# Knee issue (possible Chondromalacia patella) and taping.



## Oh My Sack! (Aug 21, 2006)

I have been affected by some knee pain for about a year, now. It's been more often in the last 6 months as my fitness level has increased. At about 9 to 10 miles of technical single track, mostly the climb portion, I start feeling the dull pain across the top of my knee. Typically, only when I pedal, more so when I hammer a rocky climb. Anyway, I mentioned it to my Doc figuring I would just get a Rx for PT to balance my leg muscle but he insisted I get an X-ray. Radiograph didn't show much (expected) but radiologist suggest maybe some fluid on the knee. This led to an MRI which I had done last week. The Cliff Note report I get from my Doc, through his assistant, was that I have "some" cartilage damage and they were referring me to an Orthopedic guy. I have no problem/pain in my day to day routine nor much on the bike until I start to pound out a climb. This has limited my rides to around 1.5 hrs or so and about 12-13 miles on average that yields about 2000' of climb give or take. 

I've been reading up a bit here and elsewhere about the Patellafemoral pain issue and it would seem, as I self-diagnosed, that I am in a pretty early stage. I believe it to be a tracking issue due to leg muscle imbalance. This makes sense to me since last year ALL my leg muscles had all but atrophied due to an unexpected/undiagnosed spinal chord compression at C5-C6 that would eventually rear it ugly head last February. I had no mass below the waist. My neck injury explained this and my recovery has pretty much all been bicycling with just a limited bit of hiking thrown in. Makes sense that my knee is doing what it is, now. 

I just stumbled onto these KT Tape Kinesiology Tape. I stumbled onto a Youtube video showing their use and decided to try it out. Walmart carries the stuff in their limited athletic section. I did 22 miles and 3300' feet of climb yesterday wearing the tapes and had only a very small amount of discomfort in about the middle of my ride. That subsided, however. I'm pretty pissed because all the local Ortho's are booking out till the end of October. One of the better knee docs in a big group might get me in mid-October, I'm waiting for them to call me back after viewing my MRI. I called back to my Primary Doc hoping they'd give me a referral to PT so I can get started but I was only met with a snooty tone from his assistant giving me grief about doing that until I see an Ortho. She was supposed to talk to my doc and get back to me. That was days ago. 

Anybody going through this or been through this? I'd love to see what outcome you have experienced. Cures? Ongoing battles? Anyone tried the tapes?


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## pwrtrainer (Oct 23, 2005)

Check if your state is direct access for therapy. You may not even need a script. Call your PT place of choice, and see if they can find out your insurance info. If Ktape helped, an ortho likely won't be necessary, but check with a licensed therapist anyway.


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## AZ Stumpy (Nov 27, 2008)

I went through something similar last spring. All of my PT exercises were targeted at strengthening my hamstrings. After about a month and a half they cut me loose and ever since then I go to the gym 2-3 times a week and do a few good hammy exercises.


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## Oh My Sack! (Aug 21, 2006)

pwrtrainer said:


> Check if your state is direct access for therapy. You may not even need a script. Call your PT place of choice, and see if they can find out your insurance info. If Ktape helped, an ortho likely won't be necessary, but check with a licensed therapist anyway.


I made a visit to a very good PT Group here. It happened that the girl running the front used to work for a General Surgeon I have seen and know so she was pretty comfortable with offering advice. From what it sounds like, I need a referral to go there. She also pointed me in the direction of the best Ortho Doc for the knee. She's been through 4 knee surgeries from 30 years of soccer. She said this Dr. Woods is the guy I want and ironically his booking schedule was a little sooner than the first doc I tried that is in the same practice. I think I'll call my insurance on Monday and get the straight skinny on it.

I went up and got my printed MRI report and did some snooping on line. The conclusion was:

1. Tiny chondral defect or blister of the cartilage in the medial femoral condyle with adjacent marrow edema.
2. No ligament or meniscal disruption.
3. Small joint effusion.

All in all, 1 & 3 are no real big deal and fairly common. #2 is just plain good.



AZ Stumpy said:


> I went through something similar last spring. All of my PT exercises were targeted at strengthening my hamstrings. After about a month and a half they cut me loose and ever since then I go to the gym 2-3 times a week and do a few good hammy exercises.


This is exactly what I was figuring. I have an old school Nautilus Gym here in my garage that does a "bazillion" things. I just want to be certain that I go about it correctly so I don't create a problem or make things worse.


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## enduromtbtrainer (Mar 1, 2014)

If you want specific help, let me know as there are a bunch of things you can do on your own!


