Patellofemoral Pain Syndrome and Cartilage Loss

[tinymoose]

Can anyone give me hope for getting back to gymnastics and/or skiing with patellofemoral pain? I could maybe ski, but I'd pay for it, and I def cannot tumble (limited to bars w/o dismounts) right now. I've had creaky/sore knees for years on stairs/squatting that I assumed was wear and tear (it is). Well it reached a bad point in the last week and now I'm basically out of commission. Went to see an ortho and start PT this coming week. I've got cartilage wear in both knees from years of abuse from both skiing/gymnastics. Hope is PT can help the pain enough to get me functional again by strengthening muscles to help stabilize the joint, but it's not going to stop the wear/progression. Very frustrating/demoralizing at only 45. Ordered knee braces to use for skiing on the advice of my doc. She hasn't tossed around the arthritis word yet, but not sure it really matters. She does think I'm at an early stage. A positive is PT is gonna work on my slightly angry shoulder/hip on top of my knees, since she wrote in treatment for those as well.

 

[santacruz skier]

Sorry to hear that. Back when I was running and had patella femoral issues I wore a brace similar to this.. Not sure it will work for you but really helped me.

https://bracelab.com/push-sports-patella-brace.html?gad_source=1&gbraid=0AAAAADHZjumi9s3MP9YUqc6RddIWe11ep&gclid=CjwKCAiA9vS6BhA9EiwAJpnXwz-ojp1Rb-FtCxPallOQuraVNdnTa1TavJqz4CQhMKpNNt97sTg0jhoCl2gQAvD_BwE

 

[tinymoose]

She wants me in a full brace, not just a band, so one with a donut hole in the middle. I ordered these for now but may have to toss down bigger bucks for something better if this doesn't work: https://www.amazon.com/gp/product/B00L9CSFSC/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

I went to a local pharmacy/durable meds store and tried on some more extensive braces, but tbh they felt too big/restrictive for gymnastics tumbling (if I can ever get back to that).

 

[tinymoose]

At this point I'm just hoping to get back to gymnastics by maybe Feb, and hope I can ski/keep up for Alta in late Jan.

 

[santacruz skier]

She wants me in a full brace, not just a band, so one with a donut hole in the middle. I ordered these for now but may have to toss down bigger bucks for something better if this doesn't work: https://www.amazon.com/gp/product/B00L9CSFSC/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

I went to a local pharmacy/durable meds store and tried on some more extensive braces, but tbh they felt too big/restrictive for gymnastics tumbling (if I can ever get back to that).

That brace looks perfect. Wish I had known about that one. Good luck ! It's probably temporary and hopefully not arthritis.

 

[McJoy]

She wants me in a full brace, not just a band, so one with a donut hole in the middle. I ordered these for now but may have to toss down bigger bucks for something better if this doesn't work: https://www.amazon.com/gp/product/B00L9CSFSC/ref=ppx_yo_dt_b_asin_title_o00_s00?ie=UTF8&psc=1

I went to a local pharmacy/durable meds store and tried on some more extensive braces, but tbh they felt too big/restrictive for gymnastics tumbling (if I can ever get back to that).

Please report back on how you like the brace. I find that the straps work better for me than knee sleeves with donut holes (better pressure without limiting mobility). But nothing stays in place very well while skiing. The one you linked here might be a good solution for me to try.

 

[contesstant]

@tinymoose I can't remember how old you are, but if you are perimenopausal or entering menopause, then estrogen therapy is something to consider. I went through several years of increasingly achy knees (I also have some patellorfemoral pain and wear under the patella, as well as pretty arthritic knees) and estrogen cream has eliminated almost all of the pain. It doesn't take much, either. Before that, I would wear a knee sleeve on both knees to keep them warm while skiing, which was moderately effective.

What can be done long term for that kind of wear and tear? Will you need TKR for both knees?

 

[tinymoose]

Please report back on how you like the brace. I find that the straps work better for me than knee sleeves with donut holes (better pressure without limiting mobility). But nothing stays in place very well while skiing. The one you linked here might be a good solution for me to try.

Will do! I feel like this will likely end up being a lot of trial and error trying to figure out what works/doesn't.

