My wife has been having knee pain, saw a doctor, and they say she has chondromalacia. She’s not an athlete, but has from time to time tried to do some running and cycling. She wanted to start running again, but this lead to pain in her knee and subsequent diagnosis. They sent her to physical therapy, which didn’t help much. A second visit to her doctor resulted in, “I don’t think we can do anything else, you’ll just have to live with it”. To me, this sounds like crap. What do you think? Sounds to me like she needs a new doctor. From those of you familiar with this, can you tell me whether this is something that is treatable in most cases? As another point of information, my wife is 36.
Stick with PT to strengthen the quads (specifically the Vastus lateralis if possible) as this is usually the best LONG TERM option. Usually results from the patella being pulled more medially when running (I’m assuming a lot here - chondromalacia patella). Chondromalacia is just a generic word meaning “soft cartilage”, so it depends upon where. Won’t see much short term relief with PT though.
Howdy,
I thought I had did also last year but turned out to be something completely different. It’d be worth getting a second opinion from a Physio or Sports Therapist if you want to take it seriously.
The injury I had caused the same symptoms but was related to a inhibited nerve in my glutes. Kept me off the road for 5 long months.
Ray.
I had a similar diagnosis except for the live with it part at age 26. Had an X-ray, MRI and finally arthroscopic surgery and the doctor could not see anything mechanically wrong, said it happens in 5-10 percent of cases with pain. Cut out running and cut back on cycling, saw physical therapist for a few weeks, continued stuff PT taught me to do and got better within about six months. Just careful to change cleat position on cycling shoe to favor spinning, avoided running downhill.
You need to see a different orthopedic doctor. I also have chondromalacia and the 1st thing my doctor said was that it’s good that I didn’t see anyone else before him. He said it is something you can rehab. I was taking glucosamine/chondroitin supplements and doing straight leg lifts. It helped out almost immediately. That was last May - my knee has felt better every month since then. I guess some forms of chondromalacia can be worse, but it doesn’t sound like you wife has “runner’s knee” from overuse. Still - it’s worth a second opinion.
Beehunter and the rest, thanks for all the advice. I didn’t think this was “terminal” so to speak, but it upset my wife quite a bit when they told her to forget about running and live with it. Some bed side manner. Thanks again.
Chondomalacia, more commonly known as “runner’s knee”, is one of the two or three most common injuries for . . . surprise, runners. It manifests itself as pain directly under the knee cap - and though it is eminently treatable, it can linger indefinitely if you don’t understand and address the root causes.
The knee cap is basically a floating bone. It is attached at both ends (top and bottom) by a tendon - and as your knee bends and straightens, it rides up and then back over the surfaces below it. Although I’m probably simplifying this, there is bascially a track or groove where the bottom of the patella bone rides if operating normally - but if it starts to ride outside that groove, the bottom of the patella starts to rub where it shouldn’t rub and produces inflammation. Swelling usually accompanies the inflammation, so now the patella is doing even more rubbing.
Why does it ride outside the groove? The most common cause is over-pronation of the foot - which when the foot/arch collapses further to the inside that normal, it takes the knee with it (to the inside of its normal track), which then means the underside of the patella bone is now riding off-center and rubbing on things it shouldn’t rub on.
My experience in treating runner’s knee has led me to recommend the following:
First, you need to get rid of the inflammation. For some, that can entail just rest (don’t run), ice, and anti-inflammatories until the pain is gone. But for some, the mere act of sitting keeps the underlying tissue unhappy (the bent knee draws the patella bone downward towards the unhappy tissue). For the latter, I counsel - in addition to ice and anti-inflammatories - not bending the knee at all for three or four days. Unfortunately, that produces some inconveniences (sitting on toilet, driving a car, working at the office) - each of these can be overcome, but to make sure you are constantly reminded, I counsel wearing a knee brace for that period of time.
Second, you need to discover the cause - and then address it. For most people, that can be handled with a motion control shoe. For some, it requires orthotics (in both the running and biking shoes). But beware of going to just anyone who says “we do orthotics” - you need to find someone who really has a gift for diagnosing your gait idiosyncrasy - and then doing what is necessary to address it. Here in Ann Arbor, for example, we’ve got at least 100 health care providers who make orthotics - but there is only one among them that I recommend. Ask around among the long-time runners in your area.
