Training & Nutrition - Knee Injury Experiences/Help- Chondromalacia

I suddenly developed quite an intense pain in one knee. My milage and effort have been fairly stable over the past 2yrs. Bike is properly fit (seat height, etc.), no changes made to it for over 1yr.. I tend to be a high cadence (100+) rider, although I'll stand up for sprints, etc.

It started in early Jan. I had done a 99mi ride and it started quickly about several days later (in the interim I had been riding 20-45mi each day with no pain) but during a 25mi ride 5 days later I really noted it - I really don't know if the long ride was the trigger or something else. I had before done 75-85 mi rides with no issue during or post. I had never had knee pain of any sort before. Pain is typical of Chondromalacia - front of knee, increases with squatting, up stairs. Was quite painful day after riding.

I stopped cycling almost as soon as pain started and scheduled Dr. appt. After two weeks of rest, icing, antiinflamatories, I tried gently cycling again (3mi, 10-12mph) and pain came back very quickly. Finally the appt. with knee specialist. X-rays found no bone damage or obvious issue, but found my knee cap to be rotated slightly outward (thicker cartlidge on inside of leg vs. outside). MRIs are planned, but not yet occured to see if any cartlidge damage.

Perscription is to see PT 2x/wk for 6wks for "knee patelofemoral pain/lateral complex, Evaluate and Treat" Dr. explained it will entail strengthening inside quad. muscles near full extention and stretching of outside knee. She said light/short cycling (i.e. round the neighborhood) is OK and wont cause futher damage. I know rest and PT is key.

Here is the point of my posting: Can anyone who has gone thru this share your experiences? Any tips (beyond following Dr.)? Any ways of coping with not cycling for so long? (I can't run due to back injury - compressed disc) It now been almost 4wks with virtural no cycling and I still get quite a bit of pain in my knee when squatting/going up stairs. I also know MRI is key to understanding if there is a more serious issues. But what I don't understand is why after 2yrs of cyling why this would come on so suddenly and so strong?

Al

That's a bummer. What's your lowest gear? Just curious. I have a bad knee but no medical background so I can't be of any help, although my guess is that you'll have to stop pushing hard for a while or maybe as a riding lifestyle to protect against that happening again. I have some low gears to be on the the "safe" side. Good luck. :)

That's a bummer. What's your lowest gear? Just curious. I have a bad knee but no medical background so I can't be of any help, although my guess is that you'll have to stop pushing hard for a while or maybe as a riding lifestyle to protect against that happening again. I have some low gears to be on the the "safe" side. Good luck. :)
My lowest gear is 38/26. I tried to use it for a very easy neighborhood ride it but it was too low so I shifted up a few cogs. Oddly the knee pain hurts more when spinning 80-90 that when pushing a slightly higher gear (even at 10mph) at 50-60.
I just gotta be patient. The MRI will be telling of how serious I problem I got. Part of what is pushing my patience is waiting for Dr. appts. and test. Like I said its been 3.5wks since I first got the problem and about 3 since I first called Dr., but each appt. and test has a several day wait. PT wont start for another 2wks and until then I feel like I am doing nothing to start rehab. (except of course the non-use rest which is certainy a very important part)
Al

Like the previous poster I'm not a medico but I have had a knee reconstruction and some problems with knee pain. During my recover from the reco I had a few issues and the physio immediately started taping my kneecap to relieve the pain. Worked fine and was only necessary for about 2 weeks.

Any time I've ever had similar knee pain I've been able to tape my knee and get good relief. Ask the physiotherapist when you see them and see what they think. You could also check out http://www.physiotherapy.co.za/images/selection%20of%20taping%20tech%20article.pdf or http://www.hughston.com/hha/a_13_4_5.htm

FWIW, this taping technique (McConnell technique) was developed in Australia so it must be good:)

cheers

kim

i had the exact same problem for about 6 months. I went to the docotrs, no help, but then i went to my team mate who is a PT, and the most effective thing he showed me was stretching my IT band. it fixed the problem well enough to ride in a matter of weeks. obviousy, this may not work as well for you, but it's just stretching, so it's worth a shot. here ya go: http://www.rice.edu/~jenky/sports/itband.html

I had some chondromalacia about 15 years ago, and after 2 physiotherapists misdiagnosed it as patella tendonitis, the subsequent rest, stretching and icing for a month did nothing. A 3rd physiotherapist diagnosed chondromalacia, and it was gone in about a week after doing straight-legged kicking exercises with light weights.
http://vmartin.bigpondhosting.com/photos/chondro.jpg
Only a few lbs was enough for me; 7 or 8lbs max.

