Chondromalacia your experience please!

[Redturbo]

How long did it take you to recover? I have been staying off the bike doing all the prescribed exercises. Every few days because my knee is feeling better I'll get on the bike and test the knee by just spinning easy and it inflames back up. The orthopedic said I should keep riding but cut back 50%. It appears to be a vicious cycle. What are your experiences with it and how long did it take to heal?

thanks

[Dave]

Here's some info on the subject. I've got a similar problem, but mine is deterioration of the cartilage from arthritis. So far, this problem has not kept me from cycling, but it will eventually.

http://orthopedics.about.com/cs/patelladisorders/a/chondromalacia.htm

[thwart]

FWIW, when I rode toeclips only (see below, I'm an old guy ;) ) I had chronic patellofemoral issues. Any strenuous hill climbing ride meant sore knees afterward, and sometimes during the ride itself. Lots of ibuprofen; not a lot of riding.

Then I moved into clipless, specifically Speedplay Frogs (now I ride the roadie oriented X-series as well). The knee pain issue just went away... and hasn't come back. 3K-4K miles last year. In this crowd that's not much, but for me... :banana:

Everyone's knee and hip anatomy is different, so keep that in mind.

[giordana93]

problem is often that when pain subsides, that does not mean there is not some inflammation still present which instantly gets worse on the bike. I assume you are truly just spinning in an easy gear (spinning a 53x17 or a fixie is not spinning). the other obvious thing to check is position of course. slightly higher usually lowers the stress on the front of the knee and you might be able to tolerate a little higher position if you're sitting more upright and never get down in a tuck, which you shouldn't be doing at this point. it might just take a few weeks off the bike to let the internal swelling truly dissipate. at this time of year, a few weeks away is much better than screwing up the whole season. and finally, don't forget to cover your knees up with tights or knee warmers if it gets to 65 or below. just because you CAN ride in shorts doesn't mean it's a good idea. your legs and knees need to stay warm because the blood will leave the knee joint very quickly and that is the opposite of what you want for healing. be patient, knees can take forever to heal, so if you gotta stay off the bike for a bit, do it now, not later

[rePhil]

I can sympathize. I went through knee pain a year ago December. I went to a Sports Ortho and MRI's were normal. He could'nt find the source but told me to do the "REST" thing along with actual rest. During that time I researched and read. Here is a good thread.

http://weightweenies.starbike.com/forum/viewtopic.php?t=11620&highlight=

I ended up taking 3 weeks off the bike and stretching several times a day, followed by lunges, and topped it by kicking / leg lifts, some weighted and some unweighted.
To my disappointment I had knee pain on my first ride, an easy 10 mile spin back, but then it disappeared.
I have been pain free since. Good luck.

[Michael Maddox]

I have occasional flare ups of my knees. I was informed--by more than one 'pod--that there really is no recovery, just periods of less trouble. I've found that IT-band stretches and an adjustment of my pedaling style--away from the "knees in" style I was coached to do and more toward a natural gait--have both helped me.

[shinomaster]

Several doc's told me I had it in highschool. Does one ever recover? Isn't it the beginning of osteoarthritis?

[Blue Jays]

My understanding is it's growth-related in nature. I had it bad as a very young teenager and the problem completely resolved itself in adulthood. No knee problems at all decades later.

[stevep]

move yr cleat all the way toward the back of the shoe on the sore side.
raise yr saddle 3-4mm.
try that. sometimes works.

if not... dont send me any $$$.

[CarlosContreros]

I developed chondromalacia when I moved from Florida
to Australia in 1982. I was a runner covering around 6-8 miles
a day on the Florida flats during a very hot(aren't they all!) summer....
then moved to Australia(which was winter time) so I found with the
temperature change I could easily run 12 miles a day.

Of course...the Sydney area is VERY hilly compared to Florida...and the
hills are what damaged my knees.

I had to have my left one scoped..and had to give up not only basketball
but running altogether as my right knee also developed problems.

That's when I started cycling...but have struggled with position lo these
many years..of course a big part is I don't consistently cycle...I might ride
a lot for 6 months.....then not start biking again until a year later!

My question?.....can you all share your leg-angle-percentage at dbc?

Mine is around 15 degrees...as I've tried to set my bike to the highest
range before my hips rock..but I get some serious hamstring pain while
riding.....and even some upper (rectus femerus area) leg pain as well.

