I seem to be developing some mild chondromalacia in the right knee. I already use orthotics in my daily wear shoes. My main exercises are cycling and walking. The knee in question is missing the medial meniscus from surgery. The tenderness on walks is on the lateral edge of the knee cap and underlying structure. Cycling has not yet been affected. I suppose I have some muscle imbalances in the leg, and need to try to address them. I’m looking for some PT-type exercises to pull the kneecap back to the centerline. Recommendations?
Sorry about the pain and knee issue. Don’t have your same issue, but i do have some knee issues to relate. Best advice is go see a doctor and verify the diagnosis before trying to cure it. They will give you the exercises or a referral to a PT guy.
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First, go see your Doc.
But for conversation on the matter…
Imbalances to the knee cap…what is the state of your quadriceps? Are they pretty even in strength? If not, work your angles, You have 4 muscles in there to hit.
Also, what is the strength balance of your quads to hams? It’s possible an imbalance will stress the knee. But these are at this point management exercises to attempt to keep the kneecap from floating anywhere else out of alignment during workouts.
Unfortunately, when cartilage is gone, it’s gone. Bone on bone will be uncomfortable, particularly full ROM movements of flexion/extension on the joint. The pain and grinding will be worse under load bearing exercises. Particularly walking, even if you’re not bouncing like the impact of running. Reason being, walking is an inefficient movement when a certain speed is reached. So, be aware that will still hurt you too. If you want some relief but maintain some cardio work, start swimming. Get off the leg. Keep ROM smaller. Wear running shoes that’ll aid the proper directional support. Be proactive about recovery too. Ice down your knee after a workout to reduce inflammation.
I’m sure you understand already, but just reiterating, you’re in management mode. I’m on a knee that’s out of cartilage too. My knee cap floats medially from a structural issue. Walking hurts me. Running is actually a relief to walking. I do a lot of legwork to maintain strength on both sides of the hinge. I wear inserts in my running shoes to support my high arches. I have also cut way down on distance. Instead utilize short distance work with high intensity. Reduces the amount of time I spend pounding on the joint.
Do all the little things you can.
Quadriceps strength/balance and steroid injections will be your best chance of putting off knee replacement surgery as long as possible.
I know your pain. I’ve had pain in both knees for the last couple years, mainly from running in formation with my squadron. I’ve been through just over a year of physical therapy over the last 2.5 years. The thing that has worked best for me, and may not work for you is weight. My therapist had me doing different weight drills. Leg press machine for example started with 80lbs 15 reps, then 120 13 reps then 200 for 10 reps. I’ve done a lot more, mostly ones using my own body weight. I’ve be glad to share some of them if you’d be interested. But remember just because using weight worked for me, doesn’t mean it will work for you. Every body reacts differently.
Serious question, aside from downtime and rehab time, and even cost depending on ones insurance what benefit is there to pro-longing the inevitable? Everything else just seems like a bandaid no?
I ask because a certain person in my family has been putting off knee replacement surgery for years now and flat out refuses to do anything other than receive injections, granted there is a dependency issue going on as well but that is neither her nor there.
Jp, my knee is no where near bad enough to merit a surgical replacement. The medial meniscus was removed in a prior surgery. I am looking for non-machine exercises to strengthen the leg and correct any muscle imbalance…think standard pt knee exercises with resistance bands.
Using a roller on the IT band seemed to help by relaxing the lateral side.
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Currently, the lifespan of a total knee prosthesis is somewhere between 10 and 15 years. Getting a knee replacement can be bad enough. Getting a revision knee replacement is an order of magnitude more difficult with a higher complication rate. Not something that should be done by your local orthopod, revisions generally require a Fellowship-trained joint specialist…relatively few and far between.
The concept is therefore to put knee replacement off as long as possible so that your first knee replacement has the best chance of being your last. Obviously, that works best if one can get reasonable relief and actually have a life on just NSAIDs and steroid injections. If not, best thing might be to just go for the new knee. Other variables are at work too…obesity, cardiovascular health, other diseases (diabetes), any of which ugh alter the equation.
