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  1. #1
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    Chondromalacia Survivers...

    Chondromalacia, who has it? What do you do about it? I've recently been diognosed with Chondromalacia in both knees and it's definately affected my cycling abilities. It's kind of depressing, but I'm hoping to overcome it without surgery. Has anyone else faced a similar obsticle? If so, any info regarding it would be much appreciated by me.

    Thanks.

  2. #2
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    22 years now

    I've had it for about 22 years now and really bad the past six years. A total of seven surgeries, five on one knee and two on the other. Lots of ice, Motrin, Tylenol Arthritis, an occasional prescription pain reliever, and pulling up with clipless pedals rather than pushing down while climbing. I basically get one big ride per week, followed by a day of taking it easy and icing them all day. Occasionally I can get a shorter ride in mid week. I also take glucosamine/chondroitin supplements and wear knee braces all the time, including biking. It's pretty frustrating. Hopefully yours has not gotten that bad yet. Discontinue all impact activities.

  3. #3
    Nat
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    I got diagnosed with it 18 years ago. It bothered me for several years but somehow no longer does. I'm not sure why.

  4. #4
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    I was diagnosed with it a year and a half ago. I had started playing in pickup basketball games back in the spring of 2005. I first developed patellar tendonitis which went away after a while. I started playing again and it started to hurt, but this time it was a slightly different pain. That's when I was diagnosed with chondromalacia. The pain was really bad at the time I went to see my doctor. I couldn't even drive a car for any length of time or sit in a chair with my knees bent without it hurting.

    My doctor gave me some physical therapy exercises to do at home and told me to take 2 alleve, 2 times a day to help with the swelling underneath the kneecap. After a while I just noticed it getting better. At this point my knees feel great and can do just about anything except run for any great distance. Mountain biking doesn't cause me anything but a slight discomfort the day after I ride and only in my left knee.

    I still take the alleve and I still do my exercises as well. Hopefully, someday it will go away completely. I'm just thankful that it's got to this point. Especially after hearing how bad it is for some of you.

    JP

  5. #5
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    I was diagnosed with it about 3 years ago when I went to the Dr. because of ongoing right knee pain. I take Glucosamine/Chondroitin. The Dr. also gave me some physical therapy exercises and stretches to help. These did help, but I noticed the biggest change when I started doing weight training on my legs. A combination of basic squats and stretching has made my knee feel better than it has in years. I started slowly and still use very reasonable weight levels to avoid over-stressing the knee.

    I am just getting into biking since I just can't jog more than once or twice a week. I am hoping that the biking will be a little easier on the joints long term.

    (Edited to remove reference to leg extensions. The consensus seem to be they are not a good idea although I have had no problems doing them occasionally with light weight. I wouldn't want anyone doing anything harmful based on my post!)
    Last edited by johnm65; 02-12-2007 at 07:19 AM.

  6. #6
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    Are you sure that is the correct diagnosis? I was diagnosed with it and did all sorts of things - except surgery. After 5 years of no real gains, I finally went to see a sports gait specialist who then correctly diagnosed my problem as an overtight IT band, and not Patella-femoral syndrome ( the other name for chrondomalacia) The cure? A serious stretching program specific to my issue, and a prescription shoe.

    moral of this story is that you need to be sure.

    Formica

  7. #7
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    Yeah as per the earlier post I guess theres differences between chrondo(I can't spell the rest!), petalla-femoral problems, tight IT band etc. I'll just call it sore knee-caps. And ditto the earlier post weight-training for me has really made a huge difference. Basically squats and single leg presses. To me initially that seemed counter-intuitive. However it seems that a fair number of people have problems with the knee-cap not tracking correctly, its very common to have the outer quadricep muscle quite a bit stronger than the inner particularly in cyclists. This then causes the knee-cap to track to the outer side of the knee more than it should. What is needed is to isolate and strengthen the inner quadricep muscle which is not easy to do. Leg extensions do a bit, but the reality is its the squats and leg-presses which are highly effective. Your foot should be angled a little out when doing these to bring a bit more isolation to the inner quad.
    For me the other thing I have worked out is that having my saddle too high or low is a recipe for having this issue come back. It has to be way low to cause me any issue, but recently I was doing some DH with my saddle way low and peddaling hard and that was not good for my knees even though it was only a little over 5 minutes. I also commute to work by bike. I have to have my saddle just a little lower than optimum for power, I find if have the saddle high, I feel a little clicking on the outside of my knee, that I will find I will regret if I don't get the saddle back down. OK thats a good ramble! but thats my experience, take what you will from that and good luck.