I'm thinking maybe I should lower my saddle....maybe around a 20 degree bend.
And I do ankle...I'm not a toes-up peddler.

thanks!

[SadieKate]

Chondromalacia is essentially the disintegration of cartilage surfaces due to improper tracking of the kneecap but it has a variety of causes. You need to know the cause to effect any kind of long term solution.

Mine is caused due by genetic abnormalities in the alignment of the joint and foot angles. Prescription orthotics were the answer plus proper position, cleats, cadence, etc., etc., etc. Of course, I also had to fall while backpacking in the snow and turn a chronic condition into an acute tear requiring several surgeries, but that is another story and problem.

You need to find out the cause of the chondromalacia. Why isn't the tibia tracking properly? Imbalance of the muscles? Foot stance? Injury? Overuse? Bike fit? Cleat position? What?

Some anatomy and chondro info:
http://www.arthroscopy.com/sp05032.htm

Several Emma Colson articles which include knee issues (thanks to somebody on this site for the wonderful recommendation) so just read them all. It's worth it. I've considered subscribing to the magazine just to get her articles.
http://www.topbike.com.au/physio.htm

Get to the root cause of your chondromalacia and then you can determine treatment, recovery and prevention.

[Bob Ross]

"recover" ?

"heal" ?


Are you talking about surgery to treat chondromalacia, or the condition itself?

I was diagnosed with chondromalacia patella in both knees a dozen years ago, most likely brought on by a lifetime of crawling across stages and ballroom floors (I work as an audio engineer/technician, spend a lot of time on my knees running wires). Doctors prescribed physical therapy (which consisted of resistance exercises, electromuscle stimulation, and shiatsu) plus prescription orthotics in my walking shoes.

None of those improved the condition.

Ironically, cycling turned out to be the only athletic activity I could engage in without exacerbating the condition...or at least, that was true for the first year or two that I rode as a "serious recreational cycling enthusiast" rather than an infrequent commuter/utility cyclist. But now my knees are sore after a ride of almost any length. Post-ride icing alleviates some of the discomfort. And it's at least encouraging to realize that the pain I experience after an 80 mile ride with 6000' of climbing is still less than the pain I experience from stepping down of a curb when walking across the street.

But I don't ever expect to "recover" unless I decide to spend the rest of my life bedridden. Or undergo surgery, which opens up a whole 'nother can of worms for healing and/or recovery.

[Registered User]

edit....my post was stupid :)

[quattro]

So I was diagnosed with Chondromalacia Patellae in my left knee this week. I read the prior posts, but they are now almost 10 years sold, so I thought I would revive this thread.

I chipped the cartilage in my left knee 40+ years ago, had surgery to remove the chips and it has been fine for 44 years. Been riding for 45+ years, I'm now 59. had a professional fitting last year with a new bike and have been back in the last two weeks to review, ended up lowering my saddle 2cm, but now I think I need to raise it back up, about 1.5cm. I think higher takes pressure of off the knee cap. Rode 22 today, was ok, some discomfort around mile 15-17.

Taking omega 3, Turmeric, Glucosamine/Chondroitin/MSM in a liquid. I try not to take ibuprofen often, only if its reallly acting up, its a day to day discomfort thing. Yesterday it was really bothering me, today, knock on wood, its been really good!

Dr. suggested I look into Platelet Rich Plasma (PRP) therapy. Not covered by most insurance, have to check on mine. Wondering if anyone has tried PRP for their knee issues and if you had any positive results. Don't know if PRP existed for knee therapy 10 years ago when this post was started.

I have been riding all summer 4x a week and started having pain in July, got worse as the summer rolled on, now when I ride 25 miles at a 17.5-18.5 avg. MPH I start to get discomfort around 15 miles.

I'll be riding less heading into winter then only on the wind trainer 1-2 times a week until spring when I hope to pick it up again.

Any advice on what helps is greatly appreciated!
Thanks,
quattro

[josephr]

nvm

[Ralph]

When I was in my 40's and 50's (76 now), my knees hurt about all the time after riding. My orthopedic Doc said I had mild chondromalacia (sp). Probably riding about 75-100 miles per week then (was working).

I'm 76 now, and ride about 50% more than I did then.....with no knee issues.

