Skiiing after chondromalacia and under patella bruising

[ski_adk]

While running back in October, I stepped down and felt a shooting pain in my knee...as if I put a bone through my pattela. Turns out, I just about did. Got an x-ray, which looked like it was a stress fracture, so I took a few months off. It didn't really seem to get much better and after an MRI 3 weeks ago, I found out it's not a fracture, but that I do have a fairly bruised patella from my femur pressing through my cartilage and the 2 banging, bone on bone. They also found the beginnings of degenerative osteoarthritis. Doc says I still need to rest to let the bruise heal and to re-evaluate beginning of march, In the mean time, I do get to bike and swim, but no running or skiing. It's slowly getting better, but then I'll feel a twinge walking down the 5 stairs at my house...

Anyways, I'm just a month away from 38 and hoping I'm not really as old as that sounds. I'm starting to get squirrelly, doubting whether I'll be able to run or ski again (hence the rant, but hey, at least it's turning out to be the driest winter on record). Anyways, anyone else been through this before? Please tell me there's hope...

[mel221]

The other Knee Gimps must be shy, so I will share you my story.

First of all, I share your pain.... Knee Osteoarthritis, Patella issues, and the low snow ski conditions here in SLC.

I am a bit over 50 and have been struggling the knee pain for about 3 ski seasons with each season worse than the one before. But, this season is somewhat better than last year. Here is what I am doing...

1. My problems are with my left knee. I have lateral compartment osteoarthritis in the left knee. I now am skiing with a lateral supporting DonJoy knee brace to manage this. I have to manage the up and down landings with care to avoid pain and further degradation of the cartilage.

2. Most of my pain comes from a poorly tracking patella that is caused by a weak VMO. But to strengthen the VMO, you have to stress the quad muscles which puts a lot of force on the patella when it is in a bad (squatting) position. Continued skiing and physical therapy have contributed to the deterioration of my femoral-patella cartilage.

3. So, I have weak muscles and poor cartilage and I still want to be very active.(skiing, mtn biking, running, Volleyball). I have had to sort my priorities and have concluded my running and volleyball days are over. I am trying to save my skiing and mtn biking career.

4. What has not worked for me; glucosamine supplements and knee joint injections. Also, Heat from a Jacuzzi and from ultrasound. While the heat may increase blood flow to recovering tissues, it contributes to swelling and that is really bad. Any exercise or stretch that bends the knee. Too much pressure on the patella cartilage interferes with recovery.

5. What is working for me.
5a. Eating Oil. Fish Oil (Omega 3 supplements) and Olive Oil. Helps with the lubrication.
5b. Liquid collagen. I think this is working the best for me.
5c. Gelatine. I get a box of Knox Gelatine from walmart and have a packet every day. I make a cup of Ginger Tea and add a packet. I cannot say this is actually helping, but it is a part of my current routine.
5d. Rest with mild exercise. Rest will help the swelling around the cartilage, but will cause the quad muscles to atrophy. Find exercise to keep the quad strong that have minimal impact on the Patella. For me, the exercises are Quad Sets and Terminal Knee Extensions. The stretches involve using the foam roller to stretch the IT band and the quad. Standard quad stretches put too much pressure on the injured patella.
5e. Skiing with adjustments. I had to change from Snowbird to Brighton. The steepness at Snowbird was just too much for the injured knee to handle. At Brighton, I have a wider selection of skiable terrain depending upon how the knee is feeling.
5f. Skiing with adjustments part 2. My knee has problems when loaded in a squatting position. Shifting weight to the bad knee while the knee is bent and then using that leg to standup is too much like a squat... which is problematic for me. So, I ski with 80% of my weight on my good leg and 20% on the bad leg. This is a bit of challenge on flat groomed runs, so I prefer moguls where I can shift my weight after I cross over the top of the mogul.
5g. Knee support. I am using a lateral supporting brace to manage the Osteoarthritis in the lateral compartment. I also use a patella strap to stabilize the patella tendon.
5h. Icing after any exercise. 20 minutes of icing per hour all day long... After skiing, biking or working out. This is to manage the swelling.

I will describe the controversial part of my program in the next message.

[mel221]

My last post focused on being active without making thing worse. Lubricating the knee joint, managing swelling, stretching and strengthening.

None of this deals with healing the damaged cartilage. You can search this forum and find posts about PRP and stem cell prolotherapy. Some have had success, some have not. The science for using stems cells is promising and I am hoping to stay active until I have more confidence in the technology. I really want to avoid a Knee Replacement.

I am exploring some ideas that are being bounced around on the internet (if its on the internet, it must be true!). The idea is mega dosing Vitamin D. To get an idea of what is being claimed, you can read an E-book (not mine, so I don't get paid) that describes an individual's success and ideas while taking a large daily dose of Vitamin D.

The e-book is THE MIRACULOUS RESULTS OF EXTREMELY HIGH DOSES OF THE SUNSHINE HORMONE VITAMIN D3
http://www.amazon.com/gp/product/B00...?ie=UTF8&psc=1

If you take vitamin D, you also need to understand Vitamin K2 and Vitamin A.
http://www.amazon.com/gp/product/B00...?ie=UTF8&psc=1

I have personally done 2 cycles of high dose Vitamin D. 50K daily for the month of August and 50K daily in October. I will do another 30 days starting April 1.