  8. #8
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    Call it what you want...

    I believe chondromalacia is the oldish school term for what they call p-f syndrome now.

    I've had mine for a long time and it's getting worse slowly but surely. My orthopedo told me what he would do IF I said let's do the surgery is to scrape the underside of the kneecap and possibly do the 'lateral release' also so the kneecap tracks better. Lord knows what kind of pieces parts are floating around in my knee joints to.

    I would be careful with the exercises you do for your legs, there was a flame war on here a while back about that very subject which led me to ask my physical therapist a couple of weeks about that issue. The upshot was DON'T do any leg EXTENSIONS! It's really bad for your knees with this affliction. If you can afford to see a physical therapist do it because they have some slightly goofy but really specific exercises you can do besides just hitting the weight machine, it actually made a lot of difference for me. Basically what you need to have happen is for the VMO muscle to fire first which makes the kneecap track more correctly centered.

    If you have access to it, have your bike(s) professionally fitted at a sports medicine clinic to. I had my road bike fitted at the Boulder Center for Sports Medicine with the super whizbang video fit that has made all kinds of difference. My insurance actually covered it as a PT visit! I get a little soreness after riding but nothing major right now, it's other things that make my knees hurt a lot. At this point also my knees crunch like celery when I bend them. It's a fun party trick!

    I'm curious to know how many of you guys (and Formica) have had your q-angle measured to? Mine is excessive at about 16 degrees but for men it's normally about 10-12 so this also adds to my misery. Also, if you're an over-pronater (like me, ugh) it will also add to the symptoms that cause chondromalacia.

    Guess I sort of rambled there but hopefully something was useful!
    Sorry what?

  9. #9
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    Hey thanks for that info Bullet Bob. I chucked the knee extensions into my routine a few months back just because I thought it might be a good idea. I only do a tiny amount - 2x5 reps each leg on light weight. I was doing more but my knee was hurting again, and on a hunch I pegged it back. I think I will stop them now.

    I have been doing leg presses and squats for about 8 months. It was after doing the leg presses for some time and squats that my knee got a lot better, but I hadn't corellated the two things until I read the recommendation by a physio on another forum somewhere.

  10. #10
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    in the hip

    I had to have my hip replaced, wow does it feel better now.I first had it scoped to see if that would help.But it was bone on bone and there is no fixing that had, so I had to heal it with steal.

  11. #11
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    Well I went to a sports medicine specialist and had some x-rays taken. P-F syndrome. I guess my bad over-pronation of the ankles caused me to overuse my outer quads for years and years, while my inner quads went to seed... so now when I bike my knee doesn't track like it should. Solution? Physical Therapy, some serious stretching, and eventually some weight training. I'm pretty optimistic though. I'm only eighteen so I've still got plenty of cartilage left (hopefully). My inner quads are pretty much dead, but the exercises are helping tons. I'll let you know how it's going in six to eight weeks. Thanks for all the input guys!

  12. #12
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    Quote Originally Posted by DistantFellow
    Well I went to a sports medicine specialist and had some x-rays taken. P-F syndrome. I guess my bad over-pronation of the ankles caused me to overuse my outer quads for years and years, while my inner quads went to seed... so now when I bike my knee doesn't track like it should. Solution? Physical Therapy, some serious stretching, and eventually some weight training. I'm pretty optimistic though. I'm only eighteen so I've still got plenty of cartilage left (hopefully). My inner quads are pretty much dead, but the exercises are helping tons. I'll let you know how it's going in six to eight weeks. Thanks for all the input guys!
    Your a young person and that will certainly work in your favor for a good healing and recovery process. I wish you good luck in getting better soon.

  13. #13
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    So here's the update I promised...

    Almost nine weeks since my last long bicycle ride. I started physical therapy about eight weeks ago, I refrained from riding nearly the whole time, I consistantly do my exercises and stretches, I had a "varus wedge" added to my carbon orthotics, I've shortened the cranks on my bike and pushed the seat back... Commuting to school (about five miles) just two days this week really hurt'em... I don't know what to do, I'm getting pretty discouraged. I've spoken to several docters, physical therapists, and bike specialists... what more can I do? Is surgery the next step? It just sucks because I'm young with no knee injuries or anything of the past.
    Last edited by DistantFellow; 04-06-2007 at 02:59 PM.

