Hi all! I’m 29 and was just diagnosed with chondromalasia patella type 2. I’m going through PT and working on peddling with my glutes more. Has anyone been able to race after this diagnosis? Also I’m hoping to be competitive for the next few decades, is this still possible?
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Yes and yes. It took a long time (two years), but there is hope. I was barely able to walk and am now racing pain-free. If I can offer some advice, it would be to accept that your current limit is not what it was before you were injured and it is not what you want it to be. That doesn’t mean you can’t get there in the future, but it’s the current reality. Find out what that limit is, and do your best to stay within it. Then very gradually increase things. Perhaps you can ride 15 minutes slowly pain-free. Next week, ride 17 minutes. At some point, you’ll overdo it and set yourself back for a few days; this is normal. Accept that too, but aim that the general trajectory is an improvement over weeks or months.
There are lots of resources out there. The two that I found most helpful (other than one particular physio) were the book associated with this blog https://savingmyknees.blogspot.com/ because it offered hope and a way of thinking, and this website Patellofemoral Pain - E3 Rehab because it encapsulates the same way of thinking in a much shorter form.
In addition, as a doctor myself, I would say that chondromalacia is not a very helpful diagnosis - the imaging does not match the symptoms and everyone seems to have a different definition of what the word means. In fact, you probably had the same scan before it started hurting, and you’ll still have it afterwards. A large majority of doctors will be useless in treating this, but a good physio can put you on the right track.
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Thank you so much for this response. I’m working towards accepting my current state but it has been difficult as cycling has been my identity for so many years.
I’ll definitely check out those resources as my doctor was less than helpful. He basically said it’s not reversible and that I can no longer run downhill.
Had patellofemoral pain in both knees for a bit about 3 years ago. Took some time but got over it and now a minor twinge of knee pain at random that doesn’t last is all that’s left, if that.
First, if you can find the source of your bad patella tracking that would be the first step to getting rid of it. Mine was a bad bike fit due to my own silly tweeking. Put me in a bad spot. After a bunch of reading and then more educated tweeking of position I got close to almost there. Was a saddle height to cleat position thing with the knees caught in the middle. Got a motion capture bike fit to confirm and get me that last little bit of the way there. Have used subtle variations of those numbers ever since.
Second, stretch and strengthen. Something that can cause bad patella tracking is a tight IT band and a weak VMO. Doing a bit of off the bike strength to work on the VMO and glute meds can assist getting things back on track. There’s a lot of videos and such out that to find exercises you like that will help. I also have a nightly stretching routing that’s at least 50% hip stretches because our hips can get quite tight which in turn affects the knees. IT gets attention as a part of the stretches in a few ways. While you’re making the changes and doing what you need to recover you can use McConnell taping to force your knee cap into the right groove while you continue on the bike and daily life but this is just a band-aid (made of tape). I do remember having a habit of putting cold packs on my knees post-workout for quite some time as recommended by my primary to help control the inflammation. Remember, the knees are always the victim.
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Yes, the body is amazing. Stay positive and mark your expectations. You’re in this for a long haul
Hi, was told by two orthopedic surgeons easy spins were all I had left, running was done forever blah blah blah, and I believed them for 5 years before ignoring them.
I needed a whole lot of ice pack use to get me through riding, lighter weight box squats and running easy, but I have been weekly riding 300 km at competitive (for my age) speeds and trail running 50-60 km up and down mountains with zero problems regard the chondromalasia. My iron knees run down things that would make most people cringe.
Keep at it, use ice when needed, and you should get past it with some perseverance. I swear my soft kneecap has reversed itself and is better than ever
By the way, that happened in my 40’s, I am now in my late 50’s. Your body is younger and I could reverse mine, you can reverse yours. Doctors say routine answer stuff, don’t believe them!
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How are you now Dev? 
You still cycling? PT was helped you?
I had type 2 chondromalacia too. Focused on hip/glute activation, single-leg strength, and cadence control. Took me about 8 months, but I got back to racing 10Ks without pain. Keep your form clean and respect recovery days.
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Hi!
Which exercises you use for hip, glute, and VMO? Did you go to PT, or do it yourself from YouTube?
I had patellofemoral pain in my left knee ~13 years ago. A break, some specific exercises, and bike fit (adjusted my shoe varus/valgus and cleat height), cured it and it hasn’t bothered me since.
Yes I was diagnosed via MRI in like 2017ish. Doctor (a well respected sports medicine physician who treats professional athletes) told me I’d never run long distances again!! Spoiler: I did. I am not running these days, although I am sure I could if I worked up to it. I used to have regular recurring knee pain on the bike. I’ve posted elsewhere on this forum about managing this knee pain so search my post history. 99.9% of the time it no longer bothers me at all on the bike. It will flare up if I am doing a lot of pushing with my knees - like lower cadence, high intensity - for several days in a row.
