Over the last month or so I’ve experienced increasing pain under my right kneecap while running. The pain is right under the patella and seems to be triggered by leg motion vs impact. Bought a strap type brace that sits below the patella which helps some for about 6-8 miles but on longer runs it really starts to flare up on me. My doc seems to have no advise other than “stop running for a while” but was hoping there were some excercises I could do to help this while continuing to train. What about heavy does of Ibruprofin? Read somewhere it is caused by some muscle imbalance so hopping I can resolve by training my imbalance.
Anyone out there have any advise or suggestions on how to resolve this while still training? I am told it is a very common injury but can’t seem to find any good rehab info on the web. Thanks!!
My advice is to get a referral to a sports medicine doctor who will hopefully hook you up with a podiatrist and a physical therapist…
There are many causes of chondromalacia and your physician is 80% right about taking time off. It is the result of inflammation (caused by a variety of things) continuing to exercise at the same rate/intensity can make things worse becuase of it is caused by an inflammatory process. Doing exercises to strengthen your vastus medialis (one of the quads) may not be the answer becuse it may be due to underlying damage to your patelly femoral groove (where the knee cap sits) excessive genu valgus (knock kneed) excessive weight, poor fitting shoes, etc. etc. the list goes on and on the best thing to do is take time off, ice if you get inflammation, get good shoes, and try to get a referral to someone that can give you a better idea of what is causing your knee pain. (better to fix the cause than to just make the pain go away)
good luck
PS. the spelling is chondromalacia in case you were having a hard time finding info about it on the web
Believe it or not, the doc is right… but, he (like most doctors who don’t deal with athlete’s) doesn’t really get a grasp of what he is asking an active person to do. Basicly he doesn’t understand excessive compulsive behavior.
You need to see a sport-medicine specific doctor (nice if he deals with knees). For your part,… yes you will have to stop. But, you can replace your activity with corrective physical therapy. This will involve (among other things) retraining the muscle groups to work properly in tracking the knee’s movement in it’s natural groove (this usually involves working with the VMO muscle).
This problem can become serious and permanently dehabilitating. I had problem similar to yours… The first key to success begins with stop doing what your doing. The second step is getting professional help from those who understand your problem. I took me many years to fully recover. So, don’t expect a problem of this nature to take only a few weeks. Expect a few months (with serious therapy) to get to a reasonable level of health. More importantly, expect a few years to fully recover. Finally, the third step is to relearned to bike and run to prevent this problem from happening again. Any skipping of a step will reduce your probability of truly eliminating or significantly reducing your problem.
Getting rehab inform. on the web may be a very dangerous proposition. You could make your problem worse, not better. Good Luck.
I’ve had it for 15 years after dislocating the patella, the first 5-6 of those I was unable to run. Surgery, physical therapy (multiple times), thousands of bike miles, glucosamine, Synvisc, Celebrex, and ice have made a big difference. The glucosamine made a huge impact. The most important thing I did was find the right physician. You’ve got to ask around and you might get the guru right off but you may have to go through several before you get to the one. University sports medicine docs would be a place to start – who are the elite athlete’s seeing in your area, find out! No kiddin, I had three orthopaedic surgeons, one on the lecture series, awards ad infinitum, tell me I was done. That was many,many triathlons ago including 2 IMs, and 3 1/2’s. Still waiting to run into that one :)! I’ve been with the right doc now for almost 2 years and he’s made all the difference.
What might the right orthopod look like? He/She will spend a lot of time taking a history, evaluating, testing, x-raying, MRI’s, bone scans possibly, and a very thorough mechanical evaluation as well as knowing what you want to do before they wiegh in on what it will take for you to get there. Somebody that listens to your symptoms does a 2 min eval and wieghs in on what they think has lost the ability to see and tx you as unique. Just like any other profession a certain comfort zone can be achieved where the wieght of experience – “I’ve seen this xxxx times before” — rules the day rather than the wieght of the assessment of the individual that sits before them. You did not reference any historical major trauma to the knee… it would seem you have a good chance of getting back on the right track. Don’t mess around, get to the right doc, it will save time/money in the long run.
Thanks for the all the great feedback and ideas. You kind of scared the crap out of me so I better get myself to the doc asap. I avoid doc’s like the plague but you convinced me it is the right way to go.
Before you despair that you have chondromalacia you need to know that that is a radiographic diagnosis and not a clinical one. What I mean is that chondromalacia refers to cracked, inflamed and generally unhappy cartilage on the underside of your patella. It is a chronic condition and if this is your first bout of knee pain it is not necessarily the proper diagnosis.
Assuming that this is your first go around with knee pain a more likely explanation is that you a patellofemoral pain syndrome. PFS is very similar to chondromalacia minus the radiographic and more dramatic changes to the cartilage. Treatment involves exercises such as wall squats (not past 90 degrees) as well as control of the inflammation.
Get some help and dont worry it is not uncommon in running and jumping athletes and it can be managed. Be patient.
It’s not about fear… it’s about getting the proper diagnosis. Once correct diagnosis is accomplished, the feeling of control replaces fear.
Your problem is solvable provided you take it a bit more serious than you have. The longer you prolong the correct diagnosis, the longer it will take to correct the problem.
