26 Nov 2005 13:55:53
Philip Nelson
What about kneecap problems?

My knee problem isnt with my ACL, it's that the cartilage on the back of
my kneecap has deteriorated. The result is days with pain, days with
a noisy knee motion (literally can hear it move) and fluid. Athritis in
both knees. All a suprise, I had never had any knee injuries or pain at
all and now at 46 this showed up. The shape of the knee is the problem,
with too flat a groove for the kneecap to ride in. Anyway, There is no
treatment my doctor could offer other than to say that glucosamine may
help but be careful of the brand. Surgical options are limited: they could
clean it out but it probably wouldn't help. The microfracture technique
mentioned was one option. They would microfracture the kneecap in the hope
that that would force regeneration of tissue that would smooth the ride of
the kneecap.

So has anybody else dealt with kneecap problems like this? Solutions? Am I
correct in thinking that knee replacement wouldn't help?

The problems first showed up on the bike in the spring, and now running
seems completely out, but roller skiing usually made me feel better if I
didn't overdo it. I may hit snow today. Full extension of the knee is the
only motion that always hurts. A deep knee bend isn't so great.


26 Nov 2005 23:02:39
gr
Re: What about kneecap problems?

Philip Nelson wrote:
> My knee problem isnt with my ACL, it's that the cartilage on the back of
> my kneecap has deteriorated. The result is days with pain, days with
> a noisy knee motion (literally can hear it move) and fluid. Athritis in
> both knees. All a suprise, I had never had any knee injuries or pain at
> all and now at 46 this showed up. The shape of the knee is the problem,
> with too flat a groove for the kneecap to ride in. Anyway, There is no
> treatment my doctor could offer other than to say that glucosamine may
> help but be careful of the brand. Surgical options are limited: they could
> clean it out but it probably wouldn't help. The microfracture technique
> mentioned was one option. They would microfracture the kneecap in the hope
> that that would force regeneration of tissue that would smooth the ride of
> the kneecap.
>
> So has anybody else dealt with kneecap problems like this? Solutions? Am I
> correct in thinking that knee replacement wouldn't help?
>
> The problems first showed up on the bike in the spring, and now running
> seems completely out, but roller skiing usually made me feel better if I
> didn't overdo it. I may hit snow today. Full extension of the knee is the
> only motion that always hurts. A deep knee bend isn't so great.
Well I have some advice that is maybe legit. I messed up both knees in
March, doing a variety of bad things to them via an extreme twist. They
fortunately said that they thought everything would heal without surgery
(good because most people do not say they liked the results of surgery).
Anyway, my recovery was handled by the physical therapy people, with the
goals of getting full range of motion back and strength. Range of motion
is handled by simple stretches (must make sure you stretch long enough
for it to be effective!).
Strength is by various exercises which seem to cover all possible
directions. At most they had me using 3lb ankle weights, but had a
couple exercises that they said I couldn't do because of the type of
injury I had.
Where I am going with this is that it would be very good to strengthen
all the leg and ankle muscles as much as possible, because this will
greatly help to hold the tendons and cartilage in place.
gr


27 Nov 2005 01:35:35
Mike H.
Re: What about kneecap problems?

I have problems with my knees (and ankles) for about 5 years. Touch wood,
my knees seem to better now than 5 years ago. And I'm older than you are.
Not sure whether this will help you but listed below are the things I have
done since the knee starting hurting:
- use custom orthodics in my shoes and boots, as recommended by my doctor
- wear a pair of Birkenstock as slippers at home, as recommended by my
physiotherapist
- I don't try to push high gears on my bike

Ah yes. I now do mostly classic instead of skating, the latter definitely
hurts my knee more.

... Mike H.




28 Nov 2005 19:43:06
John Forrest Tomlinson
Re: What about kneecap problems?

On Sun, 27 Nov 2005 01:35:35 -0500, "Mike H." <[email protected] >
wrote:

>I have problems with my knees (and ankles) for about 5 years. Touch wood,
>my knees seem to better now than 5 years ago. And I'm older than you are.
>Not sure whether this will help you but listed below are the things I have
>done since the knee starting hurting:
>- use custom orthodics in my shoes and boots, as recommended by my doctor
>- wear a pair of Birkenstock as slippers at home, as recommended by my
>physiotherapist
>- I don't try to push high gears on my bike
>
>Ah yes. I now do mostly classic instead of skating, the latter definitely
>hurts my knee more.

I have a minor version of the OP's problems, and for me orthotics are
essential. And I try to wear slippers with an arch in them at home.