The way my physiotherapist explained it to me is that during normal quad contraction (knee extension) the middle quads (both?) pull the knee cap up and out of the way of the end on the femur, but when fatigue, overuse, or imabalances develop, the firing order of the quads stuffs up, and the rectus femoris doesn't pull the knee cap up quickly enough, therefore, causing the grinding of the cap on the femur, and the wear and subsequent pain.

The straight-leg exercise somewhat islolates the middle quads (rectus femoris and vastus intermedius) and corrects the tonal imbalance, rectifying the firing order of the quads. The leg doesn't have to be dead straight, just so long as the dominant movement is hip flexion, and there's no knee extension.

My PT told me that chondromalacia and PTF syndrome a bit different: the former being as I described above ( a 'lazy'/slow tracking of the cap), and the latter being a lateral maltracking of the cap, usually toward the outer side, due to strong/tight lateralis and IT band, relative to a weaker medialis.

Thanks for the advice to everyone. What 531Aussie describes seems 'right.' - that picture is great!

But to be cautious, I will want to first meet with PT and see what they say before I undergo any self-directed treatment. But perhaps there is promise that this won't be too long term. It's been hurting the past two days with no cycling in quite a while, mostly when stepping out of drivers seat in car and lifting my self up with leg, Also after sitting for 3hrs in airplane it get stiff and hurts until I walk a bit.

Al

I've also been diagnosed with chondromalacia. Mine started about 6 months ago, it's a lot better now but I have to keep it under control with regular maintenance. For me, biking doesn't really bother it, but high impact exercise along with long sitting causes discomfort.

My PT said I was "out of alignment" due to being flat footed and my hip muscles not firing. My fix was the following:
1. always wearing (custom) othodics
2. doing hip exercises like leg raises when laying on the stomach
3. rolling on a foam roller & tennis ball on the upper leg and hip to help remove knots
4. flexibilty in the quads & hamstrings
5. ice on the knee after a hard workout

It's really important to find a good PT, otherwise you will be wasting your time and money.

But to be cautious, I will want to first meet with PT it's obviously wise to be cautious, but the kicking exercise can be done with a very light weight. The movement is unfamiliar to most people, so it doesn't take much to generate a training response. The last time I did them I used an old boot with a 2.5lb weight taped to it! :)

Generally, joint rehab focuses on movements without stress. But every situation is different, and where there's money to be made, often the scope and detail of medical treatment can vary.

My own perspective suggests a spin-trainer or rollers and aspirin until swelling and pain subsides.

My own perspective suggests a spin-trainer or rollers and aspirin until swelling and pain subsides.
It is spinning over 90rpm that brings out the pain the quickest when on a bike. Of course that doesn't mean that it is what causes the problem. I've been observed by a bike fitter when spinning and told I have a very smooth stroke with no lateral knee hitches. There is also zero swelling as confirmed by knee specialist.
Al

Update: My first visit with the PT was today (yes, it takes time to get on their schedule).

After the battery of prodding and tests the PT also confirmed I had all the classic signs of Chondromalacia. So I have a set of strengthening (inner) and stretching (outer) exercises. My left leg had some weakness in some muscles relative to right.

Even after the 6wks of rest my knee still hurts quite a bit walking upstairs/hills or cycling (which I've done more in last week)

Most interesting tidbits:
-My left leg (one with bad knee) is 5mm longer, due to a 5mm longer femur. This possibly suggests putting spacer under right cleat and raising seat 5mm.
-The PT said that high cadence can be bad for the condition, that slow and firm is better to keep legs in full control and not get any muscles pulled by momentum. This makes me wonder if riding fixed at high cadence (which I did a lot) contributed. I wonder if the implication is that if one rides high cadence ones form may degrade, or perhaps there is more to it than that.

My MRI is today at 5pm.

Al

i have that too, it kind of comes and goes, but sometimes the pain is really intense. doing straight leg raises helps a lot. extend one leg, point your foot towards your body, and lift the leg straight to a 45 degree angle.

