chondromalacia

Someone will probably be able to give you some advice.
So far as I recall, it involves pain somewhere below the kneecap. There are special exercises you can do to actually diagnose the chrondromalacia and other exercises for therapy.
Has a physio diagnosed chrondromalacia in your case? I had pain somewhere under the kneecap but I suspect it was either tendon problems or cartiliage. I cut back on my riding for a time and did some work to strengthen the joint.
Sorry I can't recall the exercises specific to your problem but I seem to recall one involves straightening the leg repeatedly.

jagrazor said:

How does one get rid of it?

Carrera said:

Someone will probably be able to give you some advice.
So far as I recall, it involves pain somewhere below the kneecap. There are special exercises you can do to actually diagnose the chrondromalacia and other exercises for therapy.
Has a physio diagnosed chrondromalacia in your case? I had pain somewhere under the kneecap but I suspect it was either tendon problems or cartiliage. I cut back on my riding for a time and did some work to strengthen the joint.
Sorry I can't recall the exercises specific to your problem but I seem to recall one involves straightening the leg repeatedly.

*bump* i need help please 🙂

No one else has had this terrible problem?

jagrazor said:

How does one get rid of it?

I have it and treat people who have it-I'm a physcian. It is degeneration of the cartilage (it's the shiny stuff that decreases friction) on the underside of the kneecap. It can be caused by faulty tracking of the knee cap on the femur. The kneecap may be tilted laterally (to the outside) instead of riding in the middle of the groove where it should track. This wears out the cartilage and can cause pain at the front of the knee. You can also get it from falling on the knee or striking the knee cap on something, like a dashboard. Exercises focus on strenghthening the muscles just above the knee cap and to the inside. Straight leg raising can help: keeping knee straight raise the leg while sitting, lying or standing with the foot turned to the outside. Leg strengthening with partial squats or using a leg press machine can help. You need to keep the foot turned outward. It can also aggravate it-any exercise you do should make it feel better, not worse. If it makes it worse-stop! Surgery, a "lateral release" to decrease the effective pull of the lateral quadriceps muscle is controversial. I had it and not sure it did much for me. Bicyling is good for this but make sure your seat is high enough and you may want to orient your cleats so that your foot is turned out a bit or certainly not turned in. Some float in your pedals may help. Be careful about big gears until your pain is gone. Don't do any exercise that hurts, any exercise should make it feel better, if not-stop it! If you have alot of anterior knee pain take anti-inflamatory medication daily for several weeks, spin against very light resistance at a fairly good cadence (maybe 80 or so) and work on straight leg exercises.

Bill Wellborn said:

I have it and treat people who have it-I'm a physcian. It is degeneration of the cartilage (it's the shiny stuff that decreases friction) on the underside of the kneecap. It can be caused by faulty tracking of the knee cap on the femur. The kneecap may be tilted laterally (to the outside) instead of riding in the middle of the groove where it should track. This wears out the cartilage and can cause pain at the front of the knee. You can also get it from falling on the knee or striking the knee cap on something, like a dashboard. Exercises focus on strenghthening the muscles just above the knee cap and to the inside. Straight leg raising can help: keeping knee straight raise the leg while sitting, lying or standing with the foot turned to the outside. Leg strengthening with partial squats or using a leg press machine can help. You need to keep the foot turned outward. It can also aggravate it-any exercise you do should make it feel better, not worse. If it makes it worse-stop! Surgery, a "lateral release" to decrease the effective pull of the lateral quadriceps muscle is controversial. I had it and not sure it did much for me. Bicyling is good for this but make sure your seat is high enough and you may want to orient your cleats so that your foot is turned out a bit or certainly not turned in. Some float in your pedals may help. Be careful about big gears until your pain is gone. Don't do any exercise that hurts, any exercise should make it feel better, if not-stop it! If you have alot of anterior knee pain take anti-inflamatory medication daily for several weeks, spin against very light resistance at a fairly good cadence (maybe 80 or so) and work on straight leg exercises.

