Recovering from chondromalacia patella

[usta2050]

My experience -

It took me about 3 months to really clear this thing with 4 different physical therapists. My condition started 4 months ago and I was really frustrated about the lack of progress in the first two months after doing tons of stretches and seeing PTs.

What really helped:

1. Rest - took a 2 week break from tennis during month 2. And limiting myself to 1 tennis games/week in month 3 really helped to calm my knees

2. Finding the right PT - the last PT diagnosed my problems more quickly and got me to stretch better and did more muscle stimulating routines and icing.

3. Doing the right stretches. The PT taught me some. But the best book I could find is this one by Susanna McGee. It's very comprehensive.

http://www.amazon.com/Tennis-Fitness.../dp/0982949960

4. Don't sit too long. I try to stand/work instead of sit/work. Sitting is really bad for the gluteus muscles.

5. I bought a bunch of knee braces (Proband KneedIT, double hingers, etc. etc.). The one thing that helped was the Ace brand neoprene. But I only started wearing it from month 3. It seems to help to keep my knee warmed up for tennis. I didn't wear it when my knee was still crunchy cause I thought it may make it worse.

[Chas Tennis]

My patella area has had some pain from time to time and MRIs for other injuries showed deterioration.

I believe that the information in this link is true and that it applied to me.

http://www.mrtherapy.com/articles/article3.html

WARNING: Stretches that involve the hip flexors put stress on the lower back and could cause injury.

The rectus femorus is the only hip flexor that attaches to the pelvis above the hip. If it is too tight or short it pulls on the patella, probably makes the patella track improperly, high, etc. and according to the article can cause pain and joint injury.

Tight rectus femorus also changes the posture of the pelvis. I noticed many years ago that the higher prominent bones on the front of my pelvis were forward at the top (anterior pelvis tilt). I did not like it but thought that it was just my posture/anatomy and my age and that was it. After doing the above stretch - modified for me by a physical therapist - for about 5 weeks the posture of my pelvis had changed to a normal upright look. The high pelvis bone moved back in relaxed position maybe about 1" at the top.

Since that time I found in the Manual of Structural Kinesiology, Thompson, Floyd a corroborating statement that fits my experience exactly

"In speaking of hip flexor in general, it may be said that many people permit the pelvis to be permanently forward as they get older."

A tight rectus femorus gives a little forward angle between the trunk and upper leg bones when standing. This posture becomes more noticeable as people age. Properly stretched, the relaxed standing posture is more upright.

The ordinary standing quad stretch can stretch the rectus femorus but only if the pelvis is held properly to stretch it as in the link.

I could not do the recommended stretch because whenever I attempted the normal quad stretch, with sharply flexed knee, I would instantly get a cramp in the back of my hamstring just above the knee. The cramp was probably due to pinching off blood flow but I don't know. The physical therapist came up with a modified stretch for me that did not require flexing the knee so much.

Did your stretches include one specifically for the rectus femorus?

[usta2050]

Originally Posted by Chas Tennis

My patella area has had some pain from time to time and MRIs for other injuries showed deterioration.

I believe that the information in this link is true and that it applied to me.

http://www.mrtherapy.com/articles/article3.html

WARNING: Stretches that involve the hip flexors put stress on the lower back and could cause injury.

The rectus femorus is the only hip flexor that attaches to the pelvis above the hip. If it is too tight or short it pulls on the patella, probably makes the patella track improperly, high, etc. and according to the article can cause pain and joint injury.

Tight rectus femorus also changes the posture of the pelvis. I noticed many years ago that the higher prominent bones on the front of my pelvis were forward at the top (anterior pelvis tilt). I did not like it but thought that it was just my posture/anatomy and my age and that was it. After doing the above stretch - modified for me by a physical therapist - for about 5 weeks the posture of my pelvis had changed to a normal upright look. The high pelvis bone set back maybe about 1" at the top.

Since that time I found in the Manual of Structural Kinesiology, Thompson, Floyd a corroborating statement that fits my experience exactly

"In speaking of hip flexor in general, it may be said that many people permit the pelvis to be permanently forward as they get older."

A tight rectus femorus gives a little forward angle between the trunk and upper leg bones when standing. This posture becomes more noticeable as people age. Properly stretched, the relaxed standing posture is more upright.

The ordinary standing quad stretch can stretch the rectus femorus but only if the pelvis is held properly to stretch it as in the link.

I could not do the recommended stretch because whenever I attempted the normal quad stretch, with sharply flexed knee, I would instantly get a cramp in the back of my hamstring just above the knee. The cramp was probably due to pinching off blood flow but I don't know. The physical therapist came up with a modified stretch for me that did not require flexing the knee so much.

Did your stretches include one specifically for the rectus femorus?

Thanks, I also want to point out that my CP was very mild and I had almost no pain. (maybe 1 on a scale of 10 for 5 min) But I could hear some noises when I walk up stairs or straightened my knee when I am sitting. That freaked me out.

Now it's all gone.

Btw, I also took glucosamines, and the New Chapter Zyflamend I read about on this site.

I also want to thank charliefed and all the people who share their knowledge on this forum. It's good for healthy tennis!

[Chas Tennis]

Originally Posted by usta2050

Thanks, I also want to point out that my CP was very mild and I had almost no pain. (maybe 1 on a scale of 10 for 5 min) But I could hear some noises when I walk up stairs or straightened my knee when I am sitting. That freaked me out.

