Chondromalacia recovery

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Chondromalacia recovery

Postby scottyj » Tue Jun 02, 2009 1:38 pm

Hi people, I am freaking out about not being able to cycle again after being diagnosed with Chondromalacia or Patella Femoral Syndrome. Has anyone else recovered from this OK to keep riding? Please post how your recovery went and the best things to do. Need some encouragement here.

For those who haven't had it before, it basically hurts generally under kneecap and gets stiff and painful sitting down or putting it under load. In my case I had a new set of cleats (bad cleats) for my SPD's which I couldn't get tight and which drifted around bringing my knee tracking off line. I adjusted it many times but seems the damage was done due to the high paced and relentless nature of the ride, 2 days of metric centuries (don't want to fall of the back of the pack all the time).

If you have phillips heads on cleats, ditch them and get allen key dome heads (stainless) from a bolt shop - more secure (would have saved my fricken knee!).

Any encouragement welcome.

Thanks. Scott J
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by BNA » Tue Jun 02, 2009 1:53 pm

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Re: Chondromalacia recovery

Postby twizzle » Tue Jun 02, 2009 1:53 pm

Yep - I had that two years ago (well before I tried racing). I took lots of time off the bike, anti-inflammatories, fish oil and improved the saddle position. Knees have been an on & off problem for me until recently when I added a 20mm spacer to the drive side pedal and switched to SpeedPlay Zero pedals. I can't wait for Crit season to start, because I'm able to train much harder now than I was before. :twisted:
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Re: Chondromalacia recovery

Postby familyguy » Tue Jun 02, 2009 3:05 pm

I took up cycling again due to chondromalacia. My kneecap tracks too far towards the outside of my knee, and has worn the back of it against my femur. Basketball had knocked my knees about for close to 20 years, and running began to hurt. I had the classic 'sitting still pain'. I have had physio for it, which was basically treating an over-tight ITB (muscle from hip to outside of knee), and strengthening the inside (VMO?) to make the kneecap track centrally. Loaded and unloaded squats on a 25 degree angled board (angled towards your toe so your foot is at an open angle from your shin) were suggested, but I didnt find them doing a heck of a lot. Stretches for every leg muscle have helped.

Personally I dont like SPD's a lot for intense or long distance use, as they dont stop the outside of my foot from tilting outwards and putting strain on my knee. Maybe SPD's with a platform edge that held your foot flatter might help?

My Look delta's are great cause they feel solid and dont let my ankle roll sideways. I have slotted screws and they're plenty tight.

Jim
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Re: Chondromalacia recovery

Postby elantra » Tue Jun 02, 2009 4:59 pm

scottyj wrote:Hi people, I am freaking out about not being able to cycle again after being diagnosed with Chondromalacia or Patella Femoral Syndrome. Has anyone else recovered from this OK to keep riding? Please post how your recovery went and the best things to do. Need some encouragement here.

Thanks. Scott J


Hi Scott.
I had chondromalacia affecting my left knee many years ago.
I dont know exactly what caused it but i suspect it did have something to do with foot position and saddle position.
But also before then i had ruptured cruciate knee ligament from rock-climbing as a teenager so this might have contributed.
My advice to you would be to get someone knowledgable to review your foot and saddle position.
Also take it easy for several months, no strenuous cycling, only easy rides, use low gears or get out of the saddle for climbs (or best, avoid them!)

Make sure you have an MRI scan of your knee :!:
I presume there is an MRI scanner in Cairns, you need a referral from your GP
be warned MRI scan of the knee will cost you about $ 200
There is no medicare rebate unless it is ordered by an orthopaedic surgeon, and it might cost you almost $ 200 to see the ortho anyway
Let us know how it goes, and do not give up cycling entirely.
Regards, Steve
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Re: Chondromalacia recovery

Postby miyata84 » Tue Jun 02, 2009 5:25 pm

Hi Scotty
Sounds very painful. There's a physio in Cairns who does bike fits. otherwise I recommend you see Oliver at Trinity Cycles...when you are ready to cycle again get him to do a bike fit on you and to set up your shoes.
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Re: Chondromalacia recovery

Postby cavebear2 » Tue Jun 02, 2009 5:36 pm

familyguy wrote:Personally I dont like SPD's a lot for intense or long distance use, as they dont stop the outside of my foot from tilting outwards and putting strain on my knee. Maybe SPD's with a platform edge that held your foot flatter might help?
+1, I use Time pedals/cleats which have plenty of float but my knees track consistently in the centre position.

