[beachgal]

Hi! I've been having knee trouble for a long time, and after a long course of PT, some tests, and a meeting with an ortho doc, I've been diagnosed with Patellofemoral Syndrome (aka Chondromalacia Patella). From the research I've seen, it sounds like this is pretty common, but mine's gotten pretty bad.

The doctor wants me to spend the next three months doing all I can to lose 20 more pounds while strengthening my muscles as much as possible. We had a long talk about the kinds of exercise I can do and most of it is allowable, which is great. However, I'm concerned about finding exercises (beyond what my PT has given me) to help strengthen my muscles, wondering what I can do to make things like running as comfortable as possible, and am dismayed that the doctor doesn't want me doing squats.

So, if you have (or have had) Chondromalacia Patella, I have some questions:

1. Have you ever tried quad sets? Did they help? My PT had me doing them against a wall, but everything I see online has people sitting down.
2. What exercises do you do/have you done to help strengthen your muscles?
3. Have you worn a brace while running? If so, do you have an brands/types you can recommend over others?
4. Is running on specific terrain easier on your knee? My doctor said it's different for everyone, but that I should avoid using any incline when running on the treadmill. I wonder if that also applies to running up actual hills outside?
5. How am I going to live without squats? My doctor's big concern was that I avoid letting my knee go past my toes (which I never do), so he seemed to feel that they are okay if I do only a limited amount. I poked around online, though, and every site said that people with this condition should avoid doing squats period, especially those that use weights. Has anyone done squats with this condition? What other exercises can I do that work the same areas as squats?
6. Any advice?

The orthopaedist says that if I still am in pain at the end of three months, even with weight loss and significant increases in muscled strength, I'll need to have surgery. So I have a really good reason to work hard at this! Thanks for sharing your wisdom and advice!

[Ilene]

Hi Laurie sorry to hear about the PS... DD had it when she shot up and just grew up too fast... The Ortho recommended orthotics, saying that they may or may not work, but they did, she still wears them...

The exercises he gave her were very simple leg extensions. I used the leg extension machine at the gym to work my quads. I've also done front squats and they really work the quads well. Here is a front barbell squat with instructions...

But I would really go with the recommendation of your doctor, be very careful you don't want to fool around with stuff like this, you could really injure yourself, and never be able to do a squat again... So be careful out there in squat land

[BlueToBlue]

I have Patellofemoral Syndrome but mine is very mild compared to yours. I'm nowhere near needing surgery.

I do run with a knee brace and I have found it to be immensely helpful. In fact, when my knee is acting up, I'll sometimes where the brace all day. The brand I like the best is McDavid, which I picked up at Sports Authority. You just pull it on and I think it stays in place just a little better than the ones that you wrap around your knee and secure with velcro (although it still tends to slide down a bit). I tried a brace with supports built in, but did not like it at all because it really limited my knee movement (but it didn't slide down at all). If you buy a brace, keep the receipt to you can return it if you try it and don't like it.

I am surprised that your doctor said not to use an incline on the TM because my sports medicine specialist said the opposite and my understanding is that going uphill/upstairs is no problem with Patellofemoral Syndrome; it's going downhill/downstairs that is a problem. That's also been my experience. I can walk uphill and upstair for miles, but going down is a real problem. I always use a slight incline (1% to 2%) on the TM and it has also helped immensely. In fact, the stepmill was one of the alternate forms of cardio that my specialist recommended.

I do squats all the time, with weights, but 1) I have a trainer so who is keeping an eye on my form and 2) my condition is clearly much more mild than yours. You should probably follow your doctor's advice.

A couple of other things that have been the difference between being able to run and not running are:

• Running on a TM rather than trying to run outside. I cannot run on pavement at all. After a mile, my knee hurts so much I can barely bend it. I can manage running on a trail for a little longer, but a couple of weekends ago I did 3.5 miles on sand, which is about the softest surface around and still could barely bend my knee by the end of the run. But I can run 3.5 miles on a TM, easy, with no knee pain whatsoever (note, however, that I'm also doing intervals on the TM rather than running continously, see my next bullet point).
• Running intervals, rather than steady state. Alternating running and walking seems to be much easier on my knees, even though I'm running at a faster pace than I would if I were running steady state. And, knee pain aside, running intervals is better exercise anyway.
• Running slower. I've dropped my fastest pace back about 1 mph and now add incline to make it harder, rather than speed. But you should check with doctor about this since he doesn't want you using the incline.
• Stretching my IT Band and quads using a foam roller. This has been a miracle for me. It hurt like a when I first started doing it and I only do it after I run and only for a few minutes (the length of one song on my iPod) for each stretch, but it's made a gigantic difference. To the point where I can now do short runs on the TM without my knee brace. You should ask your doctor or your PT about whether a foam roller my help.
• Acupuncture. I am using acupuncture to treat my allergies and happened to mention my knee problems to my acupuncturist and she said she could treat me for that as well, so I had her give it a try. And it definitely has helped. And it's far less invasive (with no recovery time needed) and probably a lot cheaper than surgery, so you might give it a try before agreeing to surgery.

[BlueToBlue]

Sorry to be so long-winded but I thought of a few other things that helped with my knee:

• Glucosamine. I rub it on my knee in the form of Blue-Emu Oil (Walgreen's sells it--it's a little expense but every few months they'll put it on sale for $10). You can also take it in pill form, but they are horsepills and expensive, so I prefer the lotion. Just a small amount on my knee and I noticed an improvement within a week. I can't believe I forgot to mention this in my first post.
• Flaxseed. I suspect that part of my knee problems stem from the fact that I don't eat enough good fats. For a while I was supplementing my diet with 1 to 2 tbsp of flax seed per day. During that time period, my knee improved to the point where could run 6 miles continously, on a trail (not the TM), with only very mild pain when I finished. Hard to say for sure that it was the flaxseed, but I'm not eating it now and I can't run like that anymore.
• Massaging my knee. This is something my sports medicine specialist recommended. I sit on my sofa with my leg stretched out on the sofa. Then I push my kneecap slightly towards my foot and massage under it it very lightly with my fingers (under the bottom end of it, the side closest to my foot). It increased blood flow to the area and increases the capillaries, which ultimately improves knee function.

Also, Patellofemoral Syndrome can be caused by lots of different things. Yours could be the result of something different than what causes it for me, which might account for why your doctor doesn't want you to run on an incline and my recommended that for me.