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Chris Carroll
03-10-2012, 02:02 PM
A couple days following Open Workout 12-2, I was doing some Wall balls and started getting a sharp pain in my kneecap...kinda right of out the blue. I have a history of chondromalacia but no problems for the last 15 years since I quit contact sports and took up cycling. Presently, my knee shows no signs of swelling but I cannot squat or bend it without sharp pain. I have been stretching and rolling the IT band which helps tremendously. However, after a couple hours later its kinda feeling the same way again. I also ice it 2-3 times a day which helps a little. Lastly, I am pretty inflexible with over-developed quads from years of bike racing. Also, I just got back into CrossFit less than a month ago and am in poor form for some of the heavy lifting.

Is this pain a result of a muscular imbalance or did I physically tweak something?

Stephan Giunta
03-11-2012, 06:22 AM
Hi Chris,

a good majority of knee pain is due to mechanical imbalance. you just have to imagine your knee being stuck between your feet and your pelvis.

if your pelvis is twisted and your feet still want to go forward then guess who takes the rotation?? thats right, your knee will be the poor guy taking the rotation load.

now imagine you squat on that.

go see your local osteopath to fix that.

hope it helps.

Sean Rockett
03-11-2012, 06:46 PM
A couple days following Open Workout 12-2, I was doing some Wall balls and started getting a sharp pain in my kneecap...kinda right of out the blue. I have a history of chondromalacia but no problems for the last 15 years since I quit contact sports and took up cycling. Presently, my knee shows no signs of swelling but I cannot squat or bend it without sharp pain. I have been stretching and rolling the IT band which helps tremendously. However, after a couple hours later its kinda feeling the same way again. I also ice it 2-3 times a day which helps a little. Lastly, I am pretty inflexible with over-developed quads from years of bike racing. Also, I just got back into CrossFit less than a month ago and am in poor form for some of the heavy lifting.

Is this pain a result of a muscular imbalance or did I physically tweak something?

could be patellar tendonitis if you are just getting back into doing some of these things at high reps and high intensity

Steven Low
03-13-2012, 07:03 PM
Corrections on page 4... but read the whole thing

wfs
http://www.eatmoveimprove.com/2009/11/shoes-sitting-and-lower-body-dysfunctions/

Chris Carroll
03-14-2012, 07:51 AM
Read it...good stuff Steven.

Cannot seem to find a good quad & hip stretch that does not irritate my patella. Ideas or links?

Thanks

David Sigmon
03-14-2012, 02:45 PM
Read it...good stuff Steven.

Cannot seem to find a good quad & hip stretch that does not irritate my patella. Ideas or links?

Thanks

My patellars are both swollen and painful so I know how hard it is to find a good hip/quad stretch.

This is my favorite hip stretch. Play around with it until you feel it really pull your hip and glutes:
http://www.exrx.net/Stretches/GluteusMaximus/ProneGlute.html

As far as a good quad stretch, I prop my foot up on the GHD machine and lean back into it. It does put some pressure on the patellar but you can normally position yourself so it's not too painful. However, any quad stretch will pull on the patellar to some degree so pick your poison.

Chris Carroll
03-14-2012, 04:02 PM
My patellars are both swollen and painful so I know how hard it is to find a good hip/quad stretch.

This is my favorite hip stretch. Play around with it until you feel it really pull your hip and glutes:
http://www.exrx.net/Stretches/GluteusMaximus/ProneGlute.html

As far as a good quad stretch, I prop my foot up on the GHD machine and lean back into it. It does put some pressure on the patellar but you can normally position yourself so it's not too painful. However, any quad stretch will pull on the patellar to some degree so pick your poison.

David...I like that one too for the glutes but it doesn't get my hip so much. I am more interested in finding out how other athletes are dealing with their patella tendonitis...do you ice, stretch, roll, and how often. Thanks

Chris Carroll
04-01-2012, 08:51 AM
Limped through the Open with Patella tendinitis and now I have several months to try to heal before July Games. Best results are from stretching and rolling, particularily KStar's MobilityWod Program.

Problem: While working on my weaknesses (hips, hammies, VMO & Adductors), I get so tightened up that the pain and kneecap pressure returns even after stretching. Anything that causes muscle tightness in the legs does not appear to be helping whatsoever.

I know there is no magic bullet but perhaps its too early for active rehab?

Brian Strump
04-01-2012, 04:58 PM
Perhaps you're doing something wrong?

What do you mean working on your weaknesses? Those particular muscles that you mentioned? Skill work?

Stretching and trying to loosen things that are tight are not the answer to every problem.


Limped through the Open with Patella tendinitis and now I have several months to try to heal before July Games. Best results are from stretching and rolling, particularily KStar's MobilityWod Program.