Now it's all gone.

Btw, I also took glucosamines, .............................

97+% of the time I am pain free, occasion twinge on steps, perhaps no pain for weeks. Never a problem playing tennis. I avoid all pain medications. The reason -my personal opinion - is that cartilage does not have nerves and only when other tissues get involved by inflammation or deteriorate does much pain occur.

The wake up call was that I requested written copies of my MRIs in 1999 and 2011. These are written by the specialist Dr examining your MRIs and usually go only to your requesting Dr. I read all the details and researched all the terms. The results for my meniscus injuries were not too bad regarding the grade or severity of the meniscus injuries. But both MRI results for my patellar-femoral cartilage looked terrible, a time bomb. At that point, I decided to request a postural examination, found some issues, and got some corrective PT. The Dr treating my meniscus injuries did not bring up the subject of preventive treatment for the patellar-femoral conditions spelled out in the MRI evaluations.

I believe that aging is one thing and that the consequences of long term joint misalignments are another. In my case I believe that it is not mostly age but posture and patellar-femoral joint misalignment. I wish I had given it my attention many years ago.

[usta2050]

Originally Posted by Chas Tennis

97+% of the time I am pain free, occasion twinge on steps, perhaps no pain for weeks. Never a problem playing tennis. I avoid all pain medications. The reason -my personal opinion - is that cartilage does not have nerves and only when other tissues get involved by deteriorate does much pain occur.

The wake up call was that I requested written copies of my MRIs in 1999 and 2011. These are written by the specialist Dr examining your MRIs and usually go only to your requesting Dr. I read all the details and researched all the terms. The results for my meniscus injuries were not too bad regarding the grade or severity of the meniscus injuries. But MRI both results for my patellar-femoral cartilage looked terrible, a time bomb. At that point, I decided to request a postural examination, found some issues, and got some corrective PT. The Dr treating my meniscus injuries did not bring up the subject of preventive treatment for the patellar-femoral conditions spelled out in the MRI evaluations.

I believe that aging is one thing and that the consequences of long term joint misalignments are another. In my case of the patellar-femoral joint misalignment I believe that it is not mostly age but posture.

Aging definitely plays a role in this but weight, posture, frequency of play, etc. also make a big difference.

I just read this http://tt.tennis-warehouse.com/showthread.php?t=411990

What CharlieFed posted is exactly what I went through now that I read it again.

Symptoms:

Patellofemoral pain syndrome usually causes a dull, aching pain in the front of your knee. This pain can be aggravated when you:

Walk up or down stairs
Kneel or squat
Sit with a bent knee for long periods of time
You may also experience a grating or grinding sensation when you extend your knee.

Causes

Doctors aren't certain what actually causes patellofemoral pain syndrome, but it's been associated with:

Overuse. Repetitive stress on your knee joint — such as that sustained during running or jumping sports — may result in patellofemoral pain.
Misaligned bones. Patellofemoral pain can occur if the bones in your knee or foot aren't aligned properly.
Injury. Trauma to the kneecap, such as a dislocation or fracture, has been linked to patellofemoral pain syndrome.

Treatments and drugs

Treatment of patellofemoral pain often begins with simple measures. Rest your knee as much as possible. Avoid any activities that increase the pain, such as climbing stairs.

Medications
If needed, take pain relievers, such as acetaminophen (Tylenol, others) or nonsteroidal anti-inflammatory pain relievers, such as aspirin or ibuprofen (Advil, Motrin, others).

Therapy
A physical therapist may suggest:

Rehabilitation exercises. Specific exercises can strengthen the muscles that support your knees and control limb alignment, such as your quadriceps, hamstrings and the muscles around your hips (especially the hip abductors).
Supportive braces. Knee braces or arch supports may help protect your joint and improve the alignment of your kneecap.
Taping. Your physical therapist may show you how to tape your knee to reduce pain and enhance your ability to exercise.
Ice. Icing your knee after exercise may be especially helpful.
Knee-friendly sports. During your recovery, you may want to restrict your activities to more knee-friendly sports — such as bicycling and swimming."
- http://www.mayoclinic.com/health/cho...ents-and-drugs

[Chas Tennis]

There are many possibilities. But if the rectus femorus is tight/short and the link is correct you can miss the cause of the problem. You need an evaluation from a qualified Dr to determine the issue.

I'm not qualified to evaluate posture issues. One possible indicator that your rectus femorus might be too tight is difficulty in doing the quad stretch while holding your hip in extension. ?

For example, look at the angle between this woman's upper leg bone (femur) and her trunk. The femur is forward of the line of her trunk (<180°). She is not stretching the rectus femorus or it has stretched to the end of her ROM. I don't understand well enough to draw conclusions.



In contrast, this man has his hip in extension and the femur bends behind the line of the trunk (>180°).



I do not know enough but believe that the rectus femorus of the woman may be relatively tight/short. ?

[t135]

I was diagnosed with this yesterday.

[usta2050]

Originally Posted by t135

I was diagnosed with this yesterday.

You are moving in the right direction. I tried to self-diagnose and treatment and it lead to a lot of frustrations.

[t135]

I was convinced it was bursitis. Thankfully it wasn't. Glad I went to the doctor.