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## Oh My Sack! (Aug 21, 2006)

enduromtbtrainer said:


> If you want specific help, let me know as there are a bunch of things you can do on your own!


I am ALL ears! This might take a while before I get to see someone. Time I'd rather spend mending, if that's possible.


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## enduromtbtrainer (Mar 1, 2014)

First things first, have you tried Dry Needle Trigger Point Therapy?
Do you foam roll or use a massage stick or ball for muscle work?


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## Oh My Sack! (Aug 21, 2006)

Never heard of DNTPT. Yes to foam roller and stick, but maybe not as much as I should be lately. After arguing with my Primary Doc's Med Asst., it took 2 more follow up messages before she finally called me back yesterday and told me the Doc agreed to my request for PT. I won't have my first appt. with the Ortho Doc till 10/22. I start PT tomorrow at 5 pm so I'll find out just what was ordered and how many sessions.


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## enduromtbtrainer (Mar 1, 2014)

make sure to use a PT that does the DNTPT and ask them to make it part of your treatment!


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## pwrtrainer (Oct 23, 2005)

Dry needling has not been shown to be more effective at treating knee pain than sham acupuncture. It is an effective adjunct for maximizing the non specific (placebo) effect of a treatment especially when accompanied by a confident practitioner and a lengthy yet incorrect explanation. Plain old exercise, stretching, soft tissue massage and some joint mobilization will probably do the trick. Dry needling purports a lot of fancy benefits that are not backed by good evidence. Anything that has the claims that needling does needs to have very high quality evidence to back it up. Don't get me started on the trigger point construct. Medical practitioners can't even agree what a trigger point is or even if it is not an anatomical norm. Too many practiotioners out there that think the anecdote is the best form of evidence.


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## enduromtbtrainer (Mar 1, 2014)

Disagree. Proof is in the pudding, so to speak. Just because the medical world is behind in "research," does't mean it doesn't work. Evidence "in the field" results with DN has shown terrific results. If we lived by "evidence based" everything, we wouldn't progress very far medically, in the fitness and performance world, or life in general. But, I'll stick to what I know is successful, and that is a combination of movement screening, soft tissue care, chiropractic, PT, DNTPT and corrective exercise. It works every time.


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## pwrtrainer (Oct 23, 2005)

Research is the forefront of what is to eventually be used in the clinic. Anecdotal evidence does not prove a method works. Post hoc fallacy does not mean needling is why a patient improved. Movement screens are continually shown to be minimally effective especially at predicting injury. Are they cool? Yes. Are they indicative of anything? Not really. 90% of people heal on their own without help from practitioners. Where they get into trouble is when they are exposed to noceboic language like out of alignment and core weakness and bone on bone. Many of the sacred cows of rehab are simply explained by the non specific effect that is attained by their implementation. Give a patient a positive therapist, a comfortable atmosphere and some subtle suggestion and you'll get a 20% reduction in symptoms. Find me a drug that does that and you got a winner. Everything I refer to is backed by decades of rct, meta analysis and countless case series. Needling is backed by a shaky premise and a shakier body of evidence to indicate its use. Go ahead and hold on to the idea that it works. When it goes the way of ultrasound I'll be there still with even more decades of evidence and effective clinical experience having followed sound science.


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## Procter (Feb 3, 2012)

I would highly, highly recommend at least trying McConnell taping over Kinestheisology tape. Its similar, but uses different tape, 2 layers.

McConnell taping is very common and well researched for patellar tracking issues, I credit taping with ending my 5 year patellar Chondromalacia by allowing my patella to track correctly while strengthening the VMO. Once you learn to spot it, if you watch pro football and college football you'll see a lot of the lineman and heavier guys using this technique.

I would recommend you have a Physical Therapist show you how to do it, and experiment with the horizontal tension applied to the knee cap. Too much (pulling the kneecap too much to the side) will aggravate the patella, just as too little will.

You'll need Leukotape and underlayment tape. Taping kits can be found at a medical supply store or ebay - be sure to get the kit with the two types of tapes.

On the question of other techniques like dry needle trigger point . . . sorry Enduro but I gotta agree with pwtrainer on this one. History is filled with thousands of years of sham remedies, because, we humans are not very good at quantifying causal relationships on our own. In most cases (in life) we heal and get better, and, in doing so, we tend to attribute our healing to whatever so-called remedy we happened upon. The whole field of chiropractic is built on this principle.