Problem: While working on my weaknesses (hips, hammies, VMO & Adductors), I get so tightened up that the pain and kneecap pressure returns even after stretching. Anything that causes muscle tightness in the legs does not appear to be helping whatsoever.

I know there is no magic bullet but perhaps its too early for active rehab?

Steven Low
04-01-2012, 05:08 PM
If traditional stretches are not working you need to try some alternatives such as PNF Or AIS.

The problem, though, like Brian said is that tight muscles may be indicators of other problems, not the "issue" that you need to fix.

Chris Carroll
04-02-2012, 08:02 AM
Please let me try to clarify...I have been doing been doing knee extensions, step-ups, Jane Fondas, and hammy-glute work with a band to try to help correct a perceived muscle imbalance from decades of racing bicycles. I believe that this imbalance, in combination with poor squating form, contributed to my tendonitis flare-up during the Open. None of these excercises cause any pain or discomfort to the patella whatsoever. However, there is some dull pain occurring 12-24 hours after exercise, which appears to be associated with muscle tightness. When I stretch it goes away.

It appears that creating more muscle tightness is exacerbating my condition. Does this make any sense?

Brian Strump
04-02-2012, 11:21 AM
Key word is "perceived" Don'y guess. Could just be making matters worse. Trigger points could be reasons for whay you experience.

Please let me try to clarify...I have been doing been doing knee extensions, step-ups, Jane Fondas, and hammy-glute work with a band to try to help correct a perceived muscle imbalance from decades of racing bicycles. I believe that this imbalance, in combination with poor squating form, contributed to my tendonitis flare-up during the Open. None of these excercises cause any pain or discomfort to the patella whatsoever. However, there is some dull pain occurring 12-24 hours after exercise, which appears to be associated with muscle tightness. When I stretch it goes away.

It appears that creating more muscle tightness is exacerbating my condition. Does this make any sense?

Chris Carroll
04-29-2012, 12:51 PM
If traditional stretches are not working you need to try some alternatives such as PNF Or AIS.

The problem, though, like Brian said is that tight muscles may be indicators of other problems, not the "issue" that you need to fix.

Thanks Steven,

My PT's diagnosis is Patellofemoral pain syndrome. After weeks of rest, my sharp pain is gone but replaced with a dull throb and lots of swelling following exercise. Icing and anti-inflams seem to do the trick, but the swelling and associated minor pain (2-4) are chronic unless I completely rest. I am managing through the minor pain and swelling but concerned that this will slow my healing. Still stretching and rolling religiously but muscles and tendons surrounding knee cap are always so tight! Doc suggested that a cortisone shot would help. Any thoughts appreciated.

Steven Low
04-29-2012, 04:50 PM
Exercises in this will help with PFPS

Basically, you can probably get your therapist ot use some taping technique if that helps.

Work on getting back quad activation and strength

And couple with hip activation and then re-education & strengthening work to get the load off the knees with better running/squatting form.

Ankle mobility may be needed too

Chris Carroll
04-29-2012, 05:14 PM
Exercises in this will help with PFPS

Basically, you can probably get your therapist ot use some taping technique if that helps.

Work on getting back quad activation and strength

And couple with hip activation and then re-education & strengthening work to get the load off the knees with better running/squatting form.

Ankle mobility may be needed too

Steven,

Any thoughts on the Cort. shot?

Steven Low
04-30-2012, 11:02 AM
Takes away the pain usually, does not fix the injury

YOu will still have to rehab it regardless.

Some may find it hard to rehab once they have a shot because it will feel better when it's not actually better.

Chris Carroll
05-02-2012, 11:46 AM
Takes away the pain usually, does not fix the injury

YOu will still have to rehab it regardless.

Some may find it hard to rehab once they have a shot because it will feel better when it's not actually better.

Steven,

MRI Exam revealed the following: "..partial tear or strain of the proximal lateral collateral ligament. Thinning of the articular cartilage in the anterior aspect of the lateral femoral condyle where there is a small amount of underlying edema in the bone. There is also edema in the patella with this most pronouned in the upper pole. The patellar articular cartilage is heterogeneous with chondromalacia. Lastly, there is evidence of tendinitis in the semimembranosus and semitendinosus tendons.

PT still thinks its Chondromalcia. Thinks the Cortisone shot may reduce swelling and help recovery. Any further thoughts or insights?

Megan Zetter
05-02-2012, 04:00 PM
The chondromalacia was already established 15 years ago. Besides, chondromalacia is not a diagnosis, it's a finding on an x-ray. Is it the source of your pain? Maybe, but it's not the problem. I'm going to bet biomechanical faults are the real issue, which is causing inflammation and therefore, pain.

Work on the dysfunction and the pain should lessen with time. I'm not a big fan of cortisone as it can decrease the pain markedly, giving you a false sense that all is good again, but it's not. The root cause was never addressed.