What ultimately worked for me was:
- regular mcconnell taping (watch a youtube video) using the same tape the physical therapists use - cover roll stretch and leukotape P. put the cover roll down first, then apply the leukotape from the outside of the knee, pulling the kneecap inward towards the right. this has the same effect as pushing your kneecap inward with your hand while your leg is relaxed. i dont usually ride with the tape - i use the tape while resting and sleeping while symptoms persist.
- avoiding too much sweetspot and threshold work and instead polarizing training. the worst things for me are lower cadence, moderately high intensity efforts.
I never found that prolonged rest helped the situation. Rather, switching to some long, slow rides, taping, and then adding in > 100% FTP intervals helped.
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Hi breeanna33!
Which CMP grade you have?
Im doing a lot better! Here is everything I have focused on this past year.
- Regular stretching and lifting to address muscle imbalances. When cycling before my glutes would never fire.
- I went all in on short cranks and put 150 length cranks on all my bikes.
- I do my best to avoid cycling when it’s super cold outside as that has caused some pain.
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That’s sounds good mate!
I have CMP grade 1. I also focusing stretching, and strengthening exercises like VMO and glutes. My road bike always have 172.5mm crank, but now changed to 165mm.
Msm+glucosamine+ collagen combo what I use. I hope my knees getting better, but my doctor want a correction surgery both knee, because my patella sit a little bit higher than normal.
Good question! I pulled up my MRI results from 11 years ago:
IMPRESSION:
1. Focal high-grade (approximately 75-90%) fissure involving the articular cartilage of the medial patellar facet without involvement of the subchondral plate.
2. Mild tendinopathy involving the proximal fibers of the patellar tendon with mild associated soft tissue edema.
3. Small focus of grade 1 chondrosis involving the articular cartilage of the medial femoral condyle near the intercondylar notch.
…..
Patellofemoral: There is a focal high-grade fissure involving the cartilage along the medial patellar facet best seen on series 3 image 15 and series 5 image 18. While this involves at least 75% thickness, there is no apparent involvement of the subchondral plate and there are no cystic or edematous changes in the patella. Medial tibiofemoral: There is a focal area of grade 1 chondrosis involving the medial femoral condyle articular surface near the intercondylar notch and slightly posterior (series 7 image 8 and series 5 image 13). The medial tibiofemoral cartilage is otherwise normal.
I’m in my mid-thirties. TBH I have not put much thought into my knee in the past few years because it so rarely bothers me but 10+ years ago it was extremely frustrating and I feel like I just tried everything to fix it. Taping + more polarized training would be the main things that helped I think. I’m super particular about my bike fit and avoid changing anything or getting new bikes because of it, although I think it’s more out of fear than actual risk. My seat height is as important to me as my social security number. I do use 165mm cranks but I’m a very short person.
I don’t run much anymore but was running quite a bit when I was diagnosed. I have run ultramarathons since the diagnosis and was fine, despite the doctor saying I wouldn’t be able to.
Since this MRI I have competed in multiple cycling races of 100+ miles, 9+ hour races, 14 day bikepacking adventures, etc. I have had flair-ups but that’s when I tape while resting and ease off hammering the pedals.
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I would definitely pursue multiple second opinions before surgery!! I just listened to Kiera D’Amato’s book (american marathoner) and it’s crazy how many times she was told she needed surgery and she would never run again and then told she didn’t need surgery… and she went on to set the American women’s marathon record at like age 35 or something.
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I went to 5 doctors with my problem, only the last one told me the specific problem with my knee.
I have a very tight ITB in my left leg, and my left leg have the most problem. 99% this cause the patela tracking problem. 6 monts of PT, working on glutes and VMO, stretching, and still have this pain ffs…
This ITB syndrome has been going on for 10 years, and I’m really tired of it making my life miserable, because i can’t fix this.
In mentally i’m very deep.
So my last hope the surgery…
Have you tried other PTs? I used to work in PT and they’re definitely not all created equal. The PT I went to for my knee didn’t help me but I was able to use what I had learned from working with PTs who worked with athletes to help myself. There’s an awful lot of PTs who mostly work with entirely unathletic people. A good PT is better than a good doctor for this imo.
I also think that sitting on a trainer is not great for knee pain like this. It’s too steady and consistent..when I was dealing with this I always noticed that my knee bugged me less on the mountain bike where the pedaling was very inconsistent than when I was on the local flat bike paths and the trainer where I pretty much sat in one place. Even now sometimes the trainer will bug me while an outdoor ride never does.
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And also, have you tried mcconnell taping? With the proper tape? If your PT has you doing VMO work, that would indicate they think your patella is being pulled the the outer side of your leg. Mcconnell taping counters that. For me it is important to tape while resting - taping while riding makes no difference but taping while resting allows the inflammation to subside and a mental break from the pain. Ice plus tape is great too. I used to tape before bed and strap an ice pack on.
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