The general idea is Vitamin D promotes recovery of injured cartilage by softening the cartilage and allowing the cartilage to regenerate. You then have to stop taking the vitamin D to get the cartilage to harden back up. My experience is too detailed to describe here, but I am sufficiently encourage to continue this program for the future.

If you are not taking vitamin D, most everyone can benefit from 5K daily supplement (IMO).

Anyway, this has been a lot of typing... especially after my nightly Scotch, so I'm sure I forgot some details. Feel free to follow up with any questions.

[bourbonisgood]

2. Most of my pain comes from a poorly tracking patella that is caused by a weak VMO. But to strengthen the VMO, you have to stress the quad muscles which puts a lot of force on the patella when it is in a bad (squatting) position. Continued skiing and physical therapy have contributed to the deterioration of my femoral-patella cartilage.

I'm not hear to rain on anyone's parade, but this proposed mechanism of patellofemoral dysfunction has been pretty well debunked over the past few years (if not decades). When physical medicine stopped focusing on the VMO and started addressing femoral dynamics, the success of treating PFPS improved exponentially. People with PFPS should be thinking regional interdependence....

The knee has the unfortunate position of being trapped between two very dysfunctional joints - the ankle and the hip. If your PT is not thoroughly addressing those two areas, find a new one ASAP.

[mel221]

>> but this proposed mechanism of patellofemoral dysfunction has been pretty well debunked

Could explain why I have had little success these past few years. But, I have been to 4 physical therapists (in multiple cities) and 1 osteo doc with similar diagnosis. I have done a ton of core and hip work(monster walk, 3 way crab, etc) which resulted in strong hips, but no knee relief.

My patella most definitely tracks to the outside, influenced by strong outside quads, tight IT band and an underdeveloped, late firing VMO. The VMO on my bad leg is noticeably smaller when compared to my good leg.

But, I am very interested in research. If you are aware of any specific regional interdependence routines recommended for lateral patella pain, I love to study (incorporate) the program. My initial search only showed regional interdependence treatments for medial patella pain.

Thanks for the tip... I will investigate further.

[ski_adk]

Funny enough, part of my knee issue definitely feels like "something not firing correctly"...

With the nice weather, I was able to get some good miles on the road bike and that definitely made things feel better. I also started to do some no-weight squats and hamstring raises which also seem to help. I should be able to get into a PT soon now that he bruising is just about healed and will definitely ask about regional interdependence. I thought I was doing pretty good running, swimming, cycling and playing volleyball last year to keep in shape, but after some quick googling, I'm now pretty sure that didn't do enough to keep my muscles in proper balance.

Thanks for the insights, guys...I feel like I've got some more homework to do...and that perhaps this ski season still isn't completely written off yet...and can definitely hit my goal of doing a sprint tri later this summer.

[rod9301]

I have worn cartilage in the trochlear groove, under the patella grade 4.

What keeps me going is really strengthening the quads and vmos.

Weights don't work, because of knee pain, or at least the heavy weights that I need to build muscle, 600+ lbs on the leg press.

About three years ago I started using an electro stimulator on quads and butt.

I gained about 2" in a few weeks, which is hard to do with weights if youre already a weight lifter.

The muscle contractions are much harder than anything I can do lifting weights, so I can understand building muscle.

Not a spam, and there is a thread here that discusses all this.

I use it twice as year,6 weeks each, before mountain bike season and before ski season, then once a week maintenance, but just 8 contractions, so I don't get sore.

[frorider]

I'm about to schedule arthroscopic chondroplasty on my right knee. 3 yrs ago I was diagnosed with patella femoral pain syndrome, which caused significant bone on bone pain when skiing in any position when the shin wasn't pressuring the boot tongue strongly. Did two 3 month regimes with phys therapists; focus was on hip flexor work and foot/knee/hip alignment, deep massage/ultrasound of scar tissue around knee, and stretching of quad and IT. Helped a lot---essentially all nonskiiing activities are now pain free incl Mtn biking. But doc and I decided that since skiing is so painful still, the next step is cleaning up the ridges on the backside of the knee. He's not a good communicator and hasn't explained whether there are downsides to the chondroplasty, other than 6+ wks rehab. He says he prefers doing chondroplasty first, then trying, only if needed, those polymer injections that have become popular. Anyone have comments on any surgery downsides/risks? And are your docs trying injections before surgery ?

[frorider]

PS round 1 phys therapy did not include enough massive ultrasound and fkn painful massage of all scar tissue/congestion around and under kneecap. For me anyway, getting that done in round 2 along with more deep stretching of quad was the key to progress.

[PITA]

I have worn cartilage in the trochlear groove, under the patella grade 4.

What keeps me going is really strengthening the quads and vmos.

Weights don't work, because of knee pain, or at least the heavy weights that I need to build muscle, 600+ lbs on the leg press.

About three years ago I started using an electro stimulator on quads and butt.

I gained about 2" in a few weeks, which is hard to do with weights if youre already a weight lifter.

The muscle contractions are much harder than anything I can do lifting weights, so I can understand building muscle.

Not a spam, and there is a thread here that discusses all this.

I use it twice as year,6 weeks each, before mountain bike season and before ski season, then once a week maintenance, but just 8 contractions, so I don't get sore.

I too was diagnosed at the time of my ACL reconstruction that I had a grade 4 defect in my trochlear groove. Hoping to find on here other people's experience with it. Pretty devastating diagnosis at age 47, especially for someone who has spent his whole adult life working in the snow industry and living in a ski town.