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Persistent chondromalacia in knee

post #1 of 21
Thread Starter 
I previously wrote about this. Unfortuanately, after 2 months of PT, it's showing no signs of going away. Lucky. Ortho is talking about injecting either cortisone or synvisc(lubricant for joint). Unless skiing somehow fixes it, which I doubt, I am looking at having to do something to be able to ski rest of season, not to mention tennis, mt. biking, etc. Any experience with this? Thanks
post #2 of 21
my wife got this after birthing our first child. she's a very experienced runner and tele-skier. boy that birthing process is funky 'cause it changes the woman's body sometimes in lasting ways.

her pt showed her how to physically manipulate the knee cap with her hands to help it get back in the correct position.

it took her about 1 month to correct.

funny that the ortho got it all wrong and told her she'd never ski or run again. pt laughed and said it's real simple ...just do "this" and you'll be back in bidiness in no time at all. pt was right - doc was wrong.

ymmv
post #3 of 21
I had a real bad episode from Thanksgiving (hiking in the Grand Canyon) until mid January one year. Doctor said rest it, don't irritate it. Twice I thought it might be good enough to do some XC so I went to the trails, skied about 2 km and went home.

Finally a friend came out and was staying at winter park for Texan ski week. I figured I could ski one legged with Texans. I took a large dose of asprin, and skied the first run with all my weight on one leg, in pain every time I weighted the other one. Next run was better. It kept getting better all day, and after lunch it did a bump run, slamming the moguls in disbelief. I have no idea what happened that day but it was gone.

A few years ago I had a bit more. Doctor told me to build up the vastus medialis muscle. She agreed skiing was a good way to do that, so I upped my skiing and it gradually went away.
post #4 of 21
Quote:
Originally Posted by newfydog View Post
I had a real bad episode from Thanksgiving (hiking in the Grand Canyon) until mid January one year. Doctor said rest it, don't irritate it. Twice I thought it might be good enough to do some XC so I went to the trails, skied about 2 km and went home.

Finally a friend came out and was staying at winter park for Texan ski week. I figured I could ski one legged with Texans. I took a large dose of asprin, and skied the first run with all my weight on one leg, in pain every time I weighted the other one. Next run was better. It kept getting better all day, and after lunch it did a bump run, slamming the moguls in disbelief. I have no idea what happened that day but it was gone.

A few years ago I had a bit more. Doctor told me to build up the vastus medialis muscle. She agreed skiing was a good way to do that, so I upped my skiing and it gradually went away.
Building up the vastus medialis muscle is a way to prevent lateral tracking of the knee. If that is the issue causing your knee problems, then skiing will definitely serve as physical therapy for you knee. But if it is not, then skiing will make the problem worse. That had to be the most fun physical therapy ever, lucky you.
post #5 of 21
I've found telemark skiing to help resolve PF syndrome and surely it will build vastus medialis. My experience is anecdotal, but I thought I'd chime in after reading newfy's post.
post #6 of 21
Thread Starter 
I was afraid that skiing would aggravate the symptoms, but surprisingly, if anything they seemed better. I'm now back and have decided to become more active and see if that will help. We'll see. One thing I have learned is that sitting for long periods with knee bent definitely aggravates it. I have 4 more ski trips this year. maybe that will be the PT that works.
post #7 of 21
Quote:
Originally Posted by Maui Steve View Post
One thing I have learned is that sitting for long periods with knee bent definitely aggravates it.
Isn't that why it sometimes is referred to as "Moviegoers knee"?
post #8 of 21
Quote:
Originally Posted by Maui Steve View Post
I was afraid that skiing would aggravate the symptoms, but surprisingly, if anything they seemed better. I'm now back and have decided to become more active and see if that will help. We'll see. One thing I have learned is that sitting for long periods with knee bent definitely aggravates it. I have 4 more ski trips this year. maybe that will be the PT that works.
I think we're on to something here! Glad to hear skiing is a cure,not a cause for you.

I believe it it has worked for me in two ways: When I cured two months of pain in one day of skiing, it had to be an alignment and tracking issue. I'm sure the right PT could have figured it out and come up with some exercises and stretches to do the same.

The longer term cure of building the Vastus medialis is another skiing benefit.

No matter how fit I am, long airplane rides are death. A trip to Europe I get to limp all the way to baggage. Asia, all the way to the hotel. Those aches always seem temporary.
post #9 of 21
never heard of this but I def have issues if my knees are bent more than 10 mins or so.

Anyway, I figure shedding a few pounds would help - working on that one
post #10 of 21
The VMO (Vastus Medialus) isn't going to be strong enough to resist the forces that are acting against it to correct things. This is old school to reccomend strengthening the VMO. You would be better off to correct tracking issues by looking at what is causing the problem to begin with, and it's not VMO weakness. Most likly the glutes need strengthening to correct these sort of tracking issues. Check into hamstring strength and hip external rotator tightness as well. Treat the cause and not the symptom.

Of course, this all depends on the actual condition of the knee. Safe to say working on your VMO isn't going to do much. It's too small a muscle to resist the forces causing the tracking issue.

Find a PT or ortho doc who is up to date on things, and you'll be better off.
post #11 of 21
I have the same problem!! As a former racer and collegiate gymnast, I have had six knee surgeries.... three on each side. I am in the medical field and know a fair amount of Synvisc, which is injectable Hyaluronic Acid (H.A.) to assist damaged indoginous synovial fluid (lube) in major joints. This is good stuff. It's an interarticular injection into the knee joint that provides significant pain relief.

