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I know that there are several people on this BB interested in chondromalacia. Recently I had the opportunity to discuss resolution of this problem with a physical therapist. She told me about an approach from an Australian physical therapist that she said takes about two weeks to see good results in totally solving the problem. It is called "Patellar Taping." Jenny Mc Connell is the PT who developed this remedy and she has the entire protocol online in an article. The link is below.
I have not tried it yet but it sounds promising. Since there are so few alternatives for resolving chondromalacia, this sounds like a good opportunity to me and I will try it as soon as I get a chance.
Best wishes,
Jan
In Reply to: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 07:03:51:
Taping is a good short term treatment. However, addressing the muscle problem mentioned throughout the article should be the final goal.
Just strengthening the muscle is not usually enough. Looking for the cause of why that muscle is not functioning properly is the key to fixing the problem, rather than just patching it up.
The research articles below discuss the muscle inhibition leading to chondromalacia patella, and the cause of that muscle inhibition.
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10220713&itool=iconabstr
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=10714531&itool=iconabstr
In Reply to: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 07:03:51:
Jan, I just wondered whether you ever tried the Pete Egoscue exercises? I remember you saying once that you had the book but hadn't had a chance to try them at that stage? I'm just interested in feedback about how useful people find his approach? It's obviously not going to be the answer for everybody, though I suspect that often the main stumbling block is the time one has to devote to his approach in the beginning rather than the e-cises not being helpful. Any feedback?
The taping does look interesting.
Rib
In Reply to: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 07:03:51:
Hi Happygal,
That was a long read.
It seems that it is meant for a course study for a therapist. It really isn't that complicated.
Resting the patella and changing the activities which cause the pain is imperative. The idea is to stop further injury by stopping the exercise which is causing the pain.
If you are a runner, ride a bike instead.
Exercise to strenthen muscles which pull the patella
toward the other leg will take the pressure off the area
which is rubbing.
Orthodics are important to prevent the pronation that occurs when you push off with the back leg.
Do things which don't hurt the knee. Don't exercise through the pain and wonder why it won't go away. Total knee replacements are not a cure either.
http://www.drmirkin.com/fitness/9963.html
http://www.drmirkin.com/joints/7934.html
http://www.drmirkin.com/archive/6245.html
http://www.drmirkin.com/fitness/8507.html
Ron
In Reply to: Re: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by DrDave [1460.109] on July 02, 2004 at 08:30:46:
DrDave,
So if one does have this in his knees. I have pain them sometimes after exercise, what is there to do to cure it? I know mine is caused by the high arch in my feet. I wear custom orthodics but that arch is tough. It has led to severe ankle instability (has many sprains), shin splints and finally knee pain. My Chiro has me to this kneeling thing every day for a minute to stregthen as well as active release when I go in.
But the MRI said exactly "Patella alta with thickened medial and suprapatellar plica. Chondromalacia patellae"
Of course the ortho called it wear and tear but did not recommend surgery, which I don't want to do anyway. What would yours be as I have done PT, been to ortho and see a chiro too. I am very active in sports. Thanks.
In Reply to: Re: Chondromalacia - for DrDave posted by Steven [280.62] on July 02, 2004 at 11:28:35:
They say that patellofemoral joint syndromes affect up to 25% of athletes in the US so you are not alone and your condition is a difficult one to resolve completely if you are "very active in sports".
I would concentrate on the function and specific alignment of the sacroiliac joint on that side to reduce the vastus medialis inhibition which is the muscle, according to all of the literature, implicated in these conditions.
Good arch support is going to be key, of course you are aware, because it contributes to the "Q Angle". Which is the angle along the femur and tibia and how they relate to each other, setting up the track for the patella. Fortunately it is a "flat foot" that is more likely to cause this knee problem so having a high arch is to your advantage as long as it's supported and stays "up".
Whatever activities you are doing I would get some lessons on proper technique. There are many activities and sports which, when done improperly, can lead to very specific conditions.
Taping the knee for this condition when you are going to participate in something you know will aggravate it may be warranted.
If you do all of those things, ESPECIALLY that regarding the sacroiliac joint, for 12 months and you have no improvement then you might consider discussing surgery for the plica.
In Reply to: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 07:03:51:
Thanks, Happygal.
I will be interested in hearing from anyone who tries this as to what success or failure they have had.
Walt
In Reply to: Re: Chondromalacia - for DrDave posted by DrDave [1460.109] on July 02, 2004 at 14:11:51:
I think I would almost rather have flat feet. My arch is real high that I can't wear low top shoes often. I can sprain my ankles from stepping on a pebble.
