Bay Area Parkour

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Anterior knee pain syndrome and "Chondromalacia Patellae"

I was looking forward to my first blog post being something REALLY inspirational, or retrospective, or biographical, but I guess -as ironical as it is, given my screen name- it's going to be about a minor, yet bothering injury; and about it's assessment, treatment and prevention...

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A recent blow to my left knee, which also caused a short, deep cut (treated with three stitches and completely healed by now), has left me with an annoying pain when putting stress on the left leg and knee itself.
The stitches bothered me only in the first 24 hours, in which it was recommended not to bend the knee to avoid pulling on them. Holding the leg stiff, while icing it, seemed to take care of the "hit-to-the-knee" part of the problem, also because the area didn't present any swelling ... that, eventually, appeared not to be true...

After 5 days rest (enough time to heal the cut) a minimal physical test proved the following: while I could jog on the balls of my feet with minimal distress, lift energetically my knee to my chest (thus bending it way more than 90degrees), and gently squat (heels down) almost to my highest flexing point, I couldn't walk down a stair without pain, cat-balance on a wide, otherwise manageable rail, and jumping with both feet down from so low as 3' high was absolutely terrifying!

The blow suffered has induced a condition called "Patellofemoral stress syndrome" (or "Anterior knee pain syndrome"), a pre-condition to a worse disorder called "Chondromalacia Patellae".

Symptoms (my specific matched with generic): pain on the front of the knee exacerbated by negotiating steps, especially descending stairs, squatting maneuvers, kneeling, and prolonged sitting. The pain associated with Chondromalacia is often dull and aching in quality, but occasionally may be sudden and sharp. The pain is often worsened by activities that require bending the knee for a prolonged period or with increased load (i.e. stairs or squatting). Pain may be associated with a grating or popping sensation of the knee. The grinding or popping may not actually cause pain but is noticed by the patient as abnormal and thus may cause patient distress. Another distressing symptom is the sudden giving way of the knee while flexing. This giving way is not due knee ligament insufficiency, but due to pain associated with movement that causes the muscle to suddenly stop contracting as a reflex to that pain.

Causes: "Chondromalacia is an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some cases, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result". That 'irritation' can be caused by genetics (poor alignment), extraordinary wear (i.e. in runners) or may be due to a sudden overload (i.e. due to a blow, or trauma). "The damage may range from a slightly abnormal surface of the cartilage to a surface that has been worn away to the bone. Severe Chondromalacia related to injury occurs when a blow to the knee cap tears off either a small piece of cartilage or a large fragment containing a piece of bone..."

Related facts: "The force burdened by the patella is about two times body weight when climbing up stairs, and seven times body weight when descending. This increased burden on the kneecap when going down stairs causes a magnification of pain during that activity". (Imagine landing any drop!)

Treatment: "The treatment of Chondromalacia is primarily non-surgical with emphasis on strengthening the quadriceps within a painfree arc of motion. Proper technique of performing the exercises must be adopted. The use of ice and anti-inflammatory medication is beneficial to initially decrease the pain associated with this condition. Avoidance of activities that place excessive load across the patellofemoral joint is also important. This would include minimizing stair climbing/descending and squatting, or kneeling activities until quadriceps strength is restored and the inflammatory response has subsided. Taping can be used to decrease pain about the patella while exercising. There are also elastic knee braces available which have adjustable pads to help maintain patella alignment. The brace is usually worn for athletic activities".

In conclusion: While the extent of my injury is not yet assessed (fluctuating between pre-condition and condition), I will of course take it easy for a while, trying to adopt this Patellofemoral Exercise Guide, while concentrating my workout on upperbody, and abs, and focusing in getting (at least!) a clean muscle-up!!!
B)






sources:
http://healthlink.mcw.edu/article/926053052.html
http://www.pamf.org/sports/king/condromaliciapatella.html
http://lipscombclinic.com/sports/Articles/Injuries/Chondromalacia/c...
http://www.orthoseek.com/articles/chondromp.html
http://orthopedics.about.com/cs/patelladisorders/a/chondromalacia.htm

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Comment by SafeNSure on March 27, 2009 at 12:13pm
Thanks!
...I'm back in shape (as much as possible...lol), alive and kickin' (my own, old and slow...) ass.