Thank you so much, you even made it *stupid proof* (not that i needed it but is cool that you did it anyway)

Will it help a lot to turn my feet to the outside for some of my leg extensions, I've been doing leg extensions and curls for a while now, i have noticed improvement, but more is always better 🙂

Is there a way to stretch to help this, or is it simply a muscle imbalance?

jagrazor said:

Thank you so much, you even made it *stupid proof* (not that i needed it but is cool that you did it anyway)

Will it help a lot to turn my feet to the outside for some of my leg extensions, I've been doing leg extensions and curls for a while now, i have noticed improvement, but more is always better 🙂

Is there a way to stretch to help this, or is it simply a muscle imbalance?

I would avoid leg extension exercises-if you are referring to a bench that you sit on and raise a padded bar by straightening your legs. That piece of equipment is more likely to be damaging than helpful. Your quad strengthening exercises should all be done with your feet on the floor or a platform, not with your feet not in contact with a surface that you are pushing against. Quad stretching and hamstring stretching should always be done, especially after your workout or your ride.

Bill Wellborn said:

I would avoid leg extension exercises-if you are referring to a bench that you sit on and raise a padded bar by straightening your legs. That piece of equipment is more likely to be damaging than helpful. Your quad strengthening exercises should all be done with your feet on the floor or a platform, not with your feet not in contact with a surface that you are pushing against. Quad stretching and hamstring stretching should always be done, especially after your workout or your ride.

so I am limited to squats and leg press for quad strengthening?

jagrazor said:

so I am limited to squats and leg press for quad strengthening?

Yes, in my opinion. Research has shown that so-called open kinetic chain exercises (those without your feet pushing against a solid surface) can over stress the patella-femoral surfaces, making chondromalacia patellae worse. NFL players have damaged their patella femoral joint surfaces with open kinetic chain exercises as opposed to closed kinetic chain exercises (with the feet in contact and pushing against a solid surface). You can also do straight leg raising which is essentially an isometric strenghthening exercise for your quads and stresses the patella femoral joint very little.

Bill Wellborn said:

Yes, in my opinion. Research has shown that so-called open kinetic chain exercises (those without your feet pushing against a solid surface) can over stress the patella-femoral surfaces, making chondromalacia patellae worse. NFL players have damaged their patella femoral joint surfaces with open kinetic chain exercises as opposed to closed kinetic chain exercises (with the feet in contact and pushing against a solid surface). You can also do straight leg raising which is essentially an isometric strenghthening exercise for your quads and stresses the patella femoral joint very little.

What about hamstring excersizes, are open chain excersizes for the hamstring bad too?

How should one progress?

Kinetic exersizes (both Quad and Hamstring) going for 4:3 ration of weight or time held up or reps from quad:hamstring (4 muscles 3 muscles?) then moving to step ups, then finally to squats?

jagrazor said:

What about hamstring excersizes, are open chain excersizes for the hamstring bad too?

How should one progress?

Kinetic exersizes (both Quad and Hamstring) going for 4:3 ration of weight or time held up or reps from quad:hamstring (4 muscles 3 muscles?) then moving to step ups, then finally to squats?

Your questions are now getting beyond my expertise. You could consult this book: Closed Kinetic Chain Exercise: A Comprehensive Guide to Multiple Joint Exercises I hope that is helpful

Bill Wellborn said:

Your questions are now getting beyond my expertise. You could consult this book: Closed Kinetic Chain Exercise: A Comprehensive Guide to Multiple Joint Exercises I hope that is helpful

thanks for all your help, it is greatly appreciated.

jagrazor said:

thanks for all your help, it is greatly appreciated.

Your welcome!

I've had this condition for 8 months now, have had a bikefit, riding feels alot more comfortable, have been seeing a good physio and so far this is what we have been working on: Balance - working on simple activities such as standing on wobbleboards etc, nothing strenuous but just requires concentration; strengthening - especially gluteal muscles, hamstrings and VMO (inner quads) squats, lunges and gym ball work; stretching - pretty much everything with particular emphasis on hamstrings, illiotibial band and the rectus femoris.
My strength, balance, alignment and coordination are all now very good so the physio tells me, and my flexibility is better than before but the symptoms are still persisting much to his bewilderment, he's now scratching his head so he's referred me to his boss who treats the olympic team for an app.this Tuesday......I'll keep you updated.....