JFT

****************************
Remove "remove" to reply
Visit http://www.jt10000.com
****************************


29 Nov 2005 12:38:58
Philip Nelson
Re: What about kneecap problems?

On Sun, 27 Nov 2005 01:35:35 -0500, Mike H. wrote:

> I have problems with my knees (and ankles) for about 5 years. Touch wood,
> my knees seem to better now than 5 years ago. And I'm older than you are.
> Not sure whether this will help you but listed below are the things I have
> done since the knee starting hurting:
> - use custom orthodics in my shoes and boots, as recommended by my doctor
> - wear a pair of Birkenstock as slippers at home, as recommended by my
> physiotherapist
> - I don't try to push high gears on my bike
>
> Ah yes. I now do mostly classic instead of skating, the latter definitely
> hurts my knee more.
>
> ... Mike H.

Skating seems easier on my knees so far but I haven't been able to classic
mmuch yet since it started acting up.

The responses so far don't seem specific to knee caps though. So maybe
this isn't a very common problem. Orthodics would imply a problem where
the knee was being pushed to one side or the other but that doesn't seem
to match what's going on for me. Doctor didn't recommend this for me
(sports medicine doctor, apparently works with football players a lot).
High gears on the bike, bad. High cadence on the bike, bad. Wimpy pace on
the bike, OK. I had it fitted but it really wasn't far off and that didn't
help.

Still looking for ideas!



29 Nov 2005 09:24:18
Gene Goldenfeld
Re: What about kneecap problems?

Philip, sorry to hear about your knee problems. My first reaction was
to wonder whether you've ventured beyond Green Bay to get a second
opinion from a top sports orthopod at UW Madison or in a big city
such as Chicago (no offense meant to GB). I don't know who that is or
whether it would make a difference. A way to maybe find out if it's
worth it would be to post on one of the medical question newsgroups
(sci.med, http://asmiforum.proboards21.com/).There are a few medical
help sites at which you have to pay a little, but with a quick search I
can't find any for sports med or orthopedics.

Gene

Philip Nelson <[email protected] > wrote:

> The responses so far don't seem specific to knee caps though. So maybe
> this isn't a very common problem. Orthodics would imply a problem
> where the knee was being pushed to one side or the other but that
> doesn't seem to match what's going on for me. Doctor didn't recommend
> this for me (sports medicine doctor, apparently works with football
> players a lot). High gears on the bike, bad. High cadence on the
> bike, bad. Wimpy pace on the bike, OK. I had it fitted but it really
> wasn't far off and that didn't help.
>
> Still looking for ideas!
>


29 Nov 2005 14:07:07
Re: What about kneecap problems?

Phillip-
I was diagnosed with this problem when I was in my late 20s, which was about
20 years ago. I was an avid soccer player and alpine skier, and my knee
pain eventually caused me to quit these sports and made it painful to hike,
go up or down stairs, etc. The older name for this is chondromalacia, but
it goes by several different names now. A pretty good web site that
describes the problem is: http://veggie.org/run/chondromalacia/

In my case, strengthening the VMO muscle via physical therapy (at first) and
then using low weights on a leg extension machine and exercising the quad at
the last 10-15 degrees of extension helped. The VMO is the small muscle
that is part of the quad, located on the inside of the quad group just above
the knee. It helps to stabilize the movement of the patella as it moves
while you bend your knee. When it is weak relative to the rest of the quad,
your patella is pulled to the outside as you bend your knee, which wears the
cartilage and causes pain.

With time (i.e. over the years), the pain diminished and I am able to do
most things now without pain. I still avoid too much running, especially on
pavement, and I've replaced the alpine skiing with nordic. I cycle a lot,
and I try not to push big gears too much and I keep my saddle a bit higher
than normal. You want to avoid any undue pressure on the patella, which
occurs when your knee is in the bent position. Skate skiing sometimes gives
me a twinge of pain; classic skiing doesn't seem to hurt (at least my knees
:).

Gene's advice is good - seek out a well-regarded sports medicine doctor who
either participates in or understands your sport. A good physical therapist
is also essential. Good luck.

Todd

disclaimer: I'm not a physician, just a satisfied customer




02 Dec 2005 00:34:39
Philip Nelson
Re: What about kneecap problems?

On Tue, 29 Nov 2005 09:24:18 -0600, Gene Goldenfeld wrote:

> Philip, sorry to hear about your knee problems. My first reaction was
> to wonder whether you've ventured beyond Green Bay to get a second
> opinion from a top sports orthopod at UW Madison or in a big city
> such as Chicago (no offense meant to GB). I don't know who that is or
> whether it would make a difference. A way to maybe find out if it's
> worth it would be to post on one of the medical question newsgroups
> (sci.med, http://asmiforum.proboards21.com/).There are a few medical
> help sites at which you have to pay a little, but with a quick search I
> can't find any for sports med or orthopedics.
>
> Gene

Thanks Gene, it does sound like a good idea to get a second opinion. I
have had a name to go for, but maybe I'll take the step and travel a
bit. No offense taken on GB, and perhaps a guy known for football wasn't
the best choice. I'm going to follow up on Todd's post as well.


