Does this sound like your situation?
You're a self-proclaimed athlete--certainly in shape, but not quite a professional runner/cyclist/etc. You decide to train for the local 10-mile race, or perhaps even a marathon, maybe you're a cyclist who is riding more than usual. Your knee starts to give you trouble, so you see your doctor and are diagnosed with chondromalacia.
You're given the treatment for chondromalacia: rest, medications, exercises. You participate, to some degree, with these treatments, but the knee pain persists.
Why is chondromalacia a persistent problem?I can't tell you how common this story is in an orthopedic surgeon's office. One of the most common problems we see is chondromalacia, and patients often take a long time to recover. Here is why the recovery from chondromalacia can be so difficult:
- You are doing activities your body is not ready for.
Running 10 miles or a marathon is not a normal activity. You are asking your body to take on a terrific burden by participating in these activities. Often patients complain that "this doesn't seem to happen to others." Absolutely wrong! Nagging injuries in part-time athletes, even in professional athletes, are probably the most common reason for a visit to a sports medicine specialist.
On top of asking your body to do some un-natural activities (running 20 miles is NOT natural), many patients spend the rest of their day at a desk. Then they set aside an hour or two to cram all their physical activity into the late afternoon.
Don't get me wrong...distance running and other activities that cause chondromalacia are great for the body. The benefits to the heart, lungs, etc. far outweigh the knee pain of chondromalacia. But be understanding of the limits of your body. It is not abnormal for your body to develop symptoms of chondromalacia if you are a distance runner!
- You don't really participate in the treatment.
This is certainly not true for everyone, but it is true for the majority of patients. If you want to rid yourself of chondromalacia, you MUST rest. Any activity that causes chondromalacia knee pain, be it a run, walking up steps, or anything else, is causing further irritation to the cartilage under the kneecap. You need to give your body a chance to heal.
Many patients are given a knee strengthening program or sent to a physical therapist. The reason for this is not so much to make you stronger (the average patient with chondromalacia is quite strong), but to better balance the muscles around the knee. Without specific exercises to balance these muscles, and a proper stretching routine, the problem of chondromalacia will likely not be solved. Doing the exercises every day is an important part of treatment.
- You haven't set aside enough time to recover.
Many patients have a race in two months, have the onset of chondromalacia, and expect a few days of backing off their training schedule should cure the problem. Sorry. You need several weeks, at a minimum, to allow the irritated cartilage to settle down. You'll then need several more weeks to slowly build up your activities in order to resume your training schedule.
I'm Still Not BetterA small percentage, less that 10%, of patients will not find relief even after a good period of rest and rehabilitation. There are surgical options for the treatment of chondromalacia, but the best results of treatment are found with rest and therapy, so unless you give these conservative measures a very good effort (3 to 6 months), it is not worth considering surgery.
The only way to really focus on recovering from chondromalacia is to not have a specific goal ahead of you (i.e. a race that you're training for). If you really want to run your race, wait until the event is completed, then set aside the time to rest, perform exercises, and slowly return to activities. Chances are, if you do this the right way, your symptoms of chondromalacia will improve.