Additionally, I had no trouble with phillips head bolts, I just had to file some of the dome shape off the head to make them work. The most important thing for security of fit is to use a bolt with the correct thread.
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Re: Chondromalacia recovery

Postby LittleWheelsandBig » Tue Jun 02, 2009 7:58 pm

Did the chondromalacia well over a decade ago, it really cut back my cycling for a year or so and I had to take it gently for another year or so. YMMV. Take care of those knees, you'll be wanting to use them for a while yet.

Personally I get sore knees with too much float. Don't people find it interesting that pedals with lots of float are considered good for knees but having loose cleats (or flat pedals) can give you sore knees?

Fixed cleats (Look black or Keywin fixed) suit me just fine. SPDs are OK provided the pedal provides enough support, a few riders use the Shimano models with a surrounding spring-loaded cage to make of this. Again YMMV.
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Re: Chondromalacia recovery

Postby scottyj » Tue Jun 02, 2009 9:55 pm

Well, somewhat encouraging, i think. Better than the doctor who said "you should not be riding bicycles at all".

So, looks like I will be hitting the pool for exercise over winter. Thanks for the advice. Guess I will just start throwing money at it and see how it pans out.
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Re: Chondromalacia recovery

Postby williamsf1 » Wed Aug 11, 2010 7:55 pm

looks like I could be suffering from this....

so how did you go?
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Re: Chondromalacia recovery

Postby rustychisel » Thu Aug 12, 2010 4:21 pm

scottyj wrote:Well, somewhat encouraging, i think. Better than the doctor who said "you should not be riding bicycles at all".

So, looks like I will be hitting the pool for exercise over winter. Thanks for the advice. Guess I will just start throwing money at it and see how it pans out.


Just as an aside and perhaps not much help, it's worth looking for a medical professional who knows a little about cycling, and asking them what they know about cycling. There are far too many who think they know what they're talking about and DO NOT have specific knowledge when you try and discuss issues (for all I know this can be applied to many sporting issues).

One of the MDs I consult is also a dedicated cyclist, and she shows real knowledge, not 'uh, you shouldn't be riding'. Same with physios if you're directed down that route.

all the best.
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Re: Chondromalacia recovery

Postby fatherofmany » Mon Aug 16, 2010 2:49 pm

rustychisel wrote:Just as an aside and perhaps not much help, it's worth looking for a medical professional who knows a little about cycling, and asking them what they know about cycling. There are far too many who think they know what they're talking about and DO NOT have specific knowledge when you try and discuss issues (for all I know this can be applied to many sporting issues).

One of the MDs I consult is also a dedicated cyclist, and she shows real knowledge, not 'uh, you shouldn't be riding'. Same with physios if you're directed down that route.

all the best.


Wise advice. Wish I'd have seen it a quarter of a century ago. I may have made it to LA, Seoul or Barcelona after all. After breaking both kneecaps and suffering all sorts of other cartilage damage and compression problems I had a doc tell me to stop training (for long jump) if I wanted to walk without new knees when I was forty. Well I did, and didn't know what else to do with all my spare time, stuffed around alot and did the best I could to ruin my late teens and early twenties then thought a complete sloth of a woman would solve my ills. That didn't last, in fact when about 12 years after being told to 'not exercise' and living with terrible knee pain I hit the weights, ran a bit and the pain started to subside. She got the dirts with my newfound activity and fit body ( that I was obviously doing/getting to impress someone else - insecurity issues methinks) and the marriage folded a while after.

I married again a few years later to a woman who is my best friend and encourages my exercise, bike riding and general good health/fitness (she must see the benefitial side effects - we have five children!) We have a great doc who is encouraging in 'alternate' methodology, eg supplements, herbal remedies, massage & bowen therapy etc. Our doc will always research possible solutions rather than give a blanket, rest and drugs fix to anything nasty.

