chrondomalacia advice?

[Fat Robert]

ok. seeking internet advice on your knees is mad painful and moronic. we're taking that as a given, here. also take it as a given that no ortho or pt around my red neck of the woods knows anything about cycling. i'll also take in all the feedback, listen to my own body, and go from there to make up my own stupid mind....

i've been dealing with this since i was a teenager. had a complete fracture of the right patella and a torn acl (in the same accident) on my right knee, had five operations on that one, with the last one being a patella realignment that involved cutting the patellar ligament, moving it over to the medial side a few mm (perhaps 3mm, atmo?) and stapling it back in. just a lateral release and some junk cleanout on the left one.

my shoes control my flat arch, i have shims to compensate for my cant. i use time pedals. i don't have any problems with hip or hamstring flexibility.

now, this year, i didn't do weights in the winter because of some broken ribs from a crash. i started having some knee pain in april, and it got worse in june from too many miles and from getting lazy with my cadence. the pain is on the bottom of both knees, in the tibial-femoral plateau area, both medial and lateral. obviously, i'm resting and not planning on continuing with any racing for the rest of the season.

so.

i know my hamstrings are stronger than my quads. i know my vmos are always a bit on the weak side from being cut during surgery several times. i try to keep my saddle high enough to get my knee bend in the 25-28 degree range. any suggestions for how i can manage this and keep it from coming back and wrecking a season?

[Too Tall]

FatMoD - Suggest you find the VMO balancing drills I posted some time back. While proper tracking is not the whole picture it can't hurt. If it has gone on this long, get r' scraped n' shaped and be done with it?

[Fat Robert]

can you post a link TT?

none of the orthos i've seen like shaving -- i had that as operation #3 on my right knee in 1982, and the problems came back quickly -- they have shared the opinion that the shave is a short-term solution that, more often than not, isn't worth the bother.

[Fixed]

bro I found this I hope you feel better soon
cheers
"The only way to alter knee morphology is by performing surgery, and
sometimes that is required. However, in most cases, exercises with or
without formal physical therapy is all that is needed to correct the
problem... In some cases, if the pain persists, your physician may
prescribe physical therapy...

A non-steroidal anti-inflammatory medication like Motrin is often
prescribed by your physician. This is taken regularly, whether you
feel pain or not. By decreasing the inflammation, the pain is often
reduced. But not only that, there is some evidence to suggest that the
drug actually helps in reforming the articular cartilage.

A knee brace is also often prescribed for patients who want to stay
active in sports. The usual brace prescribed is what is known as a
patella stabilizing brace. It consists of a knee sleeve with a patella
cutout, and a horse-shoe pad based laterally to keep the patella from
tracking laterally...

With conservative treatment, about 85% of patients improve enough that
no further treatment is needed. In about 15% of patients, the pain
stays severe, or becomes worse that surgical treatment is needed...
The form of surgery done is usually an arthroscopic surgery. The
surgery is performed through little keyhole incisions with the help of
an arthroscope."

[531Aussie]

I had it about 15 years ago, and it was gone in less than a week by doing this straight-legged kicking exercise with very light weights

http://vmartin.bigpondhosting.com/photos/chondro.jpg

The way my physiotherapist explained it to me is that during normal quad contraction the rectus femoris quickly pulls the knee cap up and out of the way of the end of the femur, but when fatigue, overuse, or imbalances develop -- or whatever -- 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 knee cap on the femur, and the subsequent pain.

The straight-leg exercise somewhat islolates the middle quads (rectus femoris and vastus intermedius) and corrects the tone imbalance. The leg doesn't have to be dead straight, just so long as the dominant movement is hip flexion, and not knee extension.

My chondro sneaks back ( a little) every few years, especially if I try to jog, but it's quickly gone if I do the exercise.

As the others have suggested, a too low saddle position, and/or cranks that are too long can increase anterior load

Isn't my dog cute!!

[Tailwinds]

can you post a link TT?



Please post a link. I've searched and can't find it.

[BarryG]

I successfully mediated chondromalacia in my left knee, which was threatening to sideline me early last season. FWIW, a cho-pat strap, shorter cranks and a slightly higher saddle position all seemed to help me.

[sailorboy]

Also keep in mind that having your knees come too far toward midline either in pedaling or running may cause tracking problems. A couple of possible solutions: 1) focus on strengthening the lateral butt muscle (glut medius) by performing leg lifts to the side as well as the ones someone suggested to the front. 2) try progressively moving you cleats to theinside of your shoe and make an effort to pedal with your knees further out from the top tube. That or try some cranks with a wider Q factor. My lawyer will fax you a disclaimer/release to sign in a few minutes.

[Too Tall]

What 531Aussie described is exactly the situation I mentioned. Str. leg kicks...cool...a bit violent? What I do is retrain using hands on feedback and a modified squat. During the contraction (the "UP" portion) phase put your hands on VMO and make the big quad muscles fire just before VMO .

===========================
Use a med. physio ball (55cm?) squats with a 4" thick yoga block between the knees to correct this problem with my clients.
Here's the drill:

Lean on a physioball against a wall, with the ball positioned at your lower
back. (The ball acts like a ball bearing between you and the wall as
you squat.) Place the yoga block between your knees to properly align and
space your legs/feet. Squeeze the block firmly, slowly
squat to parallel, hold, and slowly stand back up. Start with a 5 down, 3
hold, 5 up cadence for 6 reps. Your adductors will scream, but they will
get strong. If you tend to walk toes out, you will notice that your gait
will slowly correct itself as the strength imbalance is corrected. This
exercise combined with a flexibility program designed to loosen up the lower
body, especially the hips, or a regular yoga practice will go a long way
toward solving this problem.

VERY IMPORTANT: Once your feet are aligned and spaced do not move them
during the squat. If you have poor flexibility, your feet will want to move
during the exercise.

*** During this exercise place your hands lightly on vastus medialis obliquus and make your other quad muscles fire just before...practice...it takes time.