chondromalacia patella and cycling
06-26-23, 08:14 AM
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chondromalacia patella and cycling
Recently, I had knee pain and the orthodepist told me that I have chondromalacia patella. Now I ceased to cycle. I will wait the symptoms of chondromalacia patella to disappear before I begin to cycle again. Is there anyone who has chondromalacia patella and still contiune to cycle? What you do not to let the condition worsen? Do you use SPD pedal? I thought SPD pedal may help me to reduce the pressure on patella.
06-26-23, 08:45 AM
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Don't have time now but later today or tomorrow I'll post a piece I wrote a few years back on my experience with CP. It came on for me on a Wednesday 45 years ago.. That Saturday I rode a race, had to drop out and the race promoter introduced me to a fellow racer, an orthopedic surgeon specializing in sports medicine. He diagnosed my in the back of a cold van (March in New Hampshire) and proceeded to tell me then and in a couple of phone calls later more than I have ever heard since about CP.
I took a few weeks break after that doing the exercises he suggested, raced the rest of the season and have ridden 150,000 miles since. I still have CP. Have never had surgery or anything else for it.
I took a few weeks break after that doing the exercises he suggested, raced the rest of the season and have ridden 150,000 miles since. I still have CP. Have never had surgery or anything else for it.
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06-26-23, 09:08 AM
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Don't have time now but later today or tomorrow I'll post a piece I wrote a few years back on my experience with CP. It came on for me on a Wednesday 45 years ago.. That Saturday I rode a race, had to drop out and the race promoter introduced me to a fellow racer, an orthopedic surgeon specializing in sports medicine. He diagnosed my in the back of a cold van (March in New Hampshire) and proceeded to tell me then and in a couple of phone calls later more than I have ever heard since about CP.
I took a few weeks break after that doing the exercises he suggested, raced the rest of the season and have ridden 150,000 miles since. I still have CP. Have never had surgery or anything else for it.
I took a few weeks break after that doing the exercises he suggested, raced the rest of the season and have ridden 150,000 miles since. I still have CP. Have never had surgery or anything else for it.
06-26-23, 10:19 PM
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What I wrote 22 years ago (23 years into my journey with CP).
Chondromalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. (He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.
In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.
Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.
I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.
After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.
He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)
Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.
Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.
Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.
After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).
Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.
Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.
Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)
I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.
Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?
Ben
And back to the present: A few years after I wrote this I had a local outdoor gear repair outfit sew me some custom kneewarmers out of 2 layers of 3 or 600 weight fleece windblock fabric. Two elastic straps behind my knees on each. And a 3/4" velcro loop strap with a matching hook top that runs through a "D" ring sewn to my cycling shorts (cycling briefs I wear under in cooler weather. Every few years I need to replace the straps and velcro. I had these made with short sturdy webs I sew the straps onto. I had two pairs made. primary pair gets worn anytime the temps are below 80 F. The edges were left un-hemmed for a soft border. I always wear regular knee or leg warmers or tights over this pair. Straps were left on the loose side since the edges are held down by the layer over. A second pair for hot days has hemmed edges to somewhat seal the edges and the straps a a touch tighter. (Too tight and I find they are tightening the hamstrings I need to keep loose.) A tip that I just came across a few weeks ago when it was time to get more strap material. The really good stuff - bra straps. There are outfits that have everything for do it yourself bras including wonderfully comfortable strapping. I went with The Bra Builder. Good website. Fast.
Only when the temps are going to be 85F plus the entire ride do I do with bare knees. And probably the most important thing that doctor told me - I had to listen to my knees and let them be the boss. That if I stopped paying attention, I was probably going to be replacing them. This means long pants in summer many times when I would much rather be in shorts. I now have a coffee making routine that has me doing very long stretches. I use a Japanese spice grinder. Super "burr grinder" but - it takes about 1600 revolutions! Plenty of time to do each hamstring and Achilles (totally separate issue.).
