Run even if it pains? - chrondomalacia patellae

Question

I am stuck with a knee injury since August 2013, with not much a progress then. PT's haven't been of much help. Ortho diagnosed I have chrondomalacia pattelae. I also think i have some pelvic misalignment and strength imbalances in posterior and anterior chain muscles. I have come across two PT's now who are pretty experienced - they treat competitive athletes on a regular basis. Both of them have asked me to jog for a few days even if it hurts and that body has its own way of healing.

In my knowledge, one shouldn't exercise on the top of pain, especially when its a joint pain. And again high impact exercises when one already has leg length difference (due to pelvic misalignment?). To me, it doesn't make sense at all. Looking at their experience, I am wondering am I missing something. Are there injuries there where one has to do exercises that cause pain in the site of injury and then they really heal?

I'm afraid my question is a bit vague.

Answer 1

In general, good PTs tend to distinguish between two kinds of people. Some clients will be extremely sensitive to pain. These folks will, in general, benefit from being told to exercise even when it hurts a bit, as it will prevent muscle loss &c. Other clients will be significantly less sensitive to pain (case in point, I once finished a 10mi cross-country with a piece of barbed wire lodged in my calf - not because I'm so darn awesome and tough but because I simply have a reasonably low pain threshold). In my experience, having worked with some really good ones, they try to calibrate their advice.

Now, chondromalacia patellae is one of those things where there is no clear 'best treatment'. In general, there are two main schools. One teaches RICE and slow resumption of activities ('build-up'), another teaches to keep as close to your normal activity level as you can ('scale-down'). Generally, the best approach for you will depend on two things. One, can you, in terms of fitness, afford some downtime? Some people can easily sit out a few weeks and get back to where they were in weeks. Others can't get back so easily, and you know yourself better than we do, I'd wager. The other is what you have available. If you are near a good gym, this would be a great way to do some of the cross-training most athletes skip! Alternatively, a good personal trainer can create an exercise plan for you that involves all the elements of running but those that would irritate your patella. Ultimately, neither of these is curative and the question is what to do while your condition resolves itself peacefully. Diclofenac potassium and naproxen are two wonderful NSAIDs (you're going to get a lot less effect from ibuprofen and virtually none from paracetamol and aspirin) for this sort of pain that can make moderate exercise bearable. Of course, this is also a time when you ought to consider whether you're training too hard/the wrong way, since CMP is most often an overuse injury.

Answer 2

You should distinguish between pain in fact of sore muscles due long workout or real injuries (in my experience most time you can make a difference) running injured is a bad idea. But it sounds like you need to know whats going on with your body for real. I would advise you to contact a Osteopath, its an advanced kind of physiotherapy and they have deep knowledge of how your body works and about all the mechanics.

I had a bad injury myself, 1 ortho and 2 physiotherapist could not helped me. The Osteopath could.

Answer 3

It's a little vague, but I understand your concern.

Your PT's concerns and recommendations are VERY valid. They want you running because they don't want you to become sedentary. The lack of strength, bone density, endurance, and oxygen consumption that will result from NOT running is far worse than working through the pain.

Now I'm not with you and I can't see your data, but that's usually the logic behind that sort of thinking. Not exercising would likely make your condition worse over time.

They recommend running for the effect it has on the total body, but also the lower body itself. What about using an arm ergometer? Is that a good way to exercise that they would recommend, or is running the exercise that must be done?