise daily has kept the problem at bay.
Hope this helps…
Assuming that her saddle height is correct, cycling is actually a good exercise for chondromalacia.
I had a problem with this years ago, as noted above quad strengthening exercises were the answer. I used to just sit on the edge of a chair with my leg fully extended and lift it 2 inches or so up and down 50-100 on a side and repeat as often as possible. Also be very careful to protect the knees, the fibrocartiliage that forms is not as strong as the original and even just knocking a knee on a table leg can be quite painful, and cause minor damage to this tissue under the patella.
Perhaps the very best (but not the cheapest) approach to solving this problem is to go to a Sport Specific Clinic… the best one that comes to mind is the Sports Clinic of Boulder Co.
The problem with Chondromalcia is that you need to find the cause.
This is usually a result of poor bike fit and/or poor running form… plus a muscular imbalance and/or lack of flexibility.
In general, the causes are related from two directions. The femur (above) and the tibia (below) region play a crucial part of how the knee tracks. Most treatment involves only the femur (or the thigh). This involves strengthing the VMO muscle to help stablize the knee (note: lack of flexibility of the muscle can also be a culprit). However, most chronic causes are a result of the tibia’s (or calve’s region) reaction to the foot placement. In essense, the foot placement during running and/or biking is a common cause of most chronic knee problems. Correcting the running form and the use of running orthotics is a good first step toward removing the cause. However, correcting a bio-mechanically incorrect bike position is equally important and typiclly involves a biker’s equivalent of orthotics. To solve most knee problems involves BOTH the running and biking issues that may be causing the problem.
All to oftern, the causes of PTS and/or Chondromalacia are multple in nature involving pretty complicated bio-mechinics. Evaluating these bio-mechinical short falls go a long ways to developing a therapy that can actually solve chronic knee problems. Unfortunately, simply doing certain exercises may or may not be sufficient to reduce knee problems (this is specially true if there are the common improper foot placement issues involved).
This is why a diagnosis from sports medicine specialist (one which unders BOTH the bike AND running bio-mechanics) is the most crucial part of solving chronic knee problems. Without proper diagnosis, it not uncommon for treatment to be more general in nature and not necessarilly the correct or complete solution to problems such as PTS or Chrondromalcia.
FWIW
Joe Moya
Chondromalacia patella is the reason for my user name…can’t do tri’s anymore because I can’t run due to this. What ever she does…advise her against surgery. I had a lateral release to attempt to put my knee cap back to a place where it could track right. no dice. Surgery made it worse. This is a common problem for women, based on our hips and the strength of our outer quad vs. our inner quad. Pulls the knee cap out of alignment.
I would advise her to do the strengthening and stabalizing exercises for her inner quad muscles that a good one-on-one PT can recommend (not one of those chain operation type PT places-bad news). Active Release (ART) is also very helpful to help release some of the tight muscles to let the knee cap move back to where it needs to be, combined with strengthening.
Thank you so much for the help STers. I have forwarded this thread to her to keep an eye on in case anything new gets added to it. She sent me a pretty good email detailing the progression of the problem and I’m waiting on her permission to posts the email in full to see if that helps with any more opinions.