My knees work. CP is still there. Aspirin is still the miracle drug. I've ridden the week long Cycle Oregon with its 23-33,000 feet of climbing 10 times and roughly 100,000 miles since I wrote tne piece above. Sadly, now I have more than my knees holding me back from humbling those wippersnappers. Now it's 70 years of age. A woman blew my doors off yesterday. My knees had nothing to do with it (other than I would have cooked them like the rest of my legs if I tried to match her and they'd still be hurting today).
Chondromalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. (He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.
In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.
Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.
I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.
After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.
He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)
Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.
Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.
Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.
After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).
Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.
Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.
Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)
I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.
Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?
Ben
And back to the present: A few years after I wrote this I had a local outdoor gear repair outfit sew me some custom kneewarmers out of 2 layers of 3 or 600 weight fleece windblock fabric. Two elastic straps behind my knees on each. And a 3/4" velcro loop strap with a matching hook top that runs through a "D" ring sewn to my cycling shorts (cycling briefs I wear under in cooler weather. Every few years I need to replace the straps and velcro. I had these made with short sturdy webs I sew the straps onto. I had two pairs made. primary pair gets worn anytime the temps are below 80 F. The edges were left un-hemmed for a soft border. I always wear regular knee or leg warmers or tights over this pair. Straps were left on the loose side since the edges are held down by the layer over. A second pair for hot days has hemmed edges to somewhat seal the edges and the straps a a touch tighter. (Too tight and I find they are tightening the hamstrings I need to keep loose.) A tip that I just came across a few weeks ago when it was time to get more strap material. The really good stuff - bra straps. There are outfits that have everything for do it yourself bras including wonderfully comfortable strapping. I went with The Bra Builder. Good website. Fast.
Only when the temps are going to be 85F plus the entire ride do I do with bare knees. And probably the most important thing that doctor told me - I had to listen to my knees and let them be the boss. That if I stopped paying attention, I was probably going to be replacing them. This means long pants in summer many times when I would much rather be in shorts. I now have a coffee making routine that has me doing very long stretches. I use a Japanese spice grinder. Super "burr grinder" but - it takes about 1600 revolutions! Plenty of time to do each hamstring and Achilles (totally separate issue.).
My knees work. CP is still there. Aspirin is still the miracle drug. I've ridden the week long Cycle Oregon with its 23-33,000 feet of climbing 10 times and roughly 100,000 miles since I wrote tne piece above. Sadly, now I have more than my knees holding me back from humbling those wippersnappers. Now it's 70 years of age. A woman blew my doors off yesterday. My knees had nothing to do with it (other than I would have cooked them like the rest of my legs if I tried to match her and they'd still be hurting today).
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06-26-23, 10:36 PM
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This is a case where the best thing you can do is build awareness - of your patella and how it feels as you do things and after, of the "little quads" that align your patella, of the cold and your knees, of your hamstrings. (My hams don't like cold either.)
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06-27-23, 03:19 AM
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What I wrote 22 years ago (23 years into my journey with CP).
Chondromalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. (He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.
In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.
Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.
I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.
After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.
He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)
Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.
Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.
Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.
After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).
Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.
Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.
Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)
I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.
Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?
Ben
And back to the present: A few years after I wrote this I had a local outdoor gear repair outfit sew me some custom kneewarmers out of 2 layers of 3 or 600 weight fleece windblock fabric. Two elastic straps behind my knees on each. And a 3/4" velcro loop strap with a matching hook top that runs through a "D" ring sewn to my cycling shorts (cycling briefs I wear under in cooler weather. Every few years I need to replace the straps and velcro. I had these made with short sturdy webs I sew the straps onto. I had two pairs made. primary pair gets worn anytime the temps are below 80 F. The edges were left un-hemmed for a soft border. I always wear regular knee or leg warmers or tights over this pair. Straps were left on the loose side since the edges are held down by the layer over. A second pair for hot days has hemmed edges to somewhat seal the edges and the straps a a touch tighter. (Too tight and I find they are tightening the hamstrings I need to keep loose.) A tip that I just came across a few weeks ago when it was time to get more strap material. The really good stuff - bra straps. There are outfits that have everything for do it yourself bras including wonderfully comfortable strapping. I went with The Bra Builder. Good website. Fast.