I have a similar problem too, except mine is the earlier stage known as Patellafemoral Syndrome (PFS). I have to do similar excercises and stretches, if I don't I was told the cartilage would shred and look like crab meat (Chondromalacia Patellae) and I would have to see a physical therapist. I will also mention that massaging the muscles around the knee cap also helps by relaxing the muscles and allowing the knee cap to slide back into position instead of popping the knee back into place.

Having same problem with rt knee for a couple of months and also discovered slight leg length discrepancy (longer on rt side), probably exacerbated by my purchase last Fall of a mtn bike with longer crank arms (175) than my normal road bike (170), and using it on the street for long rides. Because that increases flexion at top of pedal stroke, it adds to stress on the knee, and I even discovered that my rt knee was kicking out slightly at the top of the pedal stroke. So I stopped riding the long arm bike, started doing the leg kick exercises and have been avoiding all high-gear pushing for a month. Just easy rides, and almost back to normal, thank God.

531Aussie, thank you for that. I saw this thread a week or so ago and have been doing that excersise because even though I was diagnosed as a slight tear of the acl, the injury was word for word with noisebeam as far as where, when and how it hurts. even had the same p.t., etc.. well after doing that 1 set of 10 with NO weights the day I read it I felt so much less stiffnes it was an answered prayer. I am doing 3 sets of 10 twice a day on top of my other excersises and have almost 0 pain and have lateral movement for the first time since early last spring. my p.t. let me get back on the bike again as long as its flat and 3 miles or less( Im a mt.biker). I cancelled last weeks appointment to p.t. because Im just doing the same thing there and its costing me $135 a visit out of my pocket. I have an appointment with the sports med dr. on Apr 3 that I am keeping as this is a follow up to see if surgery will be needed.
Im thinking this has saved me from having to get cut open!!!!. I am going to share it with him.
thank you again. btw I work on concrete all day and I got some Newbalance shoes that fit right and that has also not hurt anything.

ah, good to hear http://www.musicianforums.com/forums/images/smilies/thumb.gif

As I may have said above, I once got up to doing the movement with very heavy weights at the gym with a wall-pulley, but I think I over did it. So, lighter weight seems to be better.

Lots of good advice so far so I'll just add a few things. My wife has been through all this and had arthoscopic surgery 4 days ago by some guy named Dr. Eric Heiden. Shorter crank arms will reduce the amount of bend in your knee at the top of the pedal stroke. Saddle can probably be raised a little (less than 1 cm) to help.

Leg extension exercises using ony the last 30 degrees of movement and with toes pointed out to aim at the inner quads. Tighten this area to counteract the tight outer quad/IT band. Use 3-4 sets of 20 reps. When you can do 4 sets, increase the weight and do about 15 reps each set. Add reps each week or so until you're up to 20 again and then add more weight.

Don't sit cross-legged because this puts high pressure against that damaged cartilage you have under your kneecap. The video we got of her surgery shows the "crabmeat" of cartilage in that area, due mainly to a lifetime of running. Scraping it smooth would not leave enough good stuff behind so leaving the crabmeat is better.

Getting 'scoped isn't really a big deal and it's the best, and sometimes the only way to really know what's going on. My wife was riding her bike on the trainer the day after the procedure. The 'scope procedure also includes a lot of flushing out of the loose bits in there (in the sinovial fluid) and provides some extra relief for awhile. During the procedure they can do a better assesment of tracking issues because the muscles are relaxed.

Some people respond well with Glucosamine and Chondroitin. Costco has good prices. These act as a lubricant against the damaged cartilage.

For significant problems with patella tracking you may end up with a procedure called a "Lateral Release". It's usually effective, but still only a last resort.

Haven't heard anyone mention pedal systems yet. I have had this kind of knee pain with SPDs, and it went away when I switched to Frogs. I shortened my crank arm length, also. Recently tried SPDs again, and the pain came right back. So you may also need to consider a pedal system that allows some float, like Speedplays of various kinds.

Haven't heard anyone mention pedal systems yet. I have had this kind of knee pain with SPDs, and it went away when I switched to Frogs. I shortened my crank arm length, also. Recently tried SPDs again, and the pain came right back. So you may also need to consider a pedal system that allows some float, like Speedplays of various kinds.

A fixed cleat in the proper position can help hold the knee in its best alignment. This is why my wife prefers fixed cleats over those that float. BTW, SPD's can float too.