  14. #14
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    Don't get discouraged. It took me months to feel better. Keep at your physical therapy and stretches and consult with your doctor.

  15. #15
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    Thanks for the ecouragement Jeremyp111. I'll keep at it and have it licked eventually.

  16. #16
    GMM
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    Ask your doctor about Synvisc injections. It might work for you.

    I started out with a diagnosis of chondromalcia years ago, and then osteaoarthritis. My knees are farily bad, but I think had I addressed the problem in a manner as focused as yours, I would be in better shape today. Unfortunately, I had some poor medical advice-- "Just take motrin and it will eventually go away" words of "wisdom" instead of addressing underlying issues (stretching, muscle balance & strength, etc.).

    In any event, time off your bike can be real depressing for sure. I was literally off my bike for 2 years. I spent lots of private (non-insured dollars) on PT, and eventually I tried synvisc which worked for me, although it doesn't work for everyone. I do also take glucosamine/chondroitin religously and keep up with stretching, especially my IT band.

    Good luck.

  17. #17
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    If...

    Quote Originally Posted by DistantFellow
    So here's the update I promised...

    Almost nine weeks since my last long bicycle ride. I started physical therapy about eight weeks ago, I refrained from riding nearly the whole time, I consistantly do my exercises and stretches, I had a "varus wedge" added to my carbon orthotics, I've shortened the cranks on my bike and pushed the seat back... Commuting to school (about five miles) just two days this week really hurt'em... I don't know what to do, I'm getting pretty discouraged. I've spoken to several docters, physical therapists, and bike specialists... what more can I do? Is surgery the next step? It just sucks because I'm young with no knee injuries or anything of the past.
    ...they hurt that bad even on short rides and PT doesn't help, it might just be time to get it done. It's getting there for me at least on the left knee. I'm hoping to make it through the summer without anything going seriously wrong besides more pain probably. Fortunately, there isn't anything structurally wrong with our collective knees so you can keep going as long as you can suffer through the pain. You decide where the limit is.

    If nothing works for you it might be time to have it scoped as annoying as it will be to be off the bike for 3 months afterwards but in the long run you'll most likely be better off. Hopefully you're doing at least a couple of exercises to work your VMO, that's the important muscle to get firing at the right time.

    The surgery & recovery isn't nearly as bad as a ligament replacement for example so if you did it now you'd be good for ski season anyway. Not much help probably but I'm going mostly on my situation so your mileage will no doubt vary!
    Sorry what?

  18. #18
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    Just curious...

    Quote Originally Posted by GMM
    I do also take glucosamine/chondroitin religously
    how much the G/C is doing for you and are you taking anything else with it? I've kicked around trying the stuff but it's so damned expensive and there seems to be pretty conflicting information and studies about how much and if G/C actually does any good.

    I'm interested in that Synvisc you mentioned though so I may give my ortho a call. Thanks, I hadn't heard of that before!
    Sorry what?

  19. #19
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    Oh man you are lucky!

    Quote Originally Posted by DistantFellow
    Chondromalacia, who has it? What do you do about it? I've recently been diognosed with Chondromalacia in both knees and it's definately affected my cycling abilities. It's kind of depressing, but I'm hoping to overcome it without surgery. Has anyone else faced a similar obsticle? If so, any info regarding it would be much appreciated by me.

    Thanks.
    I just checked your profile and it says you're in FtC so you can definitely get some help!! Sorry I didn't look before!

    I guess I mentioned in my first post above but you REALLY should bring your bike(s) down to the Boulder Center for Sports Medicine and have Andy and his guys do a video fit for you. They did that for me a couple of years ago and it helps immensely. The put little reflectors on you then film you peddling to make little stick figure movies and get the measurements they need to fit your bike correctly. They also input your 'issues' in a program that figures out how your bike should be set up down to the millimeter.

    BCSM is obviously a sports medicine clinic and part of the Boulder hospital so my United Health Care insurance covered the visit as if it were a pt visit which it mostly was because they did workup on me and the assorted issues I have.

    If you can swing I'm certain it would make a huge amount of difference for you.
    Sorry what?