Only when the temps are going to be 85F plus the entire ride do I do with bare knees. And probably the most important thing that doctor told me - I had to listen to my knees and let them be the boss. That if I stopped paying attention, I was probably going to be replacing them. This means long pants in summer many times when I would much rather be in shorts. I now have a coffee making routine that has me doing very long stretches. I use a Japanese spice grinder. Super "burr grinder" but - it takes about 1600 revolutions! Plenty of time to do each hamstring and Achilles (totally separate issue.).
My knees work. CP is still there. Aspirin is still the miracle drug. I've ridden the week long Cycle Oregon with its 23-33,000 feet of climbing 10 times and roughly 100,000 miles since I wrote tne piece above. Sadly, now I have more than my knees holding me back from humbling those wippersnappers. Now it's 70 years of age. A woman blew my doors off yesterday. My knees had nothing to do with it (other than I would have cooked them like the rest of my legs if I tried to match her and they'd still be hurting today).
Chondromalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. (He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.
In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.
Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.
I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo.) The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.
After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.
He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)
Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.
Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.
Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.
After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).
Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.
Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.
Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)
I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.
Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?
Ben
And back to the present: A few years after I wrote this I had a local outdoor gear repair outfit sew me some custom kneewarmers out of 2 layers of 3 or 600 weight fleece windblock fabric. Two elastic straps behind my knees on each. And a 3/4" velcro loop strap with a matching hook top that runs through a "D" ring sewn to my cycling shorts (cycling briefs I wear under in cooler weather. Every few years I need to replace the straps and velcro. I had these made with short sturdy webs I sew the straps onto. I had two pairs made. primary pair gets worn anytime the temps are below 80 F. The edges were left un-hemmed for a soft border. I always wear regular knee or leg warmers or tights over this pair. Straps were left on the loose side since the edges are held down by the layer over. A second pair for hot days has hemmed edges to somewhat seal the edges and the straps a a touch tighter. (Too tight and I find they are tightening the hamstrings I need to keep loose.) A tip that I just came across a few weeks ago when it was time to get more strap material. The really good stuff - bra straps. There are outfits that have everything for do it yourself bras including wonderfully comfortable strapping. I went with The Bra Builder. Good website. Fast.
Only when the temps are going to be 85F plus the entire ride do I do with bare knees. And probably the most important thing that doctor told me - I had to listen to my knees and let them be the boss. That if I stopped paying attention, I was probably going to be replacing them. This means long pants in summer many times when I would much rather be in shorts. I now have a coffee making routine that has me doing very long stretches. I use a Japanese spice grinder. Super "burr grinder" but - it takes about 1600 revolutions! Plenty of time to do each hamstring and Achilles (totally separate issue.).
My knees work. CP is still there. Aspirin is still the miracle drug. I've ridden the week long Cycle Oregon with its 23-33,000 feet of climbing 10 times and roughly 100,000 miles since I wrote tne piece above. Sadly, now I have more than my knees holding me back from humbling those wippersnappers. Now it's 70 years of age. A woman blew my doors off yesterday. My knees had nothing to do with it (other than I would have cooked them like the rest of my legs if I tried to match her and they'd still be hurting today).
Sincere thanks for sharing this. It is invaluable advice and morale for me.
I have been diagnosed with chondromalacia patella just two weeks ago and have been investigating what I can do since then. Your story is an inspiration for me!
From what I read about CP, it has got stages of severity up to 4. Do you know what was its level at the beginning and later? I assume because it can not be healed, CP can stay the same or progress to later stages by time. I am 46 at stage II-III so wondering if I can achieve what you have accomplished.