Can't really explain it. Will say.....I use pedals with adequate float....VS those nailed-on cleats of years ago. I'm a lot better at setting my saddle height and fore and aft now, placing my feet/cleats on the pedal. I don't run both cleats exactly the same. Have a lot better understanding of bike fit for me (better than the highly recommended bike fit guy). I go to the gym 3 days a week, and do whole body strengthening exercises....particularly for the legs. BTW.....initially I used weights a lot lower than trainer wanted to start me (made sure no pain)....he didn't really understand my issues....and besides....I had plenty of time....wasn't doing anything else much. Making all the muscles around the knees stronger made a lot of difference. Weight lifting may not help younger cyclists much.....but it sure did me. So I did a lot of things that seemed to help.....couldn't say exactly which did the most....maybe leg exercises...or getting my saddle higher (about 1/2" then had to work on ankle flexibility.....so could pedal smoothly).

So sorry....no real help......but maybe you can rest until the pain clears up.....then approach this from all angles, meds, strengthening, rest, bike fit for you, and maybe just recognizing what you can do without pain. But my experience is riding thru pain does not help. Lot of Docs just think cycling and swimming is easy on the joints, they say that to all their patients, without really understanding your issues. Good luck.

BTW....Currently laid up with a repaired fractured fibula. Before I get back on the bike....I'll be back in the gym. That's first for me. Light weights while my leg heals.

[quattro]

Ralph, thanks for your reply and good information! I hope you are feeling better and back on the bike soon.

Best,
quattro

[Ralph]

One thing.....I had to mostly ignore the advice of the weight lifting guys around the gym. Trainers also.

For me.....and what helped the most.....if I could do a reverse leg curl several times at 60 lbs on the machine......I would only use about 30 lbs....and do it 25 times. rest and do it again, 3-4 sets. I never worked in pain. Some machines .....when I first started doing them.....I would use almost no weights. Now....for some things, I use free weights.....but lots of reps....at low weight. This 76 year old ain't impressing anyone at the gym with how much weight I can throw around. Some overweight old women use more weight than I do. LOL

And BTW....if you start a total program....if you get pain at 15 miles.....then stop at 14.....is what I would do. Good luck.

[mhespenheide]

Every person/case is unique, but here goes:

The chondromalacia that I've had came from running (in college, '91-'95). I had bicycled recreationally in high school, then signed up for cross-country. Metaphorically going from 0-60, I developed chonromalacia relatively quickly. After icing and advil for months, the only true solution came from prescription orthotics. I still work on keeping the vastus medialis muscles developed (in comparison to the quadriceps) so that the kneecap tracks properly.

On a bike, I prefer a pedal and cleat system that is completely free floating, like speedplays.

As I've tried to get back into running, I've also added in an "Aircast" system that pumps in cold water to switch in between cold compression and release, every two minutes. I do it for about ~1/2 hour on each knee as I'm surfing online or watching TV. It seems to help.

[11.4]

Quattro,

First of all, don't despair. It's frequently episodic and goes away, and even the worst can be ameliorated significantly so you can ride.

Chondromalacia is just a catchall descriptor for damage of any kind to the cartilage at the knee. It isn't used consistently to apply to any particular kind of damage, or particular bone interface, or anything else. That's why there are so many varying experiences with it.

You do want to figure out what brought it about -- the underlying predisposition. Is your knee arthritic? Is cartilage damaged in an accident? Does your knee not track like it should and thus induces excess wear on the cartilage surfaces? Do you have an aging issue (dehydrated joints, deteriorating cartilage generally, whatever)?

If it isn't straight arthritic and you didn't just shatter the knee at some point, odds are that you have an irritation problem related to wear, which in turn frequently means how the joint tracks. That can be bike position, lack of flexibility, change in weight, change in muscle strength, tight muscles or tendons (hamstrings, ITB, hip flexors, everything can contribute).

I'd start by removing a few variables. Ride very very lightly, easy low pressure spinning, for a few days or until you can get a basal level at which you can ride without exacerbating the problem. Then once you have that, begin serious flexibility and tone work -- stretching, extensive work with a foam roller everywhere from all the sides of your hips down through your calves, extensive massage of your plantar fasciae (underside of the arch of your foot), and so on. Just with that stretching and manipulation, you should start being able to increase mileage pretty quickly. Don't ease up at all with the flexibility and tone work -- that's going to be a lifestyle from now on. Miss one rolling session after a ride and become sore the next day, ride and then you're out for a month. Be religious.

