"Kip Baranoff" <
[email protected]> wrote in message
news:[email protected]...
> After many years of running, marathons, and triathlons, I've been diagnosed with chondromalacia
> patella, a softening of the cartilege under the kneecap, a.k.a. runner's knee. It is a fairly
> advanced case, and the only thing my orthopedist can recommend other than possible arthroscopic
> surgery is many months of physical therapy exercises to strengthen the quads, hamstrings, and
> other muscles around the kneecap. I haven't run for a year, but the knee pain has continued
> unabated, walking down stairs, sitting in one position for too long, etc.. I'm trying not to be
> pessimistic, but I've been very worried about the possibility that I might never be able to run
> again. This would be a really hard pill for me to swallow, since running has been an important
> part of my life for two decades.
>
> Has anyone in this group ever had chondromalacia and actually overcome it, or have any
> recommendations on how to do so?
>
Sorry to hear of your problem. At least you have not completely ruined your knees as a few exrunners
have done.
Why not pin down what works to protect your knee from damage? You need to do this anyway, in order
to run again, no matter what decision you make.
Crosstraining, running form review and adjustment, review of running schedule, choice of surface,
shoe selection ....
In my case, I backed off early, strengthened the VMO with short-arc squats, and now have to stop
running on occasion due to a sore calf muscle or some other malady, but the knees feel great. For
longevity, I avoid long runs on pavement if possible and include preventive maintenance in my
crosstraining.
Links, if still current:
Links:
http://www.clinicalsportsmedicine.com/chapters/24c.htm
http://www.emedicine.com/sports/topic96.htm http://aafp.org/afp/991101ap/2012.html
http://www.barefootscience.net/footcaresteps/pages/a_cover.html
Causes: road camber, overstriding, insufficient recovery, relatively weak VMO (quadricep that
crosses the knee joint medial to the patella) and other asymmetries, high impact running form, wrong
shoe choice,. . ., as well as structural anomalies.
BTW, the weak VMO, vastus medialis oblique, that leads to improper patella tracking and soreness,
usually responds well to simple physical training. A shallow(short-arc) one-legged squat, building
up to two sets of 60 reps seems to emphasize the VMO the most.
From:
http://www.emedicine.com/sports/topic96.htm
Physical Therapy: Conservative treatment is successful in 80% of cases. The goal of treatment is to
control the symptoms. ? Start by having the patient modify his/her activity level. Decrease
activities that increase patellofemoral pressure (eg, jumping, squatting, kneeling). Gentle
eccentric loading activities may be initiated. ? Apply ice for 10-15 minutes, 4-6 times per day,
especially after activity. ? Increase muscle strength, especially VMO, with short-arc quadriceps
sets, knee presses, isometric quadriceps sets. Biofeedback may aid in teaching recruitment of the
VMO. ? Improve flexibility of the hamstrings, vastus lateralis, and iliotibial band. Stretch tight
retinacular structures. ? Initiate proprioceptive exercises. ? Ultrasound or phonophoresis may
decrease pain symptoms. ? A patellofemoral brace with a patella cutout and lateral stabilizer or
McConnell taping may improve patellar tracking and provide stability through augmentation of
proprioception. See:
http://www.clinicalsportsmedicine.com/chapters/24c.htm ? Provide arch supports
or orthotics to correct foot malalignments. [And why not use off the shelf inserts, since there is
very little science to it anyway?] Recreational Therapy: Avoid exacerbating activity (eg, deep knee
bends, stair climbing, hiking). Initiate a home therapy program of flexibility, strengthening, and
proprioceptive exercises. Eccentric loading activities may be initiated.
Re: "Pain behind the knee cap in runners is often treated with special inserts in shoes. When you
run, you land on the outside bottom part of your foot and roll toward the inside. This causes the
lower leg to twist inward at the same time that the knee cap is pulled by the quadriceps muscle in
the opposite direction. This causes the knee cap to rub against the long bone of the upper leg.
Special inserts can be placed in running shoes that limit rolling in of the foot and prevent knee
cap pain. "
The typical prescription of orthotics includes too little attention to other factors that may be
more important and needs to be part of an integrated approach not done in isolation.
Causes: road camber, overstriding, insufficient recovery, relatively weak VMO and other asymmetries,
high impact running form, wrong shoe choice,. . ., as well as structural anomalies.
BTW, the weak VMO, vastus medialis oblique, that leads to improper patella tracking and soreness,
usually responds well to simple physical training. For some, spinning helps; however, a shallow(short-
arc) one-legged squat, building up to two sets of 60 reps seems to emphasize the VMO the most.
From:
http://www.emedicine.com/sports/topic96.htm
Physical Therapy: Conservative treatment is successful in 80% of cases. The goal of treatment is to
control the symptoms. ? Start by having the patient modify his/her activity level. Decrease
activities that increase patellofemoral pressure (eg, jumping, squatting, kneeling). Gentle
eccentric loading activities may be initiated. ? Apply ice for 10-15 minutes, 4-6 times per day,
especially after activity. ? Increase muscle strength, especially VMO, with short-arc quadriceps
sets, knee presses, isometric quadriceps sets, and straight leg raises with the leg externally
rotated. Biofeedback may aid in teaching recruitment of the
VMO.? Improve flexibility of the hamstrings, vastus lateralis, and iliotibial band. Stretch tight
retinacular structures. ? Initiate proprioceptive exercises. ? Ultrasound or phonophoresis may
decrease pain symptoms. ? A patellofemoral brace with a patella cutout and lateral stabilizer or
McConnell taping may improve patellar tracking and provide stability through augmentation of
proprioception. See:
http://www.clinicalsportsmedicine.com/chapters/24c.htm ? Provide arch
supports or orthotics to correct foot malalignments. [And why not use off the shelf inserts,
since there is very little science to it anyway?] Recreational Therapy: Avoid exacerbating
activity (eg, deep knee bends, stair climbing, hiking). Initiate a home therapy program of
flexibility, strengthening, and proprioceptive exercises. Eccentric loading activities may be
initiated.
http://www.clinicalsportsmedicine.com/chapters/24c.htm http://www.emedicine.com/sports/topic96.htm
http://aafp.org/afp/991101ap/2012.html
http://www.barefootscience.net/footcaresteps/pages/a_cover.html