My orthopedist had already suggested the exercise exactly like the one you described! I do the exercises twice a day (when I wake up and before going to bed) 30 times each. I assume you have a similar daily routine. I haven't been given any advice by the orthopedists to protect my knee from cold or wind. When I think about it, it makes sense. After CP I have to ensure that muscles around my knee function properly. Cold can potentially reduce muscle contraction. I will be using knee warmers. And could you share a photo of your custom made warmers? My mum is quite good at sewing. I may ask her to sew a custom made one for me based on yours.
From your post I understand that you never had Platelet-Rich Plasma (PRP) or hydraulic acid injections. Have you taken collagen and hydraulic acid (pill) supplements? If you have used them, do you think they have any benefits?
Thanks again for sharing. I wish you a wonderful summer.
Ahmet
10-07-23, 08:18 AM
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What 79pmooney said. I've been managing chondromalacia for 50 years and my experience is exactly as he describes.
Do strengthening exercises that do not inflame yours knees. When your knees feel healthy do high gear hill intervals once or twice a week to strengthen your quads. Avoid running or anything else that irritates your knees when they are inflamed. Do whatever you want when your knees feel healthy. Ibuprofen is your friend.
The good news is that if you develop the right training habits you will eventually forget that you even have a problem with it.
em
Do strengthening exercises that do not inflame yours knees. When your knees feel healthy do high gear hill intervals once or twice a week to strengthen your quads. Avoid running or anything else that irritates your knees when they are inflamed. Do whatever you want when your knees feel healthy. Ibuprofen is your friend.
The good news is that if you develop the right training habits you will eventually forget that you even have a problem with it.
em
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10-07-23, 09:22 AM
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Knee warmers... new to me. Looking on-line there seems to be quite a range of materials and sizes.
How does one choose what size to order?
What are the differences in materials and construction that affect their effectiveness as well as longevity?
How does one choose what size to order?
What are the differences in materials and construction that affect their effectiveness as well as longevity?
10-07-23, 09:26 AM
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I'm putting that up to a spell-check failure; correct word I suspect is hyaluronic.
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10-09-23, 05:51 AM
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I'm putting that up to a spell-check failure; correct word I suspect is hyaluronic.
10-09-23, 01:27 PM
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I had CP a couple decades ago. I caught it right away, did therapy, fixed it. I can do anything I want with no worries as long as I keep doing my exercises and stretches. I posted about it on an old BF thread here:
https://www.bikeforums.net/training-...l#post16081392
But it's best to read that whole thread. My leg "exercises" are ordinary gym stuff once a week: full depth barbell squats (knees well apart), leg sled (full range of motion), and leg extensions (120°-180° only), plus these stretches which have nothing to do with one's IT band:
https://www.bikeforums.net/road-cycl...l#post15372967
The gym work . . .I didn't just jump right in heavy. I started with no weight and simply added weight as I could, over the years. Developing the ability to do full range of motion is really important.
It's all about building well-balanced leg strength. Hiking in hilly or mountainous terrain is good, too. An aside: we discovered that taking ibuprofen for knee pain prevented adaptions which get rid of knee pain. My wife and I have been doing 10-day unsupported backpacks every year in the Cascades for at least 40 years. In '22 I went in with 60 lbs, my wife with 40. That was tough at 77 but we were way out of shape because of my heart condition. We took meals to a couple last week, younger than ourselves, both on walkers. Don't go that route if at all possible.
https://www.bikeforums.net/training-...l#post16081392
But it's best to read that whole thread. My leg "exercises" are ordinary gym stuff once a week: full depth barbell squats (knees well apart), leg sled (full range of motion), and leg extensions (120°-180° only), plus these stretches which have nothing to do with one's IT band:
https://www.bikeforums.net/road-cycl...l#post15372967
The gym work . . .I didn't just jump right in heavy. I started with no weight and simply added weight as I could, over the years. Developing the ability to do full range of motion is really important.
