Chondromalacia patella

That’s the doctor’s diagnosis. I went because obviously there’s something wrong with my knee. It hasn’t completely healed since the last training hike (about 3 months later, including >1 month of no leg work at the gym) and now it pops/cracks (like a knuckle) much more often than my other knee. WebMD tells me that these are signs you should see a doctor, so I did. Apparently my kneecap isn’t tracking correctly and is rubbing against the other bones in my knee. I’m not excited about this. It’s worse than I had hoped, and could derail my hike. Best case is I do some physical therapy, take it easy, and am back on the trail in a month or so. Worst case, physical therapy doesn’t help, I try surgery (this won’t be for a while, just giving the worst case) and it doesn’t help, and I never get to do my dream hike. Obviously there are lots of possibilities in between. Let’s hope for the best case.

I’ve had two physical therapy sessions so far. We are concentrating on strengthening and increasing flexibility in my hip flexors. Apparently (as noted in the link above) this is a common treatment. However it strikes me as interesting that it doesn’t address the area where I tend to get pain when hiking, which seems to be where my quadricep attaches to the kneecap. I geeked out today (check out the totally cool diagram of the knee found here!) and did some extra research. Apparently there are a bunch of muscles that are involved in making your kneecap track correctly – four muslces to be exