Great website, Neil! I'm 27 now, but in 1993 I did a lot of running and was diagnosed with mild Chondromalacia Patella. I rested and did the leg exercises, and the pain went away. However, I shyed away from running after that episode and took up climbing. In early February, I was training on a stairmaster for a big climb. There was never any pain during the training, but afterwards, I started to feel like I might have the Chondromalacia back again (dull pain under kneecap). Also I noticed the sideways kneecap pull as before. I did the exercises, and after about 3 weeks the pull straightened up and the dull pain went away. I was ready to get back to training, but a slightly different pain developed overnight. I noticed that there was a dull throb of pain when pressing down on the kneecap the first time. And then no pain thereafter until a while had passed. This strange pain has been with me now for another month (lessening slightly as time goes by but still present). The knee feels very strange and wrong (but no pain) when I kneel on a hard surface. There is also a VERY sharp pain that occurs for a few minutes every few days. It appears suddenly, and during this time it is too painful to put weight on my leg (although my knee and leg can still support me just fine). The pain is on the left side of my right knee, more on the top of the tibia than in my knee. When I press on the ball of the tibia, the pain gets worse. After a short time, it is gone and my knee feels fine again. Should I continue to train? Are the chondro exercises helping or agravating this? I've been stretching my hamstrings as well. I don't remember hurting my knee, just perhaps over-training. Thanks in advance for the advice!!
Generally, questions about patellofemoral pain are the most common quesstion asked of me since answering questions at this site. So a brief revisiting of the question is in order.
First, there is a significant degree of biomechanical involvement in this type of condition. Second, "muscle imbalance" or overactive lateral quads vs weakened inner quads is a function of biomechanics and not the cause of the condition. Third, cartilage deterioration is a consequence of the excessive compression associated with constant loading rather than intermittant loading as is normal during the gait cycle. With that in mind, these are the guidelines to treating chondromalacia patella:
1. Use ice daily - a half hour at least.
2. Obtain custom made orthotics to help your biomechanics.
3. Take nutritional supplements that contain both chondroitin sulfate and glucoseaminochloride (Cosamin ds is the product of choice).
4. Participate in loaded exercises beginning with balance and reach (my book, Total Conditioning for Golfers has numerous such exercises)
Finally, be patient. You are better off recovering more before you returning to running too soon. Work gradually from balance exercises to lunges, to step-up and step-down before you do jumping and hopping activities - only then do I suggest that you return to running.