It's all about building well-balanced leg strength. Hiking in hilly or mountainous terrain is good, too. An aside: we discovered that taking ibuprofen for knee pain prevented adaptions which get rid of knee pain. My wife and I have been doing 10-day unsupported backpacks every year in the Cascades for at least 40 years. In '22 I went in with 60 lbs, my wife with 40. That was tough at 77 but we were way out of shape because of my heart condition. We took meals to a couple last week, younger than ourselves, both on walkers. Don't go that route if at all possible.
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10-09-23, 03:06 PM
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Mine was solved with the same exercises mentioned here, and spinning at a lower gear in higher cadence. If I stop for any length of time, my knee pain comes back, so I just don't stop 
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10-11-23, 06:19 AM
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That's my conclusion too: keep moving!
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10-11-23, 08:48 AM
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The knee pads themselves are 2 layers of windblock 300 weight fabric, pile on the outside and felt-like on the inside. Darted enough on the sides to cup my knees. I had webbing "tabs" sewn on the side corners and top center to stitch the elastic and velcro to so sewing on replacement straps is easy.
The outfit that made them (Mountain Sole of Portland) did a great job. Used patterns I made. 2 pairs, one with the edges raw fabric to be warn under the usual sleeve knee warmers (safety pinned to my shorts; if they were tight enough to not fall down - that would be too tight, see above). Other pair has hemmed edges, looks cleaner, fits tighter around the edges because of both the hemming and slightly tighter elastics and works well alone. (But a little odd looking with the front garter strap. But I'll take the odd look over the scalpel any day.) 15 years now and both pairs are going strong. The patterns are CAD drawings I could dig up and print and send them to you if you like.
Edit: My un-hemmed warmers get used under the regular sleeved wamers or full leg warmers or tights all year when temps are below low 80s F. Hemmed alone to high 80s, even low 90s. Then I get to "splurge" and go bare kneed! So they get used a lot. Nearly every ride I've done the past 15 years. Mountain Sole did good work. Only repairs have been the straps. Expendables like bike chains. (Tip - bra straps work really well. Bra Builders is a solid website and fast service. I use 1/2" black.)
Last edited by 79pmooney; 10-11-23 at 09:00 AM.
10-11-23, 09:13 AM
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What 79pmooney said. I've been managing chondromalacia for 50 years and my experience is exactly as he describes.
Do strengthening exercises that do not inflame yours knees. When your knees feel healthy do high gear hill intervals once or twice a week to strengthen your quads. Avoid running or anything else that irritates your knees when they are inflamed. Do whatever you want when your knees feel healthy. Ibuprofen is your friend.
The good news is that if you develop the right training habits you will eventually forget that you even have a problem with it.
em
Do strengthening exercises that do not inflame yours knees. When your knees feel healthy do high gear hill intervals once or twice a week to strengthen your quads. Avoid running or anything else that irritates your knees when they are inflamed. Do whatever you want when your knees feel healthy. Ibuprofen is your friend.
The good news is that if you develop the right training habits you will eventually forget that you even have a problem with it.
em
10-11-23, 12:01 PM
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Aspirin is God's gift for my knees. I don't take it a lot but after rides where I am feeling them after I take from half to two of the 325 mg (standard) aspirins. I don't know what is going on but I think it is aspirin's "blood thinning" properties the help my patellae so much.
Motrin and Advil are brand names for products that contain the NSAID Ibuprofen.
10-11-23, 02:40 PM
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NSAIDs block a specific enzyme called cyclooxygenase (or COX) used by the body to make prostaglandins. By reducing production of prostaglandins, NSAIDs help relieve the discomfort of fever and reduce inflammation and the associated pain.
Ths issue is that Inflammation is a good thing:
Our blood capillaries will expand, increasing blood flow to bring immune cells such as neutrophils and monocytes, antibodies, protein and other fluids to the injury site. This causes inflammation and swelling, which protects and repairs the damaged tissues, kickstarting the healing process.
Pain is the body's way of saying, "Don't do that!"
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