What is a “Fellowship-trained” joint specialist? My hips need to be replaced, but I am holding out as long as possible.
A subspecialist. After completing a five year orthopedics residency, joint replacement specialists elect to spend an additional year of training (Fellowship) doing nothing but joint replacement surgery with some of the best joint surgeons in the country. This is usually divided up into upper and lower extremity reconstruction Fellowships. A total hip or knee replacement and especially a revision would be done by someone who has done a 1 year Fellowship in Adult Lower Extremity Reconstruction. There are 61 such training programs in the US, each taking between 1-3 Fellows per year. They are the true experts in total joint replacement.
Not every orthopedist doing joint replacement has such training. In fact, most don’t.
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I know researchers have been working on cartilage replacement using various techniques. My understanding is that cartilage does not have its own blood supply and therefore is difficult to cultivate. Seems like it would have to be grown outside the body and then implanted. Otherwise, the new growing cartilage would wear away before mature and able to withstand weight and wear and tear.
Anyone know how that research is coming along?
Hmac, thank you for that information. I have a friend at work who’s contemplating a knee replacement, I’ll pass that data on to him.
If your cartilage deterioration is mild to moderate, I STRONGLY recommend you look into Platelet Rich Plasma therapy for your knee. I had a similar condition in the balls of my feet/big Toe joints in both of my feet. Got the treatments a couple months ago and can stand on my toes. The improvement is nothing short of miraculous. Much cheaper and simpler than surgery and form what I have seen, works better all around.
It could easily head-off a future joint replacement ENTIRELY.
http://www.hss.edu/newsroom_prp-treatment-potential-for-knee-osteoarthritis.asp
While previous studies have shown that patients with osteoarthritis can lose roughly five percent of knee cartilage per year, the HSS investigators found that a large majority of patients in their study had no further cartilage loss. “The knee can be divided into three compartments, the medial compartment, the lateral compartment and the patellofemoral compartment,” said Dr. Halpern. “If we look at these compartments individually, which we did, in at least 73% of these cases, there was no progression of arthritis per compartment at one year. That is very significant, because longitudinal studies suggest a four to six percent progression of arthritis at one year.”
Suggest to him that he ask about a partial knee replacement (unicompartmental). Much less pain, quicker recovery, and a later revision (if necessary) is much easier to do. Some people aren’t good candidates, but those that are benefit a LOT (I am one of them).
Thanks, I will definitely pass that onto him.
Very interesting thread which will likely be useful to me in the near future. Thanks!
Conventional wisdom among most general orthopedists is that a unicompartmental knee isn’t a good idea if there is any degeneration or cartilage loss under the patella. Most of the recent studies have indicated that that’s not true, and I can attest to that…I had bilateral unicompartmenal replacements done about 5 years ago. That was done by a joint-specialist at the Mayo Clinic, a guy from whom a fair amount of that worldwide research is originating. He was the Fellowship Director for one of my partners when he did his Lower Reconstruction Fellowship. Another reason one should see a joint specialist rather than a general orthopedist for joint replacement surgery.
I had both knees done at the same time. I took very little pain medication, did virtually no physical therapy, and was back at work full time in 3 weeks. My case and photos are part of one of the definitive orthopedic textbooks on the subject http://www.expertconsultbook.com/expertconsult/ob/book.do?method=display&type=bookPage&decorator=none&eid=4-u1.0-B978-1-4377-1756-3..00031-6&isbn=978-1-4377-1756-3#lpState=open&lpTab=contentsTab&content=4-u1.0-B978-1-4377-1756-3..00031-6%3Bfrom%3Dtoc%3Btype%3DbookPage%3Bisbn%3D978-1-4377-1756-3&search=none
I copied that info down, and sent him the link as well.
Thank you again.
Struggling with knee issues for a while. My Solution (might not be the same for you) is biking and elliptical in reverse direction. This strengthens supporting structure making the overall knee stronger. I also work the entire area with reverse lunges, etc.
Find a good sports doc who doesn’t want to cut you and go to a sports specific physical therapist.
Good luck!