Chondromalacia Patella

I have recently been diagnosed with Chondromalacia Patella. This has come on after having a 3 week break from training. I currently can only ride at low watts for about 10 minutes before I get pain behind my knee cap.

  • Has anyone had any experience with this?
  • What was your treatment?
  • How long was recovery?
  • Any tips?

I have seen a physiotherapist. I have seen my GP. I’ve spoken to my bike fitter. I am 30, and train 10-12 hours a week on the road/indoor.

Thanks!

My current advised regime includes:

  • Glute strengthening
  • quad med strengthening
  • NSAID
  • Ice

If you’re not doing so already, ramp down your training for a few weeks, maybe more. Give the cartilage a chance to heal. Cartilage heals very slowly however, as it does not get any blood supply. The good thing about cartilage under your patella is it’s non weight bearing, so is under nowhere near as much stress as weight bearing cartilage in, say, your knee or ankle.

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Thanks for the reply @DaveWh. I’ve completely stopped my training for the moment. But going a bit batty without exercise…

Yeah - it’s hard to stop working out. But it’s better to rest and allow the cartilage to heal, than keep going an eventually needing surgery. Cartilage repair surgery is far from guaranteed to work, and surgery will have you not training for 3-6 months.

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This is usually a tracking issue stopping the bone beneath the patella tracking properly in the groove it should move in. Check your VMO muscle (inner quad muscle) if it is not firing it can waste away and cause alignment issues. Also the opposite side the Vastus lateralis muscle can get tight and pull the quad out also causing problems. The former problem can be fixed by doing single leg squats with the heel raised on a book to strengthen the VMO, the latter can be fixed by foam rolling the ITB and the outer quad - in fact the whole quad. Also check your glutes for trigger points - especially the Glute medius/minimus - this can cause hip problems and that can play havoc with the alignment of your whole leg…a physio can give you advice on this

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Yep, for 20 years but following trainer road in workout instructions to make sure my knees don’t go in slightly mid stroke it pretty much cured it. Also sitting cross legged may have helped with stretching my groin muscles. Your mileage may vary.

I’ve had it on and off for 20 years. In my case I caused it by using the quad extension machine in the gym and not doing any VMO focused exercise. Follow what your PT says, and as with training, rehab is all about consistency.
As the others have said, if it arrives then I need to foam roll my ITB and focus on strengthening my VMO.

Couple questions.

  1. Do you do any strength work in the gym already? 2. If so, then what?

I suffer from cartilage damage that’s always going to be there on the back of my patella. Yes it isn’t load bearing so that’s a really good thing. But I have to stay on top of my strength work, all glute work imaginable, hip abduction and adduction, and quad and hamstring lifts. Mine came about because I neglected strength work for so long. It took me 3 months to get where I was able to get on the bike with no pain.

So what you are doing is pretty much the standard regimen. I made some changes to my bike fit with my fitter. We did shorter crank arms 175>170’s. New pedal and cleat interface (Speedplay) from look’s that were 10 years old. Basically gave my knee more float and reduced the knee angle at the top of my pedal stroke. My seat came up 5mm With crank arm adjustment which gave me a 10mm increase at top of my pedal stroke. This all my situation so if you have any specific questions feel free to message me.

Mike

Hi all,

Thanks so much for all your responses. I suppose my main confusion stems from the fact that if I manipulate my kneecap laterally (literally by just pushing it with my fingers) all symptoms disappear. Yet, it seems like ALL the treatments involve strengthening the VMO to bring the kneecap medially. Seeing my physiotherapist tomorrow to chat further about it.

I currently only do body weight strength work:

  • Push-ups
  • Chin ups
  • 1 leg weighted squats
  • Lifting my bowl of weetbix to my face

I also have a regime of strengthening (not strength) exercises for my glutes and hamstrings. I should have said that I regularly roll and massage my quads and ITB as part of my normal daily physical therapy.

I have, on prior recommendation from my fitter, some shorter cranks arriving. I am quite tall at 195cm so this seems an odd move but I trust my fitter (Steve Hogg).

It’s curious that this has come on so suddenly after a break from the bike. Seems a little unfair!

Thanks again.

I got diagnosed with this a little over a year ago. Had always been able to cycle but knee really bothered me playing other sports. Started physical therapy last year and kept at it until summer when i got lazy. Started back up this fall and am having less knee pain now than in the last several years. After a hard ride I’d always have to ice my knee, but haven’t had to recently.