Actually some, albeit scant, clinical data shows oral forms of H.A. is helful. You can find H.A. capsules over the counter at most nutrition stores. Ask about and research which brands may be better "pharmaceutical grade" forms. Synthetic H.A., oral or injectable, is actally made from rooster combs of all things, or through bacterial fermentation. It's FDA indicated for osteoarthritis (O.A.), but it's being used by docs for lots of related disorders. Hope this helps.

-Dan
post #12 of 21
Quote:
Originally Posted by NE Racer View Post
This is old school to reccomend strengthening the VMO.
Find a PT or ortho doc who is up to date on things, and you'll be better off.
My "old school source" is a young, Stedman trained US Ski Team Pool Orthopedic surgeon. Former racer, married to a former US Team member, and a personal aquaintance who would not BS me. Who would you suggest?
post #13 of 21
newfydog-

What condition are they treating, and what else is part of the rehab program?

Isolating the VMO has proven difficult to do, and there is a lot of research to back that up. While the VMO is a part of helping medial tracking issues, my point is simply that there are other things going on. The VMO issues are also usually part of overall quadriceps weakness, and you skiing could help to address that.

The knee is a 'dumb' hinge if you will, and many of it's problems come from the highly mobile joints right above and below it- the ankle and hip. You have to address what else is going on contributing to the condition other than just one hard to isolate, not very big muscle. That was all I'm saying. I'm pretty sick of seeing some rehab programs just addressing the VMO like was prevalent in the past without looking at the bigger picture. It's not enough in it's self.

Your doc is probably great. I don't know anything about your knees, and I'm not going to second guess her. I am sure she was doing other things to address your knee as well. My point was only that the VMO in it's self is generally not enough to get anything done to address tracking issues. Google it if you don't believe me. :
post #14 of 21
http://forums.epicski.com/archive/in...p?t-56869.html

There are several 'philosophies" about VMO weakness and lateral tracking. The quadriceps is is 4 parts. Just worry about the VMO and VLO (vastus lateralis obligue). With an injury you basically try and avoid using your knee because it hurts. This causes tightening of your hams, calf, hip external rotators and quatrus lumborum from limping usually. So, stretch those muscle groups. The quad becomes weak and the VMO is significantly smaller than the VLO so, the patella "track" to the outside "lateral." The back of the patella is V shaped so it rides up on the lateral femoral condyle on the arthritic cartilage.

So. basically you are disagreeing and agreeing at the same time.

It is impossible to strengthen the VMO alone. You can try and emphasize the VMO but you will still recruit the VLO. Seek to bring down the irritation first. If you continue to aggravate the condition it will become chronic. Use ice and look into a brace. I like one called a Cho pat strap. This essentially takes the quads attachment to the tibia, and redistributes the force above the patella. This will give the knee a chance to heal and bring inflammation down. At this point...If you load and compress the patella by skiing it will aggravate this problem. Guaranteed.
post #15 of 21
Johnnys Zoo-

Well said. You put my thoughts more articulately than I was able to here.
post #16 of 21
Thread Starter 
As I said earlier, skiing seemed to be ok. However, I went on a small hike yesterday which involved some downhill and it got aggravated. My PT didn't just concentrate on VMO, but also stretching and strengthening of quads. Any thoughts on injection of cortisone or Synvisc. Just not sure what to do at this point. Thanks for thoughts.
post #17 of 21
Walking downhill or down stairs is bad for this condition. Because you are lowering yourself, all your weight is on a bent knee. Avoid that. Just my opinion.
post #18 of 21
Quote:
Originally Posted by Johnnys Zoo View Post
http://forums.epicski.com/archive/in...p?t-56869.html

There are several 'philosophies" about VMO weakness and lateral tracking. The quadriceps is is 4 parts. Just worry about the VMO and VLO (vastus lateralis obligue). With an injury you basically try and avoid using your knee because it hurts. This causes tightening of your hams, calf, hip external rotators and quatrus lumborum from limping usually. So, stretch those muscle groups. The quad becomes weak and the VMO is significantly smaller than the VLO so, the patella "track" to the outside "lateral." The back of the patella is V shaped so it rides up on the lateral femoral condyle on the arthritic cartilage.

So. basically you are disagreeing and agreeing at the same time.

It is impossible to strengthen the VMO alone. You can try and emphasize the VMO but you will still recruit the VLO. Seek to bring down the irritation first. If you continue to aggravate the condition it will become chronic. Use ice and look into a brace. I like one called a Cho pat strap. This essentially takes the quads attachment to the tibia, and redistributes the force above the patella. This will give the knee a chance to heal and bring inflammation down. At this point...If you load and compress the patella by skiing it will aggravate this problem. Guaranteed.
Which cho pat? There are a couple of different kinds.
post #19 of 21
PM sent.
post #20 of 21
I'd like to clarify one thing on the Cho pat brace. It really isn't a brace. It is more like a "resting splint." The largest problem I have with active, athletic type people is getting them to slow down. If the knee is swollen, hurts, you need to bring the inflammation down first. If it flares up you need to bring the irritation down again, and again. Repeated injuries make it chronic. Chronic conditions will start to flare up for 'unknown' reasons. Sometimes people never recover from these chronic flare ups.

That is why bringing down the irritation level is key.

I'm sorry but the best thing is to give up the sports for a while, bring the irritation down, and gradually, slowly bring your strength and flexibility back up.

You may lose some play time in the short term. The long term pay off is worth it.:
post #21 of 21
I also had to stretch the IT band in addition to strengthening the VMO for a similar condition.

Just my .02. It's helped.

JaneB
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