Re: Exercises for chondromalacia patellae

googlemail2003@xxxxxxxxx wrote:

Dot,

Thank you for your thoughtful reply.

Going down the stairs backwards is a good idea and I'll give it a try.

The only person who has examined my knee is my chiropractor. I've been
going to him for years for my back and I really like him. He believes
the problem is most likely a small tear in the meniscus but of course
he cannot be sure. Based upon his exam (straigntening the leg, moving
the knee cap, etc) he does not think I have chondromalacia patellae.

My PCP is quite far away but he is wonderful and normally more than
worth the trip. However he knows how hard it is for me to see him
because of my back and he suggested chondromalacia patellae based upon
symptoms I described to him via email. I know that email is not the
way to diagnose a problem. He wants me to have PT but I thought it was
important to know what the problem was first so that I'm not given the
wrong exercises which could make things worse.

Absolutely - getting the right diagnosis is critical to getting the right exercises - especially if you have back problems also. For me and my issues (muscle weakness, imbalances, but not tears), I've had my best luck with an appropriate PT. The trick is finding one.


Can a PT diagnose the problem? I thought an MRI was really the only
way. Since I can see a specialist without my PCP's referral and if
that specialist ordered an MRI my insurance would pay for it, I thought
that was my best bet. There are many specialist close by. Problem is
I don't know what specialist to see.

For some things, an MRI may be the only way, but I'm not sure what things. That's something I haven't experienced, nor have I experienced meniscus tears, which may not be something that PT's can deal with. I don't know.

A properly trained PT can diagnose some things. Note the "properly trained" part. My original PT just went with what the doctor said, which just treated symptoms. My second PT, that I had originally was just going to use for a gait analysis, but ended up having re-occurrence of achilles issues at about that time did diagnose my issues, which were generally muscle weaknesses and imbalances. Besides the gait analysis, they have a physical therapy evaluation (or something like that) where they look at a whole bunch of things since things in the hips can be causing problems in the feet. They might be able to do an evaluation that may suggest some further evaluation - like an MRI. I know with my last hip problem where I thought it was something, and my PT did a bunch of probing, he said it definitely was not that something since I'd be screaming for mercy instead of saying that it felt better doing that. ;)

If you wanted to say where you are (general area), someone here might just be in the same area and be able to make a suggestion. Otherwise, you might ask locally. Or call PT's and ask - tell them the tentative diagnoses and see what they say. But you might check around on the web first for background so you can attempt to separate the ones who know what they're talking about. You may have already done this.

My 2nd PT (about 10 mi from me, and now in same town) was recommended by the running store 50 mi away. My local GP (within 1.5 mi of me), who is a former runner (until his knees hurt too much, but still hikes, mtn bikes, xc skis, etc), was unaware of this PT. Sooo, it's hard to recommend a definitive way to find someone.

Keep in mind that I've not dealt with MRI's or tears, so, yes, it may be something totally outside the realm of PT, and I'm not sure if that's within the realm of what they can say, "yes, this looks like it might be a tear but need an MRI for diagnosis" or whether they can diagnose that at all. I have a hunch tears might be outside their realm, but not sure.

Maybe you could e-mail your PCP with the chiro's hands-on diagnosis and see what his suggestion may be. Tears may be outside chiro's experience also. Maybe he can recommend a specialist local for you who could do an appropriate diagnosis and see whether MRI is needed?

Good luck.

Dot

--
"Success is different things to different people"
-Bernd Heinrich in Racing the Antelope

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