Kind of Blued

In short: I'm young, have chondromalacia, and am wondering if I'll ever be able to ride like there's no tomorrow again. I'm seeing a sports medicine doctor in the near future, but am curious in the meantime.

I love climbing, and I live next to the Rockies. I also love pretending I'm a hotshot by doing periodic out-of-the-saddle bursts in a big gear during a long Cat. 1 climb, then returning to the saddle to recover as I continue climbing. The goal is to finish the ride; the fun is to challenge myself by throwing those intervals in.

My problem is that, in concert with a sub-par bike fit, this practice has helped me develop chondromalacia patella/runner's knee.

I've been taking it easy for a while, icing them and taking NSAIDs, and both knees are noticeably better. I COMPLETELY understand the importance of bike fit. That said, I'm wondering if I'll ever be able to do the "out-of-saddle-attacking" thing again without damaging my knees. I know that these riding techniques exacerbate chondromalacia, but assuming I heal up, and get a reeeeally good bike fit, will I still need to ride more conservatively?

Bacciagalupe

At the risk of stating the obvious, I'd check in with a sports doctor to be sure.

You may also want to talk to a physical therapist (or the doc may recommend one). They may put together a program to help strengthen your knees gradually.

And yes, get your bike fit, and don't mash.

Bob Ross

I'm in a slightly different position than you: I developed cho-pat before I became a serious cyclist. Cycling is practically the only physical activity I can do. But a combination of regular glucosamine/chondroitin supplements, physical therapy, occasional ibuprofen & ice after a ride, and especially adopting certain techniques for climbing -- increasing my cadence so I could stay seated longer, concentrating on better recruiting the large muscle groups, learning to use my body weight more effectively to drive the downstroke when out of the saddle, etc. -- I can still hang with the big kids on the nastiest of climbs.

But the fact that you developed cho-pat due to your cycling would give me pause. I'd definitely talk to the sports doc before I took advice from an internet forum!

531Aussie

I had it pretty bad in one knee nearly 20 years ago, and I've had lots of killer hard rides since then. However, it does still sneak back a couple of times a year in a minor way if I'm a bit slack with my stretching, or, more to the point, if I jog/shuffle around the park too much with my dog.

It's obviously wise to proceed carefully wth internet forum advice, but.... ....

I had great results doing some straight-ish leg (slight bend) kicking exercises with a very light weight (about 5lb). In fact, this was much better than rest, nsaids, stretching and icing.

The way my physiotherapist explained chondro 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 (because cycling works the lateralis and medialis a lot, while somewhat 'neglecting' the rectus femoris and vastus intermedius), the firing order of the quads gets slightly out of sync, and the middle quad doesn't pull the knee cap up quickly enough, causing it to rub and grind on the femur. This obviously causes the damage (roughness) and pain.

The straight-leg exercise somewhat islolates the middle quads (rectus femoris and vastus intermedius) and rectifies the tonal imbalance, correcting 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. And trying to keep your foot straight enough that you're feeling it in the middle quads, and not the groin

clink83

Ive had chropat pain for 6 years now, I just keep riding and running and ignore it. Of course, you should see a physical therapist to get rid of it or reduce whatever is causing it. I don't know about this firing order stuff, but its usually cause by a weak VMO, which is pretty easy to correct with weights.

carpediemracing 

Read John Howard's book. He must mention it since it affected his cycling career.

AFTER he was diagnosed, he:
- did the Ironman
- Broke the land speed record for cycling (158 mph)
- broke 24 hr paced record (519? miles)
He's still riding and racing and kicking butt and taking names. I figure he's got to be in his 50s. He was one of the "seniors" when Lemond was a Junior.

Kind of Blued

Thanks everyone. I'm not doing anything until I get a professional opinion, but it's good to hear from you all that I can expect to get back to 100% or better than ever.

I've come to understand the importance of muscular balance in keeping your knee cap in the right place at the right time, so I need to figure out what is causing mine to deviate.

AChristie

For me I think it's inactivity and the vastus medalis gets weak.
The exercises and ice help.

valygrl

Hey - same boat as you, only I'm not that young. Obviously everyone's situation is different, but to give you another hopeful data point.

I was diagnosed with CM & osteoarthritis in my knee. Also have some congenital malformation called a "baker's cyst." Was having knee pain behind the patella and also had a pulled hamstring.

Had a medical bike fit at Boulder Center for Sports Medicine, saw Pruitt for the diagnosis, Tammy (last name?) for the bike fit and PT. Doing great now - a LOT less knee/hamstring pain (although not zero) and I'm able to climb all the local steep test pieces standing or sitting, as I choose. Mine mostly flares up after flat windy rides, I tend to mash a big gear in the wind (stupid).

They told me not to run though, which is a bummer.

clink83

They always tell you that, but you should ignore it. With proper PT there is no reason you can't run.

That's your problem, stop doing that. Griding a big gear is a bad idea, no matter who you are.

valygrl

I guess I haven't found the proper PT yet. Every time I run I've got so much knee pain for the next 4+ days it just doesn't feel worth it. I may try again next winter.

clink83

Well, I should rephrase that. Most people with minor knee pain with proper PT should be fine. It seems like they give a blanket answer to everyone that running=bad. Most people just need to improve their flexability and get rid of minor muscle imbalances, and they would be fine.

Ive found that cycling, hiking and skiing hurt my knees worse than running does. I need to start lifting weights though, my knees are starting to make popping sounds again.