I thought this -minor- injury (for sure, compared to yours, i.e.) was particularly interesting, because in traceurs this is originated usually by chronic micro-injuries (poor landing from heights), which eventually develop in a full-blown "condition".
My case instead involved a single "blow", a precise hit to the kneecap.

Yeah... knees suck, and I would add my collateral ligament pulled while skiing to the 'collection' (gazillion years ago... always snowboarded since then: it distributes the torsion over two legs, and less angular leverage, thanks to shorter equipment...).

I've heard horror stories about torn ligaments (reconstructive surgery is a must), and (AWWW!) torn tendons...
but i rather don't see anybody posting about it.
:\
Comment by Chris Rubenstein on March 27, 2009 at 10:16am
I've noticed from your profile that you are pretty active so I am confident that you have the discipline to get through this and get back to tip top condition. I sustained a torn meniscus last year and it occurred after kicking a bag with a muy thai kick - and then feeling terrible pain in the side of my knee. I had the surgery after several mystery prognosis and finally an MRI to really see what was happening and I must say it was a long recovery process... However I can say that after a thorough recovery (meaning not even attempting to put pressure for a long time) followed by strengthening of the surrounding muscles I feel that I am back to 90%. Knee injuries suck. Cold weather is a pain! But it never really really started feeling better until I started strengthening the muscles around it.
Comment by SafeNSure on January 15, 2009 at 12:41am
...tonight at Acrosports has been the first training from the "injury" during which I never thought about the knee, or felt anything particular while soliciting it.
About 2 months...

I had been up and down from 90% during December, up to 95% (doing everything, but still feeling it and having to stretch it systematically) in January...
Tonight nothing; not even the memory of it.

I suppose that I'm still oversensitive, i.e., would suffer even a minor ding to the patella more than I should, so let's say I'm 99%.

In the meantime I managed to train (parkour...) 22 times, not too shabby...
=) <- happy traceur
Comment by nonniechan on December 6, 2008 at 8:14am
Acupuncture is really the way to go! I tore the ligaments and nerves in my right foot and acupuncture saved my life...for a minute.
Seriously though, don't put undue stress (ie catwalk) on it till the doc says you is okay dokay...
I'm so sorry, but look on the bright side:) you will heal in no time if you follow your friends and my advice. Get better!
Comment by SafeNSure on November 26, 2008 at 12:00am
...thanks Man!
No worries, though... I'm a fast healer...
I don't have much time for that... lol!
B)

Gotta speed it up: I'd say I'm 80% by now...
Comment by Sin on November 25, 2008 at 9:55pm
Damn man, that sucks. I hope you are starting to get some strength back in your knee. check with your doctor about massage therapy once the muscle starts to rebuild. My girlfriend does standard deep tissue but also does a lot of work with accupressure and energy work which may help to speed the healing process. If your doc is ok with it let me know and i will try to connect you with my gf.
Comment by SafeNSure on November 17, 2008 at 5:01pm
...oh, trust me: I was SOOOOooooo BORED!
=)

And "yeah", I'd love to do that for toes too, following an appropriate diagnosis...
THAT would make me feel better!
=P
Comment by SafeNSure on November 16, 2008 at 7:23pm
Lol! I banged the OTHER knee two weeks ago, and the specific spot still hurts a tiny bit (like when pressing a bruise), but I didn't injure THAT one...
So, I believe that in PK banging, scuffing, scratching, peeling come with the territory, while injuries should be the absolute exception, due mainly to coincidences (i.e. something that should hold you breaks ...) if one practice safely...

Anyway: ice it and wait 48 hours to assess the damage...
Good luck!
=)
Comment by Onibunny on November 16, 2008 at 7:17pm
I banged up my knee today, thanks for all the information! Hopefully it will never happen again... for either of us!
Comment by Seng on November 16, 2008 at 2:22am
Yowch. Thanks for the extensive write-up- definitely a reminder to all of us that even seemingly small injuries are compounded by the amount of stress we put our bodies through in even basic parkour motions involving distances and surfaces well within our skill and conditioning level.

Hope you have a quick recovery.

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