Talk to an orthopedist (and use a knee specialist and one who focuses on athletes; many orthopedists look at an older patient and just try to enable you to handle a walker). Ask around among cyclists and local university varsity teams for some good names. They are likely to be found at a university medical center, or at least affiliated with one.

Fitters typically aren't going to be much help with this problem, in my experience. No offense, but they have a vision of how you're supposed to look on a bike but don't know what the inside of your knee looks like and how it interrelates with every other minor muscle in your lower extremities. You'll have to do this yourself. Apart from overdoing it, you can develop chondromalacia from a change in saddles, change in saddle position or tilt, anything that caused you to lose flexibility (even just riding in cold weather is good for that), change in cleat position, change in shoes or cleats, and on and on. Don't try to use patellar bands or any gimmicks to keep working out; solve the question of why it's happening instead. Shims and bands and things like that are like gimmicks to improve your golf swing. Plus, you are aging and also training and you should always expect, at any age and in any condition, to need a possible tweak in your position. My saddle goes down a centimeter or so in increments during the winter, then back up in the spring. My stem shortens in the winter, then lengths in the summer, and it drops almost a couple centimeters. My cleats move back on the shoes in the winter. And so on. Your body isn't a constant so there's no reason your fit should be. Unless you want to pay for a $400 fit every couple weeks, this is why you need self-awareness and optimize your own fit.

Consider asking the orthopedist for a steroid pack -- an injection plus a week of graduated steroid tablets -- to take the inflammation and pain down. You can't keep taking them, but use one to get started and see how much it helps, and potentially be able to do one if you have a ride of a lifetime coming up next year and you're having any residual problems (that's for something like three weeks in the Pyrenees, not for your basic annual century or the regional championships). Naprosyn will help most people and if it doesn't bother your stomach, two tabs every night can help keep the inflammation down. Let the orthopedist x-ray you, give you a CT or MRI, and give you that one single steroid treatment. If they want to inject you, cut you, whatever, walk away at this point. The statistics on chondromalacia surgery are dismal (for most chondromalacia medical treatments, for that matter) so you really want to take this on yourself. A love affair with your foam roller (I recommend the Grid 13 inch roller from Amazon, not cheap but works much better than your basic blue or black foam or EVA roller), tons of stretching (if you haven't stretched in an hour, you're behind), lots of water (if you haven't had a pint in an hour, you're behind), and not overdoing the cycling as you figure out what helps.

As you get better, get into some weightlifting. You get people who say that it'll ruin your knees, but your knees are almost certainly giving problems because the rest of your body isn't strong enough to handle what they're doing. Learn how to lift properly, which means a really good coach (your local Life Fitness coach does not count; you need someone very good with a lot of training behind them). I personally think your personal workout can be much more effective than spending a lot on physical therapy with your orthopedist, but you want to learn a lot about how your knee works (or doesn't) and want to keep meticulous records of what you've done and how it benefits you (or not). You're an experiment of one and trying to generalize you from a mob experience is not likely to succeed. Learn yourself. But do try out weightlifting. Most joint problems arise from weaknesses in the body and as cyclists, we are horribly prone to gluteal inactivation, hamstring imbalance, an extremely tight soleus muscle, problems with our hip flexors, and so on. Cycling is one of the worst sports for discouraging your important muscles from firing properly and you can't start young enough to address that: foam rollers (again), a 65 cm exercise ball, lots of planks and reverse planks and side planks, lots of stretching, gluteal activation exercises, and the like. If it sounds like you become a better cyclist by not riding and just doing gym exercises, sometimes that's the case. It's very much the case when you have pain such as characterizes chondromalacia.

I'm confident you'll find a path to redemption and happiness in life. Be diligent about it and be patient. Get that imaging diagnosis so you know just what you're dealing with and then start analyzing your own strengths, bike fit, and so on. It works.

Edit: Damn. That was wordy.

[Bob Ross]

nm

[thwart]

Consider asking the orthopedist for a steroid pack -- an injection plus a week of graduated steroid tablets -- to take the inflammation and pain down.

Generally good stuff, except for this part. NSAID's (non-steroidals) like naproxen have pretty much replaced Medrol Dose-paks for overuse inflammatory conditions... and chondromalacia patella (the old latin name for patellofemoral dysfunction) is a classic overuse injury. Steroid injections are still frequently used, but typically not a first-line treatment.

Ralph has some good advice... he usually does.