Fortunately, there is a brilliant method for ending disputes between all of us anecdotal opinionators (online and in real life), who are individually prone to these errors in observation, and quantifying the effectiveness of different remedies with as minimal human bias as possible: Its called scientific research. To prove that something 'works' it must be shown heal statistically faster or better than a control group who receives nothing, or receives the 'regular' therapy.


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## Tracy N (Oct 11, 2014)

I have read this thread with interest. Similar to the OP, I experienced an injury which resulted in atrophy of my thigh muscles. During therapy I began to experience moderate to significant pain in the front of me knee and was told I had a Patellar tracking problem, later an MRI confirmed significant arthritis behind both kneecaps. (Interestingly, only the right one which had the injury and atrophy hurts). What did I do? 9 Months of PT for the original injury and subsequent surgery, and lots of mountain biking! I also continue to do James Wilson's dumbbell combo and body weight program with a few modifications, as many of the exercises were very similar to those I was doing in PT. I also find using a foam roller, especially on the out side of my leg (TFL) and quads, very helpful. Be cautious of some of the machines you find in gyms, the ones where the weight was close to the foot, like the quad extension machine really get a sore patella going! Incidentally, I was getting cortisone injections in my knee and taking prescription anti inflammatory meds so I could snowboard again for the past three years. (Biking is fine, but why do one sport when you can do three?) I stopped taking the meds this year after trying the paleo diet with out the increased pain I've had before. Not sure if it was the diet or time or getting more healthy, but some anecdotal evidence suggests it may help reduce chronic inflammation like arthritis. Hope you feel better, I understand how frustrating it is to have a long term injury when your sports are a big part of your life. It's been four years for me, but I still paddle whitewater, Snowboard and mountain bike!


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## neacail (May 18, 2013)

Hmm. I have bilateral chondromalacia patella. In a nutshell, it is a result of two things. The first is a car accident where my knees hit the dash (this is assumed to be what initially damaged the cartilage behind my kneecaps). The aggravating factor was underdeveloped hip abductors and very tight quads which caused poor patellar tracking.

If they had taken a "sunrise view" xray of your knees even minor patellar tracking issues should have been noticeable. Did they do the sunrise view?

I've suffered for years, but I was originally misdiagnosed. Under the guidance of my physiotherapist (I do everything she advises me to do), my right knee is starting to track better. I can still feel the cartilage catch at times, though. My left knee has not started to respond yet. But, my left knee is the worst of the two.

Something that has really helped my cycling is to raise my saddle up even higher. For a non-injured cyclist, knee angle should be 25-30 degrees (See "The Holmes" method here: How to get your seat height right - BikeRadar). My saddle height has my knee angle at 20 degrees. My bike fitter consulted with Dr. Andy Pruitt (the creator of Specialized's BG Fit) and Dr. Pruitt made the 20 degree suggestion. While my legs feel pretty "stretched" my knees definitely prefer the new angle.

Here's what else I'm doing (which is specific to my issue):

Stretching: Twice a day I give my quads, calves, and hamstrings a really good long stretching session.

Wobble Board: Every hour on the hour (while I'm at work), I balance on my round wobble board. I do one minute with both feet. Then I do one minute on each leg individually. This is to engage my fast twitch muscle fibers.

Strength Building: Squats (I stop before the cartilage starts to pop), lunges (stop before cartilage starts to pop), hip clam exercise, and standing resistance band hip abduction (with the band running behind my static leg, not in front of it).

For squats and lunges I ensure that my knees point directly at my second toes.

I also have patellar straps that I use if I'm in a lot of pain.

She adds something new to my list of stretches and exercises every week.

Overall, things are improving. I'm looking forward to years of continued cycling.


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## Bail_Monkey (May 8, 2007)

Knees are complicated and most likely need analysis by a doctor that specializes in sports related orthopaedics. That said, I've had 'some' knee pain gradually building over the last several years which I believe is caused by road biking up steep roads at close to 100% capability. (The Mtb did not help either!) I was mashing more than spinning and now I am more of a spinner than a masher. I'm an older rider as well...

I currently use a strip of Ace elastic bandage to wrap below my kneecap to keep the patella tendon down. (It is stretchy and can be pulled to desired tension. I do about 4 wraps.) I also have a velcro strap that is about 1" width that secures it. I found that this helps when riding.

I also started to use Glucosamine + Chondroitin that I purchased at Costco. (Kirkland) I was skeptical at first, but it seems to be helping. (Supports Cartilage and joints) When the bottle is empty, I do not plan on purchasing another and will see how the knee feels without it.