I don’t necessarily disagree with anyone else; but, I went to every doctor in the world, wasn’t willing to have surgery (studies show it make you no better long term), and read everything thing there is to read.
My problems started 27 years ago this year with a high school football injury. Thank goodness the arthroscope wasn’t invented (or at least not in common practice yet) because they would have used it! I finally got the problem under control when getting ready for my 1st IM in 1989, and 12 IM and 130 tris later and I haven’t had any real trouble.
Of course I haven’t examined you, besides the fact that I am a lawyer not a doctor (sometimes a hypothetical one on this group!), and this may not work for you. I read everywhere about how strengthen the vasus medialis is the key…but how? Then I read a little article about doing simple isometric contractions, knee straight, foot fully flexed (toe pulled toward your knee - is that flexed?), toe turned out, lift the leg, and hold for a 10 count - feel to make sure the vasus medialis is the one getting the work…it should contract hard as a rock during the exercise… Now, the real trick…you have to do it 100 times a day, every day, forever!!! And, that’s the problem, so noone ever follows through and you never get better. So, I was determined to win! I turned myself into Pavlov’s (sp?) dog - every time I pick up the phone during the day, I do a set. I am a lawyer (already said that) and get a lot of calls! You should see my vasus medialis - well, not in public, but you get the point.
Just thought I’d give you one success story and some hope. Good luck!!
I agree that in most cases of patellar tracking problems is due to weakness of vastus medialis obliquus. The reason that I did not emphasize this was becuase of the importance of getting a proper diagnosis.
There are several conditions that can cuase this pain some of which can be “worked through” and others that need to be treated and rested to prevent permanent damage.
But since we are on the topic of knees, it is important to strengthen the VMO (vastus medialis obliqus) it is the muscle in your quadricep group on the inside portion of your lower thigh right above the kneecap. as the previous person said…
There have also been studies done on susceptibility to knee injuries and balance in strength between the quadriceps and the hamstrings. So if there is a large differential (often quads over hams) you are more susceptible to knee injuries such as ACL tears.
Although many physicians (most surgeons) would suggest surgery there are many many physicians who would suggest a round of physical therapy and see how things go. The trick is finding the right physician. Try asking around a running club or web-boards to see if anyone knows a good sports med doc…
you can also check out ACSM.org (american college of sports medicine) and look in their directory for people in the area… be sure to check with your insurance first though…
Dr. Arnie Baker has a book on bicycle medicine. I’m sure you can pick it up at your local bookstore. It has a section on chrondo and the several tendon inflammations “available” to bikers. He recommends, as I recall, higher cadence, lower power, shorter cranks, higher seat. You may actually have the chrondo because of a bad bike position.
My VMO problem, as I understood it, was that it was firing after the VL. No way the little VMO was going to pull the patella back on track. Electrical stim of the VMO helped a great deal.
What’s the word on strength balance between quad’s and hammy’s? I’ll work my single leg extensions at 50lbs but my single-leg curls are at 37.5lbs. (3 sets 15 reps).
Actually the biggest problem with having a weak VMO is the knee has a natural valgus (bend) so the pull of the quads (except VMO) will exert a lateral vector pulling on your patellar tendon. (directed laterally) The VMO is the only one of your quads that has a vector pulling the patella medially (becuase of its oblique orientation) So when there is an imbalance (eitehr with timing which I am not familiar with or strength) there is going to be a greater pull on the patella laterally which can lead to tracking problems… This sort of thing can easily be determined through an EMG… I am not familiar enough with the specifics between these imbalances to talk specifically about your problem but this is the basis of the problems with patellar tracking and VMO
As regards to the imbalance between hams and quads… I was at a sports med conference last year where someone presented a study on knee injuries in collegiate female basketball players (double whammy for the knees, female and basketball) anyways they showed that there was a strong correlation between imbalance between the two muscle groups and knee injuries… I have heard that this is a common result coming out of the sports med world ( I haven’t read any of those papaers though)
hope this helps… for a more detailed explanation you are going to have to speak to a Physical therapist or a sports med doc
"Although many physicians (most surgeons) would suggest surgery there are many many physicians who would suggest a round of physical therapy and see how things go. The trick is finding the right physician. Try asking around a running club or web-boards to see if anyone knows a good sports med doc… " I’m not sure that that’s true. Most surgeons spend time trying to sort out the patellofemoral problems so as to NOT operate on them, as surgery (except in a few cases, like recurrent complete dislocations) has not been shown to work well. Might have been true 10 years ago. Deke
In reply to the original post - See the best Sports Medical Doc that you can see.
I am NOT a Doctor, but in my own personal experience Quad and Hamstring muscle balance can have a huge impact on Chondromalacia and patella/knee pain.
I bit of a story: 15 years ago I ran into a telephone pole ( A longer story) while doing a tempo run at 5:00 min/mile pace. The first thing that made impact with the pole was my left knee cap. I fractured it. The fracture heeled, but the knee has never been the same. If I run too much and don’t cycle and do leg extention work regularly to keep the patella tracking properly I get deep pain in the patella. I couple of intense quad extention sessions or some cycling makes the pain go away completely. It’s somewhat miraculous. One day I can barley run and two days later, I am running completely pain free. I have seen this in others who have imbalances in medial and lateral Quad muscles and also front/back imbalances with Quads and hamstrings.