See a Physical Therapist. They tend to do very well with this particular problem. Pick one with a sports-related injury interest.

[Ti Designs]

Learn how to pedal...


The other day one of the other fitters at my shop was working with a guy who had all sorts of knee pain. He asked if the he spins a small gear or pushes a harder gear and the client admitted that he pushes a hard gear. In most people's minds that's what causes knee problems.

My coach used a 44x18 for 99.9% of his riding over 50 years, and he didn't exactly avoid hills. I ran my Florida gearing (44x56, 11-21) for most of last season in the Boston area. Very few of my coaching clients run compact gearing, including the 2 that are in their 80's. Clearly the common advice that pushing harder gears is bad for the knees isn't working here...

The problem is you learned how to walk first, any you never really learned how to pedal, you just borrowed the skill set from walking. When you lift your body weight (which is what you do all day long) you fire the vests lateralis (the big muscle in the quad) - thats the motor skill you practice the most in life. So naturally, when you push on the pedal you do the same thing. The connective tissue goes over the patella and attaches near the top of the tibia. Tension on that connective tissue pulls down the patella and creates sheer. That plus range of motion causes knee pain.

My solution to this is to teach pedal stroke - how to use the right muscle at the right time within the pedal stroke. The problem is that I'm one voice in 10,000. If everybody else says that pushing big gears is damaging to knees and one guy says "Look at the mechanics of the system, it's not the force, it's how it's generated", they're labeled an idiot. Go back and look at the rest of this thread, or any other thread about knee pain, tell me that's not the case...

To me, chondromalacia is the rare case where being stupid is painful. I love that idea!

[thwart]

To me, chondromalacia is the rare case where being stupid is painful. I love that idea!
Ed makes some excellent points.

But like many things, the issue is a bit more complex. Good pedaling technique alone is not the answer for some of us. There is anatomic variation (surprise... we're not all designed the same) that can increase your odds of having difficulties with this.

Google 'Q angle'... although recently it's thought that there are other factors that may be much more important, such as overpronation of the foot (... if this applies to you, think of some arch support in your cycling shoes) and weakness of the hip abductor muscles (the ones used to move one leg away from the other).

[quattro]

Thanks everyone for taking the time to provide your thoughts and suggestions.
A few more details about my issues: It's definitely related to arthritis diagnosed by X-ray and MRI, have been to a sport orthopedic Dr. , I'm doing PT to build muscles , hip flexor...Had a cortisone shot, lasted for 10 days. Take ibuprofen minimumly. Had a total hip replacement on right hip 5.5 years ago, have weird angles where femur attaches to my pelvis, been wearing orthotics for 20+ years, cycling shoe specific for last 5 years, have a number of foot issues. I'll be touching base with Ed to schedule a time to meet and look at my pedal stroke etc., fortunately I live not to far from BWW.

Haven't heard anyone chime in about experience with PRP, anyone, Bueller...

Thanks so much for the wealth of knowledge.
quattro

[Ti Designs]

But like many things, the issue is a bit more complex. Good pedaling technique alone is not the answer for some of us. There is anatomic variation (surprise... we're not all designed the same) that can increase your odds of having difficulties with this.

Google 'Q angle'... although recently it's thought that there are other factors that may be much more important, such as overpronation of the foot (... if this applies to you, think of some arch support in your cycling shoes) and weakness of the hip abductor muscles (the ones used to move one leg away from the other).

Yes, quality control for humans sucks...

You bring up the reasons I can't separate bike fitting with pedal stroke coaching, you need both. Understanding how the human body interfaces with a bike isn't as simple as I often make it out to be. Take the rotation of the hip for example, google FAI and you'll find the condition where the hip socket limits range of motion. It's not a question of having FAI or not, the pedal stroke hits end range of motion at the top of the stroke, and that crank doesn't move side to side to accommodate the shape of the hip socket. There's always going to be some lateral force.

Force is a hard thing to explain to people. They can see movement, they get that. They often mistake one for the other, they see they pedals go around in a circle and assume the force generated by the rider is doing that - I've had a bunch of MIT students insist this was the case. Force is what causes injuries. In my own study of FAI I built a set of pedals with lateral strain gauges. What I learned is that the pedal stroke uses more range of motion than the body was really designed for, and there's need for different pedal spindle lengths to get people to the center of their tracking range. I've also spent the last few years fighting with various pedal companies, trying to get them to make different length spindles.