I got this comment -- a story really -- and it's a long one, so I've edited it down. You can find the full comment here. I've underlined some parts that I found interesting.
I am a 28 year old female, very active, but unfortunately twisted my knee 3 years ago getting ready to take off for a run on wet grass. The sharp pain was horrendous, as my leg twisted my knee tensed and it felt like I had torn everything in there. I carried on stupidly as I was in a bootcamp and embarrassed to highlight myself as injured!! As a 25 year old healthy girl at the time, I assumed it would fix itself and carried on about my life ignoring the niggle up the stairs and when hiking. I initially went to a doctor who told me I had patellofemoral pain syndrome and to get back in the gym.
I never had pain squatting or lunging with weights, it was only the act of load bearing with my knee over my foot where I got the sharp pain. Similarly to a few previous comments I have read on your blog, the pain when I work out seemed to disappear and even after prolonged weights I found improvements in my knee and could run up the stairs no problem! Well I think all of this was not allowing it to heal properly as the pain always came back when I didn’t work out for some time.
I think the strength on the other areas were maybe masking the knee problem short term, who knows! But I certainly didn’t do it any favours getting back lifting weights. Pain started to feel a little more prominent this past year. I can walk totally fine. Hiking is my passion and something I haven’t been able to give up. But this causes me a lot of pain the next day and is hard on the joint coming down.
All of this led me to pay for an MRI to see what was going on. It showed I have a ‘punched out lesion within the cartilage of the patella in a central position. There is thinning of the trochlear cartilage in association with this. No reactionary oedema but evidence of a dominant lateral trochlear facet which is slightly dysplastic. Grade 3 chondromalacia’
The specialist said I could require arthroplasty in the distant future, but I should focus on swimming and cycling to manage it and avoid impact activities. He said there is no way to treat it and it will continue to get worse with age. Sure enough I left feeling very upset, hopeless and frustrated.
My strength PT said we should be still focusing on strengthening quads, glutes, calves core and hips etc but he has me still load bearing with some weight which I don’t feel is the best option for healing after reading through the blog! Would you agree? I have a lot of range of motion and don’t get any pain walking but when bent with pressure I’m getting the sharp pain. I have only just recently the past two weeks started to feel a burning sensation in that knee after movement. Is this a worrying sign that it is getting worse?
Desperate to find a way to combat the pain and make sure I am not doing further damage. I am due to go traveling to Canada (I’m from the UK) in a matter of months, a trip I have planned for a long time when my knee wasn’t causing me these problems) to do a lot of hiking which is so important to the trip. I don’t want to miss out on life because of this, but also do you think I could progress my grade 3 into grade 4 if I hike?
The magic question I suppose is, do you think it is possible to turn grade 3 chondromalacia around and live pain free!? I have an unbelievably healthy lifestyle, my passion is fruits and veg and I am 5ft8 and 51kg so I have this in my favour!
For starters, congrats on the healthy lifestyle and the ideal weight! You're young, eating well, and not carrying around a lot of extra pounds (or kilos). That seems like a good way to start a healing journey.
Next, I avoid giving advice. I'm not a medical professional, and even if I were, I've never seen you (or your knees). But I will share some things to think about.
I half-like the specialist. He said to focus on swimming and cycling and avoid impact activities. That strikes me as quite sensible, at least early on. Once your knees are in better shape, maybe you can do impact activities. For now, swimming and cycling, as long as your knees tolerate the activities well and you are careful not to push too hard, are two of my favorite "knee rehab" exercises (along with slow walking).
But I only half-like him. He also said there is no way to treat your condition and it will continue to get worse with age. Boy, he's a real cheery fellow, huh? I know nothing about your knee, but I think his dire prognosis is probably crap. One of the best things I read, early on during my struggle, was from Doug Kelsey, who was responding in his head to a doctor who had just told a patient that he'd never get better. And Kelsey's reaction was terrific, along the lines of: That's ridiculous, absolutely ridiculous.
Hope is so, so, so important. Orthopedic doctors should be smart enough to know that at least some knees do heal, without surgery. Mine did!
I'm not crazy about the strength physical therapist. I see the word "strength" and I wince. One thing I've come to realize about many physical therapists: they're young, frightfully fit, and haven't had any personal experience of whatever they're giving you advice about treating.
And they love strengthening muscles: because their playbook is full of strengthening exercises (and stretches). Stronger quads are great, but not if the effort to strengthen the muscle is greater than what the knee can tolerate. Unfortunately, you don't always realize that until the next day.
You might think, "Well, working out with weights helped my knees before, didn't it?" Okay, maybe it did. But maybe your knees aren't in the same place anymore. They could be worse, or more sensitive to the heavy loads and the bending.
Last, will going on this planned hike cause your knees to worsen? Maybe yes, maybe no. It depends on a lot of variables. How many miles a day? How many miles a day can your knees tolerate? How fast? How much climbing and descending? How many breaks? And you have to ask yourself: If this hiking trip isn't working out, is there a Plan B that you're confident enough to execute? Or do you just plan to suffer through?
Some thoughts. And one parting thought: If you bought Doug Kelsey's book, then you made a smart move. His book should be an invaluable guide on your journey. Doug really, really knows his stuff.
