Hi Richard, not sure if you have any suggestions or experience on exercises or treatments regarding diagnoses of focal chondrosis, narrowing of the patellofemoral joint, subluxed patellas or joint effusion?Well, that's a mouthful certainly. What's all this clinical jargon mean? (And why do medical technicians and professionals always speak in some baffling foreign language?)
Anyway, here's my take. If I'm wrong, someone feel free to correct me, but I think I'm in the ballpark:
"Focal chondrosis" appears to be simply a loss of articular cartilage. "Focal" suggests a particular location (or locations).
"Narrowing of the patellofemoral" joint is what it sounds like, and was perhaps seen on an X-ray. If there's loss of your protective cartilage, an X-ray will simply detect that the joint space has narrowed. That's because the cushioning cartilage has thinned, showing the bones closer together. Remember: an X-ray can't actually see the tissues, so basically someone infers what's going on based on how far apart the bones are.
"Subluxed patella" seems to be a patella that's mistracking or becoming partially dislocated. On this point, I'd be curious. Is this something that's just been "clinically observed"? Or what exactly is the evidence of this?
There are plenty of reasons to be skeptical when it comes to the role of patella mistracking when it comes to knee pain. See here, here and here, for instance.
And finally we have "joint effusion." "Effusion" is just swelling. So you've got swelling in your joint. D'oh! No big revelation there, I'm guessing.
At this point, what exercises might be suitable?
Well, "effusion" suggests that the joint is being stressed beyond what it can handle. That means that, whatever exercise regimen you choose, it should probably be fairly easy, at least in the beginning.
As for the cartilage loss, this bears repeating: cartilage loss, by itself, doesn't have to be a sentence of knee pain and misery. It does often correlate with knee pain and misery, true. But someone can have knees that feel healthy while having pockmarked cartilage.
What exercises are good for these conditions? You might want to consider activities that slowly build the strength of the remaining cartilage. They could be low-load, high-repetition. And, of course, you want them to be easy (see "joint effusion" above).
Finally, what about the "subluxed patella"? Hmm. A couple of quick thoughts:
(1) It's not really medically significant, even though some misguided doctor/physical therapist thinks it is. In that case, you might want to just try the light-load, high-repetition, and see how it goes ...
(2) It is medically significant. In that case, honestly, you might not get any satisfactory results apart from surgery. "Muscle strengthening" programs probably won't do the trick.
So those are a few thoughts. Others are welcome to comment below. And, of course, remember: none of us has seen your knees. We're just throwing out things to consider. Your best advice, in the end, is really to see another doctor and get that second opinion.
Good morning All. I was interested to read this this morning because I get the results of my XRays and MRI on Wednesday. I started to push for them before I got your book and so I feel rather more self-educated than I did before. I've even got to the stage where I read the comments and look up the terminology. I had no desire to do this before because I had no hope and therefore didn't want to read that there was 'no hope'!
ReplyDeleteSo I shall look up all these terms and continue to educate myself.(For the first time this morning I looked up The Envelope of Function)
I wanted to touch on another issue here and thank you all so much for responding to my previous messages.
There are many of you who read Richard's blog who are extremely enthusiastic sports people, it would seem mainly cycling and running and some of you seem to undertake large amounts of training in the gym. Some of you are able to return to these kinds of activities and delighted when you can go back to running or cycling for 20 miles.
So I thought I would write to you as a woman of nearly 60 who was diagnosed with osteoporosis at the same time as damaging my knee skiing. I'm really just writing on behalf of people like me who are simply hoping and praying to return to some sort of gentle normality rather than strenuous sport.
My hobbies in the recent past were skiing, rambling, travelling, DIY, gardening, caring for my family, dancing, yoga and wild 'dipping'. I probably never completed more than about 10,000 steps a day and have never really taken to high impact activity. I love sorting cupboards in my house, de-cluttering, sorting out family photos etc etc. A real home bird.
I thought that I would introduce myself because there may be other readers out there who are more like me and who have found the process of not being able to so much as lift a garden trowel or walk across the kitchen to get the salt as depressing and draining as me. And all the time with the fear that my bones and muscles are getting weaker because I didn't have massive core strength in the first place and will not get back to a massive core strength in the future.
However, I have been working in the Envelope of Function since I read Richard's book about 6 weeks ago? and this morning I have been active for 3 hours and there is no knee pain yet. That is AMAZING!
I wanted to share a nearly old lady's perspective of mat work that may or may not have been mentioned before.
Since I am this person who is not rugged and strong, I started to do yoga 4 years ago and have carried on through lockdown. I do it three times a week, twice with family on Zoom (aged between 1 and 70) and once with a teacher online (aged between 30 - 70). I want to talk about the fact that there is mat work and mat work. There is yoga and there is yoga, pilates and pilates. I think that many people assume that yoga, pilates and mat work is done by 20 something year old beautiful bodies or 60 year old lean male gurus who can place themselves in impossible poses and indeed, many yoga teachers are hyper mobile which is not healthy and can give an unrealistic impression of what a regular body can do.
However, in praise of gentle mat work, this has managed to keep my body flexible, somewhat toned (Dog pose and plank) and a little bit stronger than it would have been had I not done it. There is a wonderful type of yoga called Yin where you hold a position for a minute or two which strengthens and stretches parts of the body in quite a relaxed pose. You can imagine that with painful knees and osteoporosis there are many things that I have to be careful of but it is the only exercise that I have been able to maintain without any pain. I am hoping to train to be a Yoga teacher in the Autumn with an emphasis on osteoporosis care. I shall be most interested to see if the school will allow me to train whilst moving within my level of comfort! We shall see!
I hope that this in interesting to other people in my position and I send you all best wishes for continued healing.
Rose
Richard I was the individual who posted those questions so I truly appreciate the response back. All the results above including the "Subluxed patella" was analyzed through an MRI of my right knee. So I basically typed out the results of the MRI for you. Any additional thoughts here would be appreciated!
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