Its not as much the technique as much as the arch. It spread. First it was ankles, then shin, then knees.
I wear the orthotics I have a podiatrist make me. They cut down on the sprained ankles but I don't run hard ever. They are still wobbly.
I will not have surgery because coming back from that isn't always 100 percent. I know from my shoulder.
I remember in physical therapy how they had me do ankle exercises when I had to balance my feet on those rubber ball things and my feet were extremely wobbly. The therapist noticed this as well. The shin splints from running on the treadmill (I wouldn't dare run outdoors as I would have to use hightops and watch ever step for rocks or anything) let to these small lumps (one on each leg) showing up when I exercise. They are slight when not exercising now but they kind of swell when doing exercises. I play basketball and softball, as well as cardio and weight training so it's rough.
In Reply to: Re: Chondromalacia - for DrDave posted by Steven [280.62] on July 02, 2004 at 16:49:52:
You seem to have decided that it's primarily the high arch to blame. Unfortunately I don't have any further recommendations about that.
Good luck with whatever course you take.
In Reply to: Re: Chondromalacia - for DrDave posted by DrDave [1460.109] on July 02, 2004 at 17:15:56:
This has been ongoing since I can remember. I have had hundreds of sprained ankles in my life. They have cut down severely since I wore the orthotics but they are still there.
Every person who has seen me about it (4 different orthopedic surgeons), one podiatrist, 2 physical therapists, 1 chiropracter all have said it was from the atch.
In Reply to: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 07:03:51:
Great comments, everyone.
The PT said that the taping helps in part by shortening the vastus medialis muscle -- so then the muscle tightens up and that helps keep the patella in alignment. It seems the taping kind of jump-starts correct movement of the patella. All the instructions are there for how to do it -- the PT suggested that I could even do it myself but some people might rather have a PT do it.
Dr. Dave, the idea of manipulating the SI joint sounds interesting. I agree with your point, what is the cause of the muscle not working right? I will keep the SI joint in mind and see if I can find someone to adjust it. My arches do tend to be a bit flat, and I have started doing strengthening exercises for the arches -- but I need to be cautious because then my calves might tighten up too much, leading to spasms or other problems.
Rib, do you have Pete's book? I still haven't had time to look at it. Are there one or two exercises that seem to be appropriate to this? I would really like to learn more about his method but geez, there's only so many hours in a day.
Ron, my kneecap still isn't hurting, it's just making a loud grinding noise mostly when going down stairs and doing lunges. I mostly avoid these activities. The knee is getting very subtly sensitive now and I would like to solve this problem before pain starts to happen.
I tried doing leg lifts to strengthen vastus medialis and they just made that muscle start to spasm, so I had to stop. I cannot do any exercises that are too focused on just one muscle. I still have not been able to do bike riding consistently -- I know that would strengthen the muscle in an easier way and am waiting for the correct opportunity.
I've had some people tell me that knee problems are also related to the liver (acupuncturists would agree) and I am now getting acupuncture for my liver and will see if that helps my knee.
I suspect that working on this a variety of ways -- strengthening the arch, adjusting the SI joint, taping the patella, some acupuncture and doing a little bike riding -- might all work together to fix this!
Thanks everyone for your thoughts. I hope that everyone else with a similar problem finds a solution.
Best wishes,
Jan
In Reply to: Re: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Happygal [2070.350] on July 02, 2004 at 21:48:31:
Yes, I do have Pete Egoscue's book and have to say that I only do them when desperate - I've got used to a background level of knee pain, which is stupid - I ought to sort it out. However, from time to time my knees have got really bad, occasionally one hip too. A few days of Egoscue make a HUGE difference. I would suggest reading the intro. chapters and then having a go at the knee exercises one weekend when you have more time - you need to do the full sequence because he's working on your whole structure. I think they are very powerful. I've also persuaded a couple of people to use them for shoulder problems - helpful on both occasions. Although they do take some time, you usually feel a difference even after just one session. Though in your case you say you don't have pain as such, I suspect you'd feel some result, perhaps feeling better balanced or stronger. Rib
In Reply to: Re: Chondromalacia - Patellofemoral syndrome (Walt, archive?) posted by Rib [1602.4] on July 03, 2004 at 11:31:51:
Thanks, Rib.
I will try as soon as I can. Gotta find a book publisher ASAP!
I hope you find a way to get your situation taken care of -- ongoing pain is not usually a good idea.
Best wishes,
Jan
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