As others mentioned, make sure your bike setup/seat height is optimized. The fore/aft position also affects the down stroke stress on your legs/joints. Stem height, stem length, bars / risers-flats all make a difference in the setup and riding position.

Good luck.


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## Clyde250 (Oct 18, 2013)

I have dealt with chondromalacia for the last 3 years. What helped me was using a 3/8" steel bar and massaging my quads and hip flexors to loosen things up. Once the muscles in the quad were allowed to relax, the knee healed gradually on its own. It still took 6 months of modified activity, so be patient. Get your bike fitted by a PT, who can get your completely dialed in.


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## Oh My Sack! (Aug 21, 2006)

Appreciate all the input that's flowed in. I've been busy working the knee, riding, and getting involved in our local trail build group. Here's where I'm at now. I met with my trainer and have been at it for just over 3 weeks, going 2 days a week. I'm confident I made the right choice of PT facilities. This location is VERY sports oriented and though they do a fair amount of geriatric PT, they're really geared up for us "youngsters" (52 goin' on 53) to get up and get back out there doing what we do. My girl graduated from Duke University and has her Doctorate in PT and undergrad in Kinesiology. Cool thing is she worked for Specialized for a number of years so she's pretty tuned in to all cycling disciplines. Through some exercises and tests, she immediately identified a significant muscle imbalance as I expected. As I think I mentioned, after losing all my muscle mass from the waste down due to my severe spinal compression and inability to walk, after surgery rehab since Feb 2013 has been mostly bicycling. There are a lot of muscles that need work. She's got me started on glutes and hips with lots of stretching.

I caught an earlier than scheduled visit with an excellent Orthopedic Surgeon that specializes in the knee. He walked me through every slice of MRI scan from 3 aspects. Very interesting stuff. The good thing is my knee looks great for someone my age. No meniscal, ligament, or cartilage damage which was all written in the report. I have a tiny-tiny spot or blister on the femoral condyl cartilage with a tiny bone edema but he says that's nothing and not causing my pain. He identified a medial plica which is what is giving me an occasional jolt of pain but will not cause any damage. That's mostly inflammation related. What he did note that the radiologist didn't note was an unusual issue with my quad tendon as it interfaces with the patella. Instead of being a nice straight grained tendon, just above the patella the tendon has a slight bend or scarring. I've never had any damage or injury there but the patella tracks up and over that at extension. This could be some of the cause of my pain. Other than that, I'm clean. He suggested PT as we're underway already and also suggested I pay close attention to the float in my pedals. He too is a cyclist (road) and suggested that what I was experiencing could be related. I came home and ground down the sole on my relatively new M162 Shimano shoes. I haz the float, big time, now.

My Chiro just started grinding on my leg and hip muscles this past week, too. Oh dear God that hurts so bad yet so good! My non-problem leg (right) is shorter than the left. My I.T. band and quads are really nutted up on the left. My medial quad on the right is too. He's heavy into myofacial release therapy rather than just cracking bones. He's helped my low back issue immensely when the regular Doctors threw their hands up unable to help or even identify a problem. So....no needle therapy, thank you! I think between my PT and my Chiro that are both on the same page, I'm on my way to fixing this issue. I did about 9 miles of techy single track this morning with no issues other then too much down time because my buddy exploded his brand new light-bicycle chinese carbon front rim build, and then I did another 11 miles on the road this afternoon. Knee feels great after a total of just over 50 miles for the week ending tomorrow. Btw....I am taping still on recommendation of my PT. She's very familiar with the KT tapes and suggested I stick with that for the time being but also mentioned using the McConnell method should I not have satisfactory results with my current approach. We're omitting the medial side of the tapes in order to induce the patella to track more medially. So far it seems to be good.


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## neacail (May 18, 2013)

Oh My Sack! said:


> I think between my PT and my Chiro that are both on the same page, I'm on my way to fixing this issue.


That is great news. I know that having my physician and my PT on the same page, after years of pain, disappointment, and a misdiagnosis by a different physician over ten years ago, has been a source of huge relief. The future most look quite a bit brighter to you now.

It sounds as if you've found the perfect PT to guide you down the road to recovery. Her work with Specialized is more than just icing. I would love for my PT (MScPT - BScExS) to have that kind of additional experience, but as she doesn't I have to involve another professional who does have access to the Specialized BG knowledge base.

Please keep the rest of us broken folks updated on how your rehabilitation and recovery is progressing . . . especially if you've got good and inspiring news to share (though what doesn't work, if anything doesn't work, would certainly still be valuable information . . . just not as uplifting).


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