From: ead@tmsoft (Elizabeth Doucette)
Subject: Re: Knee problem
Followup-To: rec.bicycles.misc
Reply-To: ead@TMSoftware.ca (Elizabeth Doucette)
Organization: EAD MoneyHealth Inc, Toronto, Canada
Date: Mon, 5 Oct 1992 02:21:59 GMT

In article <1OCT199209205250@xenon.arc.nasa.gov> laforce@xenon.arc.nasa.gov
(Soren LaForce) writes:
>[...]
>My experience is that this kind of injury does not heal
>**ever**.  

Ah, but it can.  See below.  I had very bad knees and was told that I
would never run again.  But, the physio-therapist gave me a very
simple exercise that worked.
 
>The condition is called condramalasia of the patella (could
>be a spelling error there...), at least MY condition is called that.
>
>What I have is not bruising of the cartilage, it is roughening of the 
>cartilage.  This is not something that shows up on an x-ray, so it is
>dificult for me to see how the doctor could diaganose is exactly, of
>course I should warn you that I have a, uh, poor, yeah, poor!, opinion
>of doctors (guess I've been told "gee that's too bad, why don't you 
>try to learn to live with it - that will be $100 - " a few too many 
>times).

When running (also walking, and cycling), the inner most quad. muscle
(inner part of thigh) does not get exercised as much as the other
three quad. muscles of the thigh.  If this inner muscle isn't
strengthened by specific exercises, an imbalance of the muscles may
occur.  This can cause irritation of the underside of the kneecap
(chondromalacia patellae) because the imbalance of the muscles can
pull the kneecap towards the outside of the leg. 

I believe there is a groove in the underside of the kneecap that rides
on a ridge of bone in the knee.  If the kneecap is pulled to the
outside of the leg, the groove will want to move in a slightly
different direction than the ridge of bone.  This can cause the groove
to become irritated. 

I had chondromalacia patellae for a long time (and many of my running
friends did too) but I haven't had problems since I've been doing
specific exercises for my inner quad. muscle.  It is tedious and
boring but it works.  I haven't had knee problems for about 3 years
now :-).  I should do this every day, whether I work out or not, but I
don't always.  If I feel any discomfort at all in my knees, I make
sure I'm more diligent with this exercise and the discomfort always
disappears.  I'm always able to prevent a problem now.

The EXERCISE is just a leg raise with the foot flexed and pointing
away from the body.  With this exercise make sure that your back is
supported.  As your quad. muscles fatigue, there is a tendency to help
out with your back muscles.  You may not realize that you're doing
this until you notice later that your back is a little sore.

Sit on the floor with both butt cheeks on the floor.  Lean your back
against a wall, to support your lower back. 

O
|         
| /\_      <---  left leg bent
-------\   <--- right leg straight

Bend your left leg, bringing your left knee towards your chest.  This
ALSO helps to support your lower back.  You can't be too careful when
it comes to back injuries.  Your right leg is straight.  Now, flex
your right foot (bring your toes towards you, as opposed to pointing
away from you; your toes should be pointing towards the ceiling), and,
keeping your butt on the floor, rotate your leg to the right, as close
to 90 degrees as you can.  Your right foot, flexed, will also turn to
the right. 

Now, you are in the correct position to do leg raises.  Raise/lower
your right leg (about 12 inches) as many times as you can in a minute,
or until your quad muscles begin to quiver/shake.  Repeat with the
left leg.  When I started these I could only do about 10 with each leg
and only one set.  Now, I can do 60 with each leg and I do three sets.
So, I do 180 repetitions in total, with each leg. 
  
The position of the foot is important because it helps to isolate the
inner quad. muscle.  Don't do the leg raises too quickly because
technique is more important than speed.  It takes me about 10 minutes. 

You can tell if your muscle is getting fatigued because it will start
to quiver.  Don't push it, change legs.  Keep note of how many
repetitions you do before you get fatigued and try to increase the
repetitions next time.  Compare you to you, not to others.

Good luck.

Elizabeth