Sounds like you’re on the right track, I’m sure your PT will have some good advice for you. One thing you might ask him about is using KT tape on your knee to help align your patella. I did this for a while and it helped me, but haven’t had to resort to it in a long time.

The core exercises in my routing are
Single leg deadlifts
Split Squats
Clamshells with resistance band
Side lying hip abduction
Single leg glute bridge
Resistance band side walks.
Various hip mobility and hamstring stretching.

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Hey @tcmoore02 - the strength stuff I have been doing sounds very similar to what I am up to now. Looking forward to seeing my physio tomorrow. I’ll ask about strapping. I was surprised my normal physio didn’t do it - she normally does.

Hopefully I can get back to something approaching normal training soon - going from 10+ hours to almost no activity is driving me a bit nuts…

I have had this issue for about the last 5 years. Luckily, it does not bother me on the bike somehow. But, running any significant distance became too painful too continue. And I like to run.

Mine is caused by a small chip in the patella, lack of cartilage, and tracking issues from what the docs have told me. I tried strength training and PT to no (well, maybe a little) avail. I did a few rounds of Orthovisc, which supposedly acts as a synthetic lubricant. It didn’t work.

I recently did a PRP injection as a last ditch effort before considering stem cell therapy. I’ve run up to about 10K since then with no issues. I am cautiously optimistic that PRP May have actually helped.

Good luck with recovery.

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One other thing to note - I can cause pain even if my knees are working fine by wearing tights that put pressure on the kneecap when flexed. I’m lucky in that I don’t need leg covering other than shorts unless it’s really cold.

How is this Chondromalacia Patella diagnosed, using MRI scan or just by feel? I’ve had knee issues for one year now. First doctor diagnosed patellar tendonitis and directed me to pt who gave these typical glute activation and strengthening exercises and did some manipulation. Nothing much changed. Then I broke my arm last summer (nothing to do with cycling nor exercise) and knee was not my first priority. Every time I tried to start TR workouts or running the pain came back. Next doctor told me he doesn’t think there’s really anything broken but I understood he referred to Patellofemoral Pain and I went to another pt. He found alignment issues and muscle imbalances. I’ve been doing one legged exercises for glutes and vmo etc. but I felt that even though nothing bad happens during the workout the knee was usually sore afterwards. According to pt that’s not an issue.

I recently saw this link on another post on this forum. https://www.painscience.com/tutorials/patellofemoral-pain-syndrome.php The free chapters sounded so familiar to my own experience that I paid for the full copy (17 €). What it says is basically that so many things starting from sitting with tight knee angle can irritate the tissue around kneecap once the problem exists. It also criticizes theories behind biomechanical explanations, imbalances and tracking issues and says that research based evidence really isn’t there even though that seems to be the “official explanation”.

As recommended on that e-book I’m now trying to finally give my knee a proper rest and avoid all the activities that possibly irritate it – to best of my ability, ski season is here and….well you know how difficult resting can be. :laughing:

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Good list to follow right here!

Mine was only diagnosed by MRI.

I’ll tell you with this condition. Usually always a reason behind it. Wether it’s overly tight IT band and outer thigh or super weak VMO. Cycling does break down the VMO and over work the outside of your thigh. All it takes is a very small mis alignment of the patella. Mine was caused by weakening of the Glutes and VMO. I had quit strength training all together on the lower body and this is how I got into trouble with it. The outside of my thigh is obviously very developed but the VMO is under developed. My advice for anyone is do everything you can corrective wise and fit wise as a cyclist and rest initially. It will get better.

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Been managing this for 20 years. Started with an overly aggressive running training program. Had to stop running for a year.

The simple things:

  • Exercises - many have suggested ideas, you can find a top on the web
  • Stretching - ditto
  • Knowing when to back off, when to stop - do not exercise with pain.
  • Ice when needed (but if you are careful, you won’t need it)
  • Manage volume and ramp-up - it’s a wear and tear issue, so increasing training load faster than you can heal/reinforce will always bring it back. Listen to your knee, it won’t lie to you.

Lots of good ideas…I had developed this about 12 years ago. You won’t want to hear this, but I took the summer off completely after being diagnosed that Spring…no riding, avoided stairs where possible (which is a common paint point) and basically just took it easy. My doc also recommended a strap to wear just below you patella to keep its alignment in check. I’m also a skier and was able to ski again that winter w/o pain, and…I eased back into cycling that fall on a trainer, and raised my saddle just slightly above normal. YMMV, but I am completely pain-free in both knees. The key for me was the initial layoff…not the summer I looked forward to but kept me going the years after that w/o any knee issues. Good luck and rest well!