2zanzibar said:

I've had this condition for 8 months now, have had a bikefit, riding feels alot more comfortable, have been seeing a good physio and so far this is what we have been working on: Balance - working on simple activities such as standing on wobbleboards etc, nothing strenuous but just requires concentration; strengthening - especially gluteal muscles, hamstrings and VMO (inner quads) squats, lunges and gym ball work; stretching - pretty much everything with particular emphasis on hamstrings, illiotibial band and the rectus femoris.
My strength, balance, alignment and coordination are all now very good so the physio tells me, and my flexibility is better than before but the symptoms are still persisting much to his bewilderment, he's now scratching his head so he's referred me to his boss who treats the olympic team for an app.this Tuesday......I'll keep you updated.....

this is much how my progress went. I ended up having surgery for Plica Syndrom, but I still have chondromalacia also, when the doctor was in there, my cartilage all looked smooth and nice though, it was microscopic.

Yeah let me know how it goes, because this might help a lot of people. I have a friend who has the same problem. He can't fix it either.

I had it pretty bad about ten years ago.

After resting, icing and very light stretching for a month (I thought it was patella tendonitis), nothing happened, then I went to the old family physiotherapist who gave me the exercise.

My condition was gone in two or three days after doing straight-legged, weighted "kicking", forward raises!! Not much weight is needed; sometimes I even did them with only a heavy rollerblade on my foot! 😄

If you are still in any pain at all, I wouldn't be doing extensions or squats.

It has come back once or twice over the last ten years (altough, less significantly), and I can quickly knock it out with those straigh leg forwrd raises.

jagrazor said:

so I am limited to squats and leg press for quad strengthening?

Please, if you are still in any discomfort at all, don't do these exercises for the time being.

My experience is obviously only anecdotal, but still.......

[quote="Bill Wellborn"]


Hey, a fellow NMican

531Aussie said:

I had it pretty bad about ten years ago.

After resting, icing and very light stretching for a month (I thought it was patella tendonitis), nothing happened, then I went to the old family physiotherapist who gave me the exercise.

My condition was gone in two or three days after doing straight-legged, weighted "kicking", forward raises!! Not much weight is needed; sometimes I even did them with only a heavy rollerblade on my foot! 😄

If you are still in any pain at all, I wouldn't be doing extensions or squats.

It has come back once or twice over the last ten years (altough, less significantly), and I can quickly knock it out with those straigh leg forwrd raises.

can you explain this a little further, how long do you do it, do you do it laying on the ground?

is it like flutter kicking only in the air, somewhat like walking with weight on your legs?

would "forward raise" mean i stand and raise my leg as high as i can?

this reminds me of essentric calf raises for Achillies tendonitis, if it is just as effective, then you are a godsent, and have cured at least 2 people just by me knowing about it 😄

jagrazor said:

can you explain this a little further, how long do you do it, do you do it laying on the ground?😄

At home, I did them standing up, keeping my leg as straight as I could, and kicking forward to just past horizontal. The idea is to feel it in the upper middle quad (rectus femoris), and not have the knee joint moving, which brings in the stronger quad muscles (medialis and lateralis).

Other times I've done them at a gym using a wall pulley, and using the low pulley, I would not kick up as high.

At first I was very gung-ho, and used about 20lbs, and did about four sets of 15ish reps. I subsequently found that using less weight was sufficient, so I just did them at home with a 5lb weight taped to an old boot. Three sets of 20 seemd to be enough.

When looking for info on another injury, I recently stumbled across some stuff that said there's some confusion between chrondomalacia and patellofemoral syndrome, even amongst the medical ranks. So, I guess it's important to find out what you have, which can apparently be tricky because the pain is in the same spot.

but I'm no doctor...... 😄 :p.........:

My (limited) understanding is that patellofemoral syndrome is a "crooked" tracking of the patella which requires strengthening of the vastus medialis and a "loosening" of the lateralis and IT band (etc), and chrondomalacia is a "lazy" tracking of the patella, which requires strengthening of the rectus femoris. By "lazy", I mean that, during normal quad contraction, the firing order determines that the rectus femoris quickly pulls up the knee cap up and off the top of the tibia, but when we over do things, the rectus femoris gets a bit slack and weak, and doesn't pull the knee cap up quickly enough during the contraction, so the the knee cap grinds a bit on the tibia, obviously causing pain and inflamation.