Sean Rockett
05-02-2012, 07:29 PM
Steven,

MRI Exam revealed the following: "..partial tear or strain of the proximal lateral collateral ligament. Thinning of the articular cartilage in the anterior aspect of the lateral femoral condyle where there is a small amount of underlying edema in the bone. There is also edema in the patella with this most pronouned in the upper pole. The patellar articular cartilage is heterogeneous with chondromalacia. Lastly, there is evidence of tendinitis in the semimembranosus and semitendinosus tendons.

PT still thinks its Chondromalcia. Thinks the Cortisone shot may reduce swelling and help recovery. Any further thoughts or insights?

MRI is showing arthritis in kneecap, if pain is coming from front of knee that is most likely the source, it also showed tendonitis in the tendons in the back of the knee. Both arthritis and tendonitis can have delayed onset of pain, after exercise and not during. As far as treatment goes, PT, Tylenol or NSAIDs for bad pain relief, cortisone, viscosupplementation or PRP to sum up what a surgeon would say with that kind of MRI. Good luck, Sean

Chris Carroll
05-03-2012, 08:40 AM
Thanks Megan and Sean,

Oops...forgot to mention the MRI also notes a grade 3 tear in lateral meniscus. I had this operated on in 1999 and PT thinks this is old not new.

FWIW, The PT diagnosed me with the Chondromalacia before MRI results. I too believe that biomechanical faults are the root of the problem. The PT noticed significant difference in musculature of right vs. leg quad, which he thinks is not from recent injury. I will start PT immediately.

PT's suggestion for Cort shot was interesting...he said that if the pain and swelling subsides quickly following the shot; he can therefore rule out the meniscus & ligament tear and then focus on the Chondromalacia and patella tendonitis. Thoughts?

Sean Rockett
05-03-2012, 01:10 PM
physical exam can give you the answer to Thanks Megan and Sean,

Oops...forgot to mention the MRI also notes a grade 3 tear in lateral meniscus. I had this operated on in 1999 and PT thinks this is old not new.

FWIW, The PT diagnosed me with the Chondromalacia before MRI results. I too believe that biomechanical faults are the root of the problem. The PT noticed significant difference in musculature of right vs. leg quad, which he thinks is not from recent injury. I will start PT immediately.

PT's suggestion for Cort shot was interesting...he said that if the pain and swelling subsides quickly following the shot; he can therefore rule out the meniscus & ligament tear and then focus on the Chondromalacia and patella tendonitis. Thoughts?

I don't want to get into a "he said she said", but a good physical exam can give you the answer between patellar arthritis, patellar tendonitis, meniscal tear, and strain of ligament

Chris Carroll
05-03-2012, 01:52 PM
physical exam can give you the answer to

I don't want to get into a "he said she said", but a good physical exam can give you the answer between patellar arthritis, patellar tendonitis, meniscal tear, and strain of ligament

Indeed... Within the last month he has twice physically examined my knee, twisting, turning, pulling, pressure, etc with no sign of miniscus/ligament problems. I guess the real question is whether the Cort. shot is necessary to treat Chondromolacia (I already know I have patella tendo in both knees but that is not my problem). My real problem right now is that light excercise results in swelling and dull throbbing pain (2-4). There is definitely some kind of irritation occurring under the kneecap, which is being exacerbated by exercise. Will Cort. reduce the swelling so to improve and speedup recovery? Or will the Cort. just mask the pain and not help the problem? Thanks for your input

Joe Bernard
05-03-2012, 07:40 PM
Indeed... Within the last month he has twice physically examined my knee, twisting, turning, pulling, pressure, etc with no sign of miniscus/ligament problems. I guess the real question is whether the Cort. shot is necessary to treat Chondromolacia (I already know I have patella tendo in both knees but that is not my problem). My real problem right now is that light excercise results in swelling and dull throbbing pain (2-4). There is definitely some kind of irritation occurring under the kneecap, which is being exacerbated by exercise. Will Cort. reduce the swelling so to improve and speedup recovery? Or will the Cort. just mask the pain and not help the problem? Thanks for your input

I'd go for the PRP over cortisone. Yea the cortisone will make you feel like a million bucks, but it will not heal it to the extent that PRP will; see Steve's comment on the previous page about it.

I've had two PRP shots, the first one was poorly done so I really had one good one (switched docs). I have patella femoral syndrome in my left knee and I'm flat-footed, which doesn't help. After I got the good shot, which was ultrasound-guided, I've felt much better. I used to not be able to plant and twist my knee without pain, nor fully straighten and tense it, but now I can. I also got custom orthotics which have been helping alot. It's not the cheapest solution, but I've been able to feel much better. I'd say I'm around 80-85% right now, and that's with slacking off with rehab stuff because I've been focusing on rehabbing a strained pec. So all that was to tell you that if you have the option of getting a PRP shot do it, don't get cortisone.