Very good explaination! Another reason the patella tracks wrong is a muscle imbalance. I was told that by strengthening the inner quads, that it will help “pull” the kneecap back so it can track better.
I ran for 10 years, was told by an exercise physiologist that I have excellent natural “tracking” of the knee when I walk/run, and never got chondromalacia. However, after a long bike ride 3 weeks ago I suddenly got it for the first time in my life. Or at least I believe that is what I have (pain in front of the patella).
I can still run on it and there is NO pain when running. However, get on the bike and it returns within 10 minutes.
From my experience, and doing some reading, I’m guessing my problem is either
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Improper cleat position (I have a new bike - it was fit to me professionally, but the shoes/pedals as well as the bike are new). OR:
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Improper bike fit - maybe seat is too low or too far forward (again, my bike was fit to me professionally but that doesn’t mean I need to take the bike fit as the final word). OR:
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I just overstrained the dang thing on a particularly long ride and now I just need to let it rest, avoid the bike for a few weeks, then go easy on hills/long rides for a while.
What I can’t figure out is who to go to for support. The original bike fitter? A new bike fitter (best one in town)? An exercise physiologist or orthpedist? Do I mess with the cleats and/or the seat myself and see if anything changes? Do absolutely nothing and try the bike again in another 3 weeks?
What would you do?
Oleander
Did they do an MRI? If cartilage is worn away, no amount of PT will help.
Before you do anything, first eliminate the simplest cause and that is overuse. Take a week or longer off, once the pain goes away, start VERY easy with your training, always doing less then more. If the pain doesn’t come back, your home free and continue VERY gradually. If it does come back, then you need to find the cause, otherwise you’re just wasting your time doing everything else. Go to a reputable sports doctor or clinic and have them evaluate your movement. I’m sure they will find something biomechanically incorrect. Probably 90% of the world population has some biomechanical problems. They only show up once you start repetitive movements. Those two steps will take some time but are well worth it, otherwise you’ll have this problem for a long time and it will probably force you to stop.
I got it from ramping up training to quickly, mine went away with one thing. REST
One other note. My wife caught wind of the thread I started in her honor, and asked if anyone has had cortisone injections as treatment? I know from personal experience that you can’t take too many as they can weaken tissue. Also, has anyone experienced audible grinding noises, when for instance, climbing stairs? I’ve personally heard it walking up behind her. Makes my eyes water.
Personally, I would reserve cortisone to much lower rung on the treatment totem pole. This is a two-layered problem - current inflammation and root cause - and cortisone only addresses the former. Use ice, ibuprofen, and rest (the ultimate rest is keep the knee straight for a few days) - and 999 out of a 1000 times, this will get rid of current inflammation. Use cortisone if and only if nothing less invasive works.
Once inflammation is gone, address the root cause. It’s probably due to foot mechanics - and you have to find the right person to address that. One final note: Do not - repeat DO NOT - let someone talk you into surgery for this condition. In my experience, it never works out positively.
Chondromalacia is typically a catch all term for a variety of knee problems.
If the cause of the pain is patella tracking it could be caused by a number of different things. Lew is right that foot mechanics play a role. However patella tracking could also be caused by muscular imbalances at the knee joint or more common in my experience with women is that the patella remains stable and the femur is rotating due to imbalances at the hip.
If you can see a good certified athletic trainer or PT who can analyze what is going on mechanically you can solve the underlying problem. Any therapy will take some time and hard work to be effective. Too many times people to hear about an instant solution instead of one that may take 2-6 mo to work.
I agree with Lew - do not have any surgery for this. I would also not have a corticosteroid injection for THIS condition (and I perform about 5 per day for various maladies mind you).
My personal interest is in human biomechanics and as mentioned numerous times needs to be addressed.
Good luck.
This is what my ortho thinks I have, after x-rays and MRI. There’s a small cartilage fissure there as well.
But here’s the thing. It’s not like you can move your kneecap once your leg is bent at all. Sure, when your leg is relaxed and straight, you can move it side-to-side. But when bent, the cap is a rock in place. How is PT supposed to change that? NO muscle could yank that hard.
This is what my ortho thinks I have, after x-rays and MRI. There’s a small cartilage fissure there as well.
That is exactly what my MRI shows. Aztec–you are done. Right now you can ride a bike hard and walk without pain. If you keep running you won’t be able to do either of those things. Swim, hammer the bike and run/walk the run–just to be a “part of it”.