Hello Aussie531 i am a fellow Aussie from Newcastle Australia i hope you are still out there as i have just discovered this forum.
I have had a problem in my left knee for a while now, it clicks & creaks not severe pain but annoying it is definatley a tracking problem & my quad does seem tight on the outside.
It does not seem be getting any worse but also not any better, i have tried stretching whist lying with my leg extended behind.
I have been to plenty of physios even to a knee surgeon all to no avail.
I have even been to the the famous Jenny Mcconnell in Sydney (Mcconnell taping method) & she did not really help nor the taping.
I am curious about the leg kicks so you are just standing & lift your leg straight up to 90 deg as if you are doing one of those Russian soilder marches?
How long do you hold the leg in the extended position at 90deg a couple of seconds?
Also can you support yourself for balance?
looking forward to your reply.

Yep, still here. :thumb:

I obviously can't say you have the same thing I had, but....

Yeah, an almost-straight leg to roughly 90 degrees. I found it a little better if I had a tiny bend in my knee, because I reckon it takes a bit of pressure off the front of the knee if there's discomfort.

In my experince, the movement doesn't have to be super strick to feel it in the right spot, which is the middle quads; nor is too much weight required -- probably 5lbs max. Just make sure you're feeling it in the mid quads, and not the groin.

I don't hold it; I just do normal-movement reps, like when doing any weights.

Yes, I hold onto a door frame or wardtrobe door, or whatever, for balance.

My chondro sneaks back about every year or two, just in a minor way, and, for the exercise, I use an old rollerblade with 2.5lbs of weights (two 1&1/4lb plates) bolted where the wheels were. So, it's probably no more than 4 pounds in total, and I do about 15 reps.

I can't promise any miracles, but I also can't see it doing any harm.

:thumb:

My physio diagnosed mine by rubbing my knee cap quite firmly from side to side with my leg relaxed flat on the bench. He said he felt roughness and some grinding under the cap (the surfaces are apparently meant to be very smooth), hence the chondromalcia.

He told me that there's a difference between what I had and the regular PTF syndrome (patello femoral syndrome). He said that PTF is a knee cap maltracking (usually towards the outer, due to tight IT band -- and/or a strong and tight lateralis -- relative to a weak medialis), and that my chondromalacia was a 'lazy' or slack tracking of the knee cap, due to the buggered up quad firing order, caused by the comparatively out-of-tone middle quads (rectus femoris or vastus intermedius?).

He said that both problems aren't uncommon with cyclists, because the middle quads don't get as much work as the medialis and especially the lateralis.

I got the impression from him that recognising my problem the way he did, and giving me that exercise, was a bit of an old-school thing that's gone out of favour. All the buzz these days is about PTF syndrome and patella tendonitis. He retired a coupld of years ago, so he ain't young.

Thanks,
I beleive mine is definatley pulling to the outside but the funny thing is that my vastus medialis is very strong as i have done a lot of weights in the past when i used to play rugby physios even told me this & it is visual in my legs as well.
I had never had any problems with my knees prior to this which has been on going for the last 3 years.
I am approaching my 38th birthday my flexability is good especially in the hamstrings i can touch my toes easily, actually place my palms flat on the floor.
I found a website from the US which mentioned the major cause is the tight IT Band which he had some recommended streches for.
So what i will do is try both & hopefully i will get a result!
As mentioned the pain is not severe just uncomfortably annoying in all this time of cycling & doing weights it does not seem to have got any worse nor better, alot of people mention pain on stairs up or down i have never had this it seems to get better once it is warm!
I was still doing weights only a few months ago but i deceided to give it a rest for a while i have even slowed up cycling to try & get this right.
Some days it certainly feels better than others it seems to have amind of its own.

Do you do any weight training? Is it uncomfortable for you to squat or climb stairs?
Does or did yours click when you had your leg bent & then extend it?