02 Dec 2005 00:46:13
Philip Nelson
Re: What about kneecap problems?

On Tue, 29 Nov 2005 14:07:07 -0500, Todd wrote:

> Phillip-
> I was diagnosed with this problem when I was in my late 20s, which was about
> 20 years ago. I was an avid soccer player and alpine skier, and my knee
> pain eventually caused me to quit these sports and made it painful to hike,
> go up or down stairs, etc. The older name for this is chondromalacia, but
> it goes by several different names now. A pretty good web site that
> describes the problem is: http://veggie.org/run/chondromalacia/

Great site. Your symptoms and mine seem almost identical. From that site
the problem is shallow femoral groove, genetic.
>
> In my case, strengthening the VMO muscle via physical therapy (at first)
> and then using low weights on a leg extension machine and exercising the
> quad at the last 10-15 degrees of extension helped. The VMO is the
> small muscle that is part of the quad, located on the inside of the quad
> group just above the knee. It helps to stabilize the movement of the
> patella as it moves while you bend your knee. When it is weak relative
> to the rest of the quad, your patella is pulled to the outside as you
> bend your knee, which wears the cartilage and causes pain.

OK now you really have my curiosity up. Time to seek some extra advice. In
my case I was told to avoid the extension of the last 15 degrees if I did
extensions. The plot thickens ;-)

>
> With time (i.e. over the years), the pain diminished and I am able to do
> most things now without pain. I still avoid too much running,
> especially on pavement, and I've replaced the alpine skiing with nordic.
> I cycle a lot, and I try not to push big gears too much and I keep my
> saddle a bit higher than normal. You want to avoid any undue pressure
> on the patella, which occurs when your knee is in the bent position.
> Skate skiing sometimes gives me a twinge of pain; classic skiing doesn't
> seem to hurt (at least my knees
> :).

Interesting! I had settled on a higher seat position too and it got me
riding again, but then the other knee started acting up in the back. I
suppose I can keep experimenting, but with some snow on the ground now,
forget the damn bike, go skiing! I haven't done much hill work yet, but
when I have it's felt fine, so for now things are looking up.

Thanks so much for the information.




02 Dec 2005 00:58:33
Gene Goldenfeld
Re: What about kneecap problems?

When I had kneecap pain several years ago, I had no idea what the cause
was but the Sports Medicine Bible or Sports Injury Handbook suggested
for something else 30 degree single leg extensions to strengthen the
mid-quad muscle. The result was not only pain disappeared (almost
immediately) but also much more strength climbing when the snow came.
For someone with a bad knee, limited range of motion strengthening
makes good sense.

Gene

Philip Nelson <[email protected] > wrote:

> On Tue, 29 Nov 2005 14:07:07 -0500, Todd wrote:
>
> > Phillip-
> > I was diagnosed with this problem when I was in my late 20s, which
> > was about 20 years ago. I was an avid soccer player and alpine
> > skier, and my knee pain eventually caused me to quit these sports
> > and made it painful to hike, go up or down stairs, etc. The older
> > name for this is chondromalacia, but it goes by several different
> > names now. A pretty good web site that describes the problem is:
> > http://veggie.org/run/chondromalacia/
>
> Great site. Your symptoms and mine seem almost identical. From that
> site the problem is shallow femoral groove, genetic.
> >
> > In my case, strengthening the VMO muscle via physical therapy (at
> > first) and then using low weights on a leg extension machine and
> > exercising the quad at the last 10-15 degrees of extension helped.
> > The VMO is the small muscle that is part of the quad, located on
> > the inside of the quad group just above the knee. It helps to
> > stabilize the movement of the patella as it moves while you bend
> > your knee. When it is weak relative to the rest of the quad, your
> > patella is pulled to the outside as you bend your knee, which wears
> > the cartilage and causes pain.
>
> OK now you really have my curiosity up. Time to seek some extra
> advice. In my case I was told to avoid the extension of the last 15
> degrees if I did extensions. The plot thickens ;-)
>
> >
> > With time (i.e. over the years), the pain diminished and I am able
> > to do most things now without pain. I still avoid too much running,
> > especially on pavement, and I've replaced the alpine skiing with
> > nordic. I cycle a lot, and I try not to push big gears too much and
> > I keep my saddle a bit higher than normal. You want to avoid any
> > undue pressure on the patella, which occurs when your knee is in
> > the bent position. Skate skiing sometimes gives me a twinge of
> > pain; classic skiing doesn't seem to hurt (at least my knees
> > :).
>
> Interesting! I had settled on a higher seat position too and it got me
> riding again, but then the other knee started acting up in the back. I
> suppose I can keep experimenting, but with some snow on the ground
> now, forget the damn bike, go skiing! I haven't done much hill work
> yet, but when I have it's felt fine, so for now things are looking up.
>
> Thanks so much for the information.
>
>