"Arthritic changes" along patella

[Hope'sMom]

I went to my PCP for a regular checkup and mentioned the knee pain that's kept me from running for several weeks. He thought it was runner's knee, but took x-rays. A phone call from the nurse with the results said the x-rays showed "arthritic changes" and they plan to send me to an orthopedic doctor. I run in VFF's, and I will be interested to see if the doctor says I should go back to traditional shoes. If I have arthritic knees, can I still run minimalist? Are there questions I should be sure to ask when I have my appointment?
Thanks!

 

[migangelo]

wheat and vegetable oils are big cuplrits in arthritic inflamation. try changing your diet first and see what happens. up your omega 3.

 

[Hope'sMom]

I've been thinking about this for a few weeks now ... just haven't taken the plunge yet. Pasta makes me so happy ... I do take an omega 3 supplement, but the pizza I just had for lunch is heading in the wrong direction.

 

[Longboard]

If x-rays show arthritic change there is either evidence of cartilage loss or bone spurring. Changing your diet can't correct either.
Probably your orthopod will say that you must not only run in built up motion control or shock absorbing shoes, but must also use custom orthotics.
If so, he/she has not been keeping up with the most current research..which is typical.
The studies done recently show that you reduce the loads on knees when barefoot rather than shod,
so I'm just reminding you that not only can a doc be wrong, but currently the MAJORITY are when it comes to the relationship between footwear and osteoarthritic knees.

 

[migangelo]

so I'm just reminding you that not only can a doc be wrong, but currently the MAJORITY are when it comes to the relationship

of good health and diet also.

 

[Longboard]

of good health and diet also.

Agreed, but a change in diet eliminating osteophytes or re-growing cartilage?
I'm a bit skeptical of that, but will stay open minded to it.
I'd love nothing more than finding out that spurring can resorb just by eating the correct.............pizza!
With an enhanced effect provided when washed down by a real cask brew!

 

[Hope'sMom]

You guys know I love you, right? But I'm still hoping an actual doctor responds to this post ...
I expect to hear two things right off the bat. "You need to lose weight" and "You need cushioned shoes and/or orthotics." So I will be bringing papers with me showing that 95% of all intentional weight-loss efforts fail within 5 years, and minimalist running puts less force on your knees. And I'm holding out hope that I'll be pleasantly surprised by the doc.

What I'm not looking forward to from my friends and family: "Well of course running destroys your knees!" And, since I turn 40 on Friday, "Well, you just turn 40 and everything falls apart."

I am already pre-annoyed at both of these.

 

[Barefoot TJ]

The docs should be by shortly. Sorry for the wait.

 

[Longboard]

The "actual doctors" will respond, but they won't have any magic for you.
The weight loss is really the only thing you can do that will be almost certain to reduce the load on your knees.
Possibly switching to true barefoot from the VFFs' will change your form enough to also be kinder to the knees.
Not running may work, but you don't want that. No doctor can know that orthotics or shock absorbing shoes will help you, but you can conduct a simple experiment yourself.
Seriously, we expect too much from our docs, in a case like yours only personal experimentation will reveal the answer.
That being said, you probably would find symptomatic relief from steroid injections or rooster comb/synthetic cartilage injections...but you probably don't want that either.....I'm guessing.

 

[Hope'sMom]

All I'm looking for from the doc is suggestions for how to alter my diet to reduce inflammation and how to exercise to get better joint mobility/range of motion/strength in surrounding muscles etc. Assuming, of course, that the orthopedist concurs with my PCP that it's arthritis -- currently my only diagnosis is having a nurse say "The doctor said your x-rays show arthritic changes". For all I know my issues could still be runner's knee, and arthritic changes are just something to be aware of in the future. I believe strongly in being my own advocate for my health, and for trying things to see if they work for me. I also believe in doing my own research, and I'm talking peer-reviewed papers, not wikipedia. So, I'll hear what he has to say. Then the real fun begins!

And if, at some point in time, the answer becomes "Swim instead of run", I'm completely fine with that too. I'm wedded to movement, not necessarily to running. But that day is probably not today -- I have minor pain when I run and only vague hints of pain during everyday activities.

 

[Hope'sMom]

The docs should be by shortly. Sorry for the wait.

You mean our barefoot docs aren't at our every beck and call?

 

[Dr Emily Splichal]

Thank you for your question Hope's Mom. Sorry for the delay getting a response!

Arthritic changes in the knee, just like in many joints in the body are inevitable as we age. When we look specifically at the knee joint, it is particularly at risk for injury or degeneration simply because it lies between the hip and the foot. This means that any weakness or instability in either the foot or hip will increase the stress placed on the knee. This also means that one of the most effective techniques for preventing knee pain is through hip and foot exercises.

So what does this mean in your case?

I would integrate a program the integrates mobility & stability/strength.

Mobility: Make sure your calves (ankles) are flexible. Any calve tightness increases the stress (and ground reaction forces) placed on the knee joint. Make sure your hips are flexible - specifically your TFL (or ITB), hip flexors and adductors. MOST causes of knee pain in runners is due to a tight TFL (ITB) because 1. it is a hip flexor and 2. it specifically stabilizes the knee when your foot strikes the ground.

Stability: After you mobilize your ankles and hips, you want to ensure you have stability in the ankle, knee and hip. This means you will want to strengthen the foot (posterior tibialis muscle), knee (vastus medialis/VMO) and hip (glutes).

One of the best exercises for strengthening the foot, knee and hip simultaneously is balance training or single leg exercises! Of course you will want to do them barefoot

This is of course all said without knowing what your foot type is.....but this is a great place to start! If you do not have a severely over-pronated foot I would not do the cushion-sneaker/orthotic bit.

And as far as omega-3s - great idea!! I love natural anti-inflammatories. Another great one is Bromelain (found in pineapples) and Quercetin. If you have any other questions - please let me know!

 

[Hope'sMom]

Thanks, Dr. Emily!! I know that my level of flexibility is approximately nil. Ditto for my level of balance, so you've definitely given me things to think about. Perhaps I need to think a little more about finding a regular yoga class.
Cheers!

 

[Dr Emily Splichal]

Your welcome!

 

[Hope'sMom]

So, an update since I finally had an appointment with the orthopedist yesterday. He saw no major issues in my knee. He looked at the x-rays and noticed the arthritis, but he doesn't think it was an unusual level of arthritis for my age and ... chunkiness ... and he didn't think it was the cause of my problem. He diagnosed chondromalacia, which is what my PCP and I had also thought. So I have a list of exercises to do for my quads and hamstrings, I have a dictum to ice my knee for 15 minutes every night, I have a prescription strength anti-inflammatory, I have a doctor's advice to avoid squats, lunges, biking, and anything that hyperflexes my knee until it feels better. And encouragement to swim or use an elliptical, and then to start back running slowly when I think I'm ready.
Good news, all of it, so I'm happy. Cheers!

 

[Longboard]

You might want to see what various experts have to say online regarding your condition and the concept of avoiding cycling. Proper high cadence cycling with the seat post at it's correct extension and the use of cleats is often prescribed as a therepy for problems like yours.
Indeed, triathalon enjoyed it's boom several decades ago as runners were forced to add cycling to their training not just as cross training to prevent runner's knee from too many miles on the roads, but as a form of PT to strengthen the various muscles involved in sheilding and correctly tracking the patella.
Worth reading up on.
Lunges, squats, and stair climbing are nothing like cycling when it comes to knees.