  20. #20
    GMM
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    Quote Originally Posted by bulletbob
    how much the G/C is doing for you and are you taking anything else with it? I've kicked around trying the stuff but it's so damned expensive and there seems to be pretty conflicting information and studies about how much and if G/C actually does any good.

    I'm interested in that Synvisc you mentioned though so I may give my ortho a call. Thanks, I hadn't heard of that before!
    G/C definately seems to help me, although incrementally, and it is expensive. I have had a very good ortho tell me it's a waste of money, and others have said more recent studies seem to show benefits. They give it to animals for arthritis and there is no placebo effect there. I started taking it when a jogger friend, who can only be described as a real skeptic, told me it made a significant difference in his quality of life. Personally, I am a believer.

    Synvisc is a different gig altogether. For me, it wasn't an incremental change. It was monumental-- literally got me back out on the trails. As a disclaimer, my current ortho, who I really like, said he has some patients like me that swear by it, and others for whom it doesn't work. Insurance companies have a pretty signficant protocol before they will reimburse. I had all the prequisite conditions, and had been in physical therapy for a very long time. I have taken synvisc every year for the last 4 years.

  21. #21
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    One thing that I did not see recommended in these posts that a couple of different PTs have recommended to me...

    Taping the kneecap during exercise so that it is pulled over slightly; helping fire the VMO muscle and ultimatley strengthen it. I would see a PT before doing this, and have them show you how to do it.

    As stated in previous posts, the problem is a combination of things, and you need to work on all aspects that can cause the patella to track wrong. I've just recently been diagnosed with this, and mine started AFTER having my knee scoped for another problem. The VMO became so weak after the surgery and rehab complications, that I now have this problem. I've started lifting weights (leg presses...I was also told DEFINITELY NO LEG EXTENSIONS!!!), but it's too early to render a verdict. I would also suggest a foam roller to help stretch, massage and loosen the IT band. I'm also looking at the possibility of orthodics.

    I would suggest trying all other means possible before surgery.

  22. #22
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    Went back to the doc today, so here's the verdict.

    Physical Therapy has been successful in strengthening my left knee (inner quad), and loosening up my IT Band in that leg as well... unfortunately the inner quad in my right knee is chronically inflamed and showing signs of minor atrophy. The last eighty mile ride I did before the start of physical therapy really did it in. Any exercise thereafter only continued to irritate the muscle. So now it's prescription anti-inflammatory drugs, icing four times a day, and a knee brace for three to four weeks before I begin therapy on that leg once more.

    So it's definately going to take a while. In the meantime I'll be looking into a Boulder Center for Sports Medicine bicycle fitting, and doing a lot of climbing.

    As always, thanks for the input. I'll post an update in a few weeks. Hopefully I'll be riding again by June...

  23. #23
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    Well, it's been three weeks since my last post. I went for a little spin around the hood and my knee's now stiff and swollen. Fuge. Well Mr. Bicycle, it was nice while it lasted. Maybe someday we'll see each other again.

  24. #24
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    Quote Originally Posted by DistantFellow
    Well, it's been three weeks since my last post. I went for a little spin around the hood and my knee's now stiff and swollen. Fuge. Well Mr. Bicycle, it was nice while it lasted. Maybe someday we'll see each other again.
    Sounds like you should look into surgery, since you've tried everything else, and that
    doesnt seem to have worked. Have you had an MRI taken ? What did it show ?

    I've had a few injuries to my right knee and have had on and off problems with my knee
    since a really bad fall where I impacted the kneecap a couple years ago.
    I haven't been biking for a couple months since I sold my bike, and the problems have
    increased. It doesnt track right and hurts at weird times, like if I'm sitting too long.
    Strange. I recently had an MRI and the only thing that showed up was trace fluid under
    the kneecap.

  25. #25
    POG
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    I've had a diagnosis of chondromalica for over 15 years. Orthopod told me: "when people get to be your age..." and that was when I was 35ish!!! Over the years I have sought out additional opinions and they all agreed I was getting older. I had a flare up last fall and thought I was going to finally have to give up cycling entirely. I am pleased to report that after 8 months of semi-rest and the adoption of a modified pedaling style I am now 100% pain free! The bad news is I can't produce any power with the modified pedaling style and it makes my HR skyrocket but at least I'm riding.

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