@tinymoose I can't remember how old you are, but if you are perimenopausal or entering menopause, then estrogen therapy is something to consider. I went through several years of increasingly achy knees (I also have some patellorfemoral pain and wear under the patella, as well as pretty arthritic knees) and estrogen cream has eliminated almost all of the pain. It doesn't take much, either. Before that, I would wear a knee sleeve on both knees to keep them warm while skiing, which was moderately effective.

What can be done long term for that kind of wear and tear? Will you need TKR for both knees?

I'm 45 and assumed to be be perimenopausal. Still having periods, rather heavy ones at that, so not menopausal yet. My doc has never tested my hormone levels, although I do have to find a new GYN this year anyhow, b/c my husband's company changed to UHC for insurance, which my current doc no longer accepts. So that's something I can ask my new doc about once I find one. I'm assuming the estrogen cream is a prescription? My only concern with estrogen therapy is if they'll feed/exacerbate my fibroadenomas and fibroids (I've developed both in the last 5 years... yay), likely from hormone imbalance.

Nothing can really be done about the wear and tear, and I don't know how extensive it is b/c she didn't take any x-rays of my knees, but she thinks I'm likely earlier stages based on her physical exam and my description of pain. No mention of knee replacement yet, and she technically didn't use the arthritis word, although I think that's obviously where this is all headed/the start of. She even said she wasn't going to tell me to quit gymnastics, but she did say it would lead to further wear and tear, which is expected, so definitely something I have to consider. For now, we're going to try PT to strengthen muscles around the knee to help stabilize it in the hope that helps with the pain.

 

[skibum4ever]

@tinymoose no advice but I'm sorry you're going through this and I hope you find a solution.

 

[contesstant]

Will do! I feel like this will likely end up being a lot of trial and error trying to figure out what works/doesn't.



I'm 45 and assumed to be be perimenopausal. Still having periods, rather heavy ones at that, so not menopausal yet. My doc has never tested my hormone levels, although I do have to find a new GYN this year anyhow, b/c my husband's company changed to UHC for insurance, which my current doc no longer accepts. So that's something I can ask my new doc about once I find one. I'm assuming the estrogen cream is a prescription? My only concern with estrogen therapy is if they'll feed/exacerbate my fibroadenomas and fibroids (I've developed both in the last 5 years... yay), likely from hormone imbalance.

Nothing can really be done about the wear and tear, and I don't know how extensive it is b/c she didn't take any x-rays of my knees, but she thinks I'm likely earlier stages based on her physical exam and my description of pain. No mention of knee replacement yet, and she technically didn't use the arthritis word, although I think that's obviously where this is all headed/the start of. She even said she wasn't going to tell me to quit gymnastics, but she did say it would lead to further wear and tear, which is expected, so definitely something I have to consider. For now, we're going to try PT to strengthen muscles around the knee to help stabilize it in the hope that helps with the pain.

Estrogen cream is prescription and is compounded BUT there are also patches and other delivery methods. It's a vasty understudied and misunderstood thing, this whole menopausal journey and how the waning hormones affect our bodies. You will likely be dismissed by a GYN unless you can get some word-of-mouth referrals from friends who have found one that has a deep understanding of hormone therapy. But I'm telling you, the joint pain relief is IMMENSE. I sometimes wonder if I'm just doing more damage, but wear and tear from living a full life and then being forced to slow down because I hurt so much, well, it's worth it. Will I need surgery in the future? Hard to say.

PT for patellar tracking issues can definitely be very effective. Lots of glute and hip work, plus hamstrings. I hope it helps you feel better and get back to doing what you love! Keep hormone therapy in the back of your mind as a potential option to explore. Nailing down dosages, balancing it with progesterone, etc can take quite awhile. I still have aches and pains but nothing like I used to, and my brain works better, too! (Most of the time.)

 

[VickiK]

Maybe try pool therapy for knee issues? It’s what the Weekend Warrior doctor recommends. See his book Heal Your Knees.

 

[skivet]

Have you tried glucosamine supplements? Might help a bit and probably won’t hurt. Just be aware that the vitamins are giant. Also I’m a big fan of cold plunges to help reduce inflammation generally. And it feels great …..afterwards.

Perimenopause absolutely sucks.