Does or did yours click when you had your leg bent & then extend it?

i've got similar problems and yes my right leg clicks when i bend my knees - when my heel comes up to my gluteus maximus!

unlike you i've got really stiff legs and knees. ive never been able to touch my toes, or even get close. i really regret not looking after my knees. for years i used to do demanding sports like tennis and football, sometimes for four hours straight, just jumping straight into it without the slightest thought for my knees. no warm ups. no stretching. i'm only 21 now though and this all happened in my teens, when i didn't know any better. i think this is the cause of my knee problems. but i've started to do exercises at home and things have gotten slightly better over the past two days.


this is a good exercise to help with IT band problems:

http://www.youtube.com/watch?v=4pQkgyYeV30

:thumb:

As mentioned the pain is not severe just uncomfortably annoying in all this time of cycling & doing weights it does not seem to have got any worse nor better, alot of people mention pain on stairs up or down i have never had this it seems to get better once it is warm!
I was still doing weights only a few months ago but i deceided to give it a rest for a while i have even slowed up cycling to try & get this right.
Some days it certainly feels better than others it seems to have amind of its own.

Do you do any weight training? Is it uncomfortable for you to squat or climb stairs?
Does or did yours click when you had your leg bent & then extend it?Good luck.

I do a little upper body weights, but not legs.

I get a bit of clicking, but I'm "around" 40, so lots of things click :D

I have aggravated it once or twice by not going up stairs carefully. This might sound silly, but when stepping up onto anything, I'm careful to make sure my weight is moving up, rather than forward over my bent knees.

I'm also careful getting out of low chairs, low dunnies, and in and out of low cars. It probably sounds paranoid, but it's not hard to get into what I consider to be good habits. My car is a little low, so I get in and out of it like an old lady. Getting I sit first, then swing my legs in, rather than the 'manly' way. . :D

Have you tried the common bike position tips for anterior knee pain? These are typically making sure your saddle's not too low, and your cranks aren't too long for your leg length.

Thanks,
I will see about my bike position as i am going to take my bike to the shop so hopefully i will find someone helpful,but i am pretty sure my seat is not too low as i did read a lot about this being a problem for chrondro & found a website that gave a few measurments & tips see below. http://www.ultracycling.com/equipment/bikefit.html
I also read that Chrondromalacia does not like a dramatic increase of training eg. if you were only riding
20km's three times a week & you went to 40km's everyday. They say you should increase your training gradually
I have been doing the straight leg kicks for about a week now combined with my stretches i have some ankle weights i wear i think they are a couple of kilos & it does feel pretty good although i have not been on the bike for about 10 days.
As everyone has mentioned it is a difficult one because physio's do not seem to know much about it (i actually had one guy early on say i have no idea what this is?) & surgeons just want to operate!
I think you just have to try what everyone mentions in this forum & see what works for you.

Its funny how you said getting in & out of the car i do exactly the same thing i am also wary when squatting down or kneeling with my kids about the way i get up you do train yourself dont you!
I also love Aussie531 that you are around 40 so this can be anywhere from 40 to 49 great tip since i am approaching 38 i am going to say i am around 30, love it!
Thanks again.

Ha! I'm 42. :)

I reckon don't overdo it on the leg kick. When I first did them I hooked into it like I was doing a typical weight-training movement, but, as I said, I eventually found that only a few kg was enough, and only a few days a week.

Thanks will do.

Just wanted to ask as well as you mentioned it still comes back once in a while. When it does come back do you stay off the bike or keep riding?

and could you do a full tour with it or does continuous riding aggrevate it?

NB
I think if the PT says that high cadence is worse for the knee, then he or she is not a cyclist.Higher cadence means less load on the knees, doing lighter work.Fixed gears are bad on the back of the kneecap if you brake with the gear. Fixed gear is probably the last thing you need at this point.
Shimming the cleat of the shorter leg helps, but have a Chiropractor check you over first, sometimes this is due to a mis aligned pelvis (the longer leg)
Good Luck to you, and God Bless

Stretching my IT band made the biggest difference for me. The stretching started with a nice physical therapist who would literally stand on a stool and use her full body weight to push my kneecap sideways. After 3-4 weeks of that, I started doing stretches on my own and using a roller. You can buy a roller at most places that sell Yoga supplies. Just lay on it sideways around your hip and scoot until the roller is at your knee, reverse and repeat.

You should also consider asking a massage therapist to work on the facia around your knee. That can make a huge difference.

If you're riding in cold weather tights can put pressure on your kneecap and make things worse. I took a pair to tights and knee warmers (for extra material) to a tailer and had them cut out a section of the tights over the knee and replace it with a section 2-3 inches larger cut from the knee warmers. Yes, it looks bad but I'm able to ride and/or walk the next day which is a definate improvement.