I'm now 45 and other than a bad run this year with a bike crash - broken rib & wrist and then stubbing and breaking my toe shortly afterwards, I live with no pain from previous injuries, my knees are better than ever. I take no regular painkillers (occasional panadol and ibuprofen for headaches and a slight lower back disc problem I am fighting too) and I am as fit (although not as fast) as when I was competing at state/nat level athletics in my late teens.

Don't give up just yet, there's very little impact in cycing (unless you come off and then the impact can really hurt), there is a lot of movement however. Get it wrong and the wear and tear could hurt, so get it sorted biomechanically and you should be fine. Also find a good doc, one that won't baulk at takling to your lbs mechanic about solutions and DON't SUFFER from it - FIGHT it !!

All the Best.

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Re: Chondromalacia recovery

Postby williamsf1 » Mon Aug 16, 2010 9:40 pm

awesome post FOM!!!

I've gone to see a physio last week, and I think I knew more about ITB etc than they did.... hmmmm

anyone worthwhile seeing in south australia?
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Re: Chondromalacia recovery

Postby fatherofmany » Wed Aug 18, 2010 1:20 pm

Strange isn't it. Next time a doctor asks "what's wrong with you?" I'm just replying, "well you're the doc, work it out"
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Re: Chondromalacia recovery

Postby scotto » Thu Aug 19, 2010 10:09 am

I love reading these posts from the point of a health professional seeing what "the general public" suggest.
The best comments that i see for most posts are along the lines of.
1. change your seat height - this might be a good suggestion for those getting pain having bought a new bike
2. you must get an MRI - unless contemplating surgery, or ruling out an injury that requires surgery, theres little value in this
now, back on track ( clearly i have too much free time this morning!)

Patella femoral pain should be extremely easy to diagnose and easy to treat. I am yet to ever see a knee MRI taken for PFjt Pain. At best, a skyline view via XR will demonstrate a poorly sitting patella, although if your doctor or physio cant figure this out in their rooms, well......

The muscles that control the patellas location on the femur form part of the quads, and are known as the VMO(small muscle on the inside) & VL (large muscle on the outside)

In very simple terms
, we must
1. retrain the VMO muscle with some specific single leg squats
2. avoid ANY activity that causes or increase your knee pain.

Imagine pain or swelling acting like a dimmer switch for the VMO, but not the VL muscle. Exercising through pain will make the imbalance between these two muscles greater, and therefor increase the patella issues. It os for this reason that we often tape or brace the patella - it allows painfree exercise. once the strength has improved, get back on the bike.

your physio should do a complete assessment of the leg and ascertain the causes of the PF pain. people like to talk about ITB a lot, but neglect to investigate altered foot mechanics, which is a far more common factor in PFjt pain.

good luck.
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Re: Chondromalacia recovery

Postby williamsf1 » Thu Aug 19, 2010 11:16 am

1. retrain the VMO muscle with some specific single leg squats


any tips for this?
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Re: Chondromalacia recovery

Postby scotto » Thu Aug 19, 2010 1:01 pm

williamsf1 wrote:
1. retrain the VMO muscle with some specific single leg squats


any tips for this?

mmm, how to describe this.
1. stand on affected side, foot turned out about 30-45degrees
2. lean a bit to the affected side, until your navel is over the top of your foot, you should feel a bit off balance and its ok to hold onto something ( often neccessary)
3. as you do the mini single leg quarter squat, try and remain bow legged. if you imagine a line drawn from your foot outwards ( ie in line with you big toe), keep you knee to the outside of that line.
4. squat slowly down and back up, starting with only about 10-15cm of squat.
5. it MUST be painfree or it'll do more harm then good. if you cant achieve a pain free mini squat, get your physio to teach you how to tape your knee ( google mcconnell taping, use leuko P tape, pull it tighter)
6 progress the exercise by adding a short hold, or doing more. dont try to go lower, as it'll put too much pressure onto the patella for now
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Re: Chondromalacia recovery

Postby williamsf1 » Thu Aug 19, 2010 1:23 pm

thanks!!!

I have seen a physio about this, but was mildly disappointed that I knew more about the problem than she did ... :(

I have been advised that sportsmed here in SA has a few guys involved in cycling, so I might go see them also!!!

but its all good help!!
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