Sean Rockett
05-03-2012, 07:47 PM
Indeed... Within the last month he has twice physically examined my knee, twisting, turning, pulling, pressure, etc with no sign of miniscus/ligament problems. I guess the real question is whether the Cort. shot is necessary to treat Chondromolacia (I already know I have patella tendo in both knees but that is not my problem). My real problem right now is that light excercise results in swelling and dull throbbing pain (2-4). There is definitely some kind of irritation occurring under the kneecap, which is being exacerbated by exercise. Will Cort. reduce the swelling so to improve and speedup recovery? Or will the Cort. just mask the pain and not help the problem? Thanks for your input

Cortisone is a powerful antiinflammatory med used to treat arthritis when you run out of other options. It does not heal anything, it only helps relieve pain so people can function better again. Sometimes athletes will get it to get them through some pain from arthritis so they can compete in an upcoming event. It is not a good idea to do multiple injections. However I have seen one cortisone shot help people dramatically to the point where they can get through their arthritic flare up and they can start functioning and exercising again when the pain quiets down. I would not get one unless you have tried to modify for at least 4 weeks.

Chris Carroll
05-04-2012, 08:56 AM
Cortisone is a powerful antiinflammatory med used to treat arthritis when you run out of other options. It does not heal anything, it only helps relieve pain so people can function better again. Sometimes athletes will get it to get them through some pain from arthritis so they can compete in an upcoming event. It is not a good idea to do multiple injections. However I have seen one cortisone shot help people dramatically to the point where they can get through their arthritic flare up and they can start functioning and exercising again when the pain quiets down. I would not get one unless you have tried to modify for at least 4 weeks.

Sean,

Thanks for the info. After reading my MRI, my DOC suggested surgery to clean up my knee. Not what I wanted to hear. I told him that I want to try PT, and then meet back with him in a couple months to how it goes. I originally wanted the cortisone shot 'cause I am planning on competing in the Games in July as a master, and want to get back to training. Sigh...so it goes.

Alex Blazhevskyiy
11-25-2013, 09:46 PM
Hi Chris,
Not sure if you already sorted that problem out but here is what I think. It does sound like patellofemoral pain. However, if the pain doesn't go away for a long time I would recommend taking a set of X-rays to rule out what we call an osteochondral lesion/injury under the knee cap. If all is clear, then a well-structured exercise programme should fix your knee pain. You may need help of a qualified sports physiotherapist to create such a programme for you. You're right it may be a muscle imbalance causing this pain.
If you're interested you can find more interesting artciles about knee pain (http://www.bodyfitphysio.co.nz/articles/) and other health topics here.
Hope this helps!

Chris Carroll
11-26-2013, 09:57 AM
Thanks Alex. I am having surgery in 3 weeks. The procedure is a simple smoothing chondroplasty. No microfracture, which probably wouldn't work anyhow at my age. I am bone on bone, but only on one compartment.

Kyle B Cooke
12-10-2013, 02:42 PM
A couple days following Open Workout 12-2, I was doing some Wall balls and started getting a sharp pain in my kneecap...kinda right of out the blue. I have a history of chondromalacia but no problems for the last 15 years since I quit contact sports and took up cycling. Presently, my knee shows no signs of swelling but I cannot squat or bend it without sharp pain. I have been stretching and rolling the IT band which helps tremendously. However, after a couple hours later its kinda feeling the same way again. I also ice it 2-3 times a day which helps a little. Lastly, I am pretty inflexible with over-developed quads from years of bike racing. Also, I just got back into CrossFit less than a month ago and am in poor form for some of the heavy lifting.

Is this pain a result of a muscular imbalance or did I physically tweak something?

If you have swelling due to this imbalance than you need to deal with that which will help relieve pain and reduce your chances at re-aggravation by creating an elastic environment rather than stiffness. Once your inflammation has subsided your knee will receive regular blood flow which is the start of the healing process. If you can do gentle stretches to increase your blood flow while avoiding re-aggravation than you will reduce your recovery time. You can also use a blood flow stimulator (BFST) to speed up your recovery time while you rest or for prevention of re-injury before working out. Hope this helps!

Kyle

Jeff Enge
12-10-2013, 03:41 PM
Kyle, does a blood flow stimulator cure every injury or pain?

Chris Carroll
12-11-2013, 12:55 PM
If you have swelling due to this imbalance than you need to deal with that which will help relieve pain and reduce your chances at re-aggravation by creating an elastic environment rather than stiffness. Once your inflammation has subsided your knee will receive regular blood flow which is the start of the healing process. If you can do gentle stretches to increase your blood flow while avoiding re-aggravation than you will reduce your recovery time. You can also use a blood flow stimulator (BFST) to speed up your recovery time while you rest or for prevention of re-injury before working out. Hope this helps!

Kyle

Thanks Kyle, have you tried a blood flow stimulator?