 

[floatingyardsale]

Post-ACL injury I learned that my MRI said that I had severe patellofemoral cartilage degeneration. I have no pain. There isn't apparently a lot of correlation between the MRI and symptoms, but my knees *did* hurt and now they don't.

For me, keeping the VMO --- the inside quad -- strong is the key to being pain-free. Things that do this: leg extensions, backward walking (weird but it works), and to a less extent single-legged squat variants. Leg extensions can be weighted, as in the machine at the gym, but I also have an elastic band that I use. One is in my office tied around the desk leg for leg extensions whenever I think of it. KneesOverToes on YouTube is a good resource.

Hormones also matter -- some days everything feels "loose" and those are days to be careful. (I'm likely peri, too, but still in the phase of the brain overreacting to signal the ovaries. It's like being sixteen in reverse.)

 

[gourmetJo]

Can anyone give me hope for getting back to gymnastics and/or skiing with patellofemoral pain? I could maybe ski, but I'd pay for it, and I def cannot tumble (limited to bars w/o dismounts) right now. I've had creaky/sore knees for years on stairs/squatting that I assumed was wear and tear (it is). Well it reached a bad point in the last week and now I'm basically out of commission. Went to see an ortho and start PT this coming week. I've got cartilage wear in both knees from years of abuse from both skiing/gymnastics. Hope is PT can help the pain enough to get me functional again by strengthening muscles to help stabilize the joint, but it's not going to stop the wear/progression. Very frustrating/demoralizing at only 45. Ordered knee braces to use for skiing on the advice of my doc. She hasn't tossed around the arthritis word yet, but not sure it really matters. She does think I'm at an early stage. A positive is PT is gonna work on my slightly angry shoulder/hip on top of my knees, since she wrote in treatment for those as well.

Don't give up....I tore my cartilage in my right knee when I was 15 years old while playing soccer, had surgery and the surgeon severed my artery, removed my entire cartilage, a complete disaster. My recovery took months and I was never the same. No doctor would help me with the constant pain because they were concerned about a potential lawsuit. I learned to adapt and cope with my knee pain.

Years later when I was about 42 years old and things were getting worse I was forced to find help. I found an orthopedic surgeon who immediately identified the source of my pain. His goal is to get you "back to living" and not limiting yourself. I was bone on bone and was developing arthritis at a very young age. He had a solution but the recovery was long. If I did nothing I would have needed a knee replacement by the age of 40. It took awhile to find a surgeon I trusted.

I decided to have surgery and had a cadaver cartilage implanted into my knee. I had to be non-weight bearing for about 17 weeks and then a few months of physical therapy. I had a custom knee brace that I used to play sports and to ski with. My surgeon was very strict about the recovery process. Many of his colleagues did not have success with this surgery which he attributed to loading the joint to early. His protocol was very strict but I'm glad it was.

That surgery was about 18 years ago and I'm still doing pretty well. I will never be 100% but my knee is significantly better than if I had done nothing. I ski without a brace, I hike and I'm still very active.

I try to be very conscious of strengthening my peripheral muscles to help stabilize the knee joint and pre-season conditioning is definitely important. I also just ordered Bracelayer tights (read about on the SkiDiva forum--thank you ladies) and skied this weekend with them. I have to say, Bracelayer really did make a difference in knee support.

Hope this helps.

 

[Iwannaski]

@tinymoose … how tight is your IT band? I have a family history of knee problems, so when my knee was tweaky 2 years ago at the start of ski season (and I need to shed some #s) I was super stressed. My PT was able to help me get my knee back on track by just teaching me how to release my IT band - apparently, it was so tight that it was yanking my patella to the side. And every time I feel even the slightest twinge, i do that, and it’s amazing. So, hopefully your PT has something equally magical for you.

 

[jthree]

@tinymoose just seeing this now... I don't have specific advice but sorry you're going through this! I remember how important both gymnastics and skiing are to you.

I hope your PT is able to bring you back to decent functionality! I had a knee injury ~ 3 years ago (close to my 47th bday). PT helped but when I slacked off, the pain and instability came back- I was miserable at the start of last year's season. Now I'm in a better routine, I did a ski-prep workout class (run by a local PT) in the fall. I still feel it at times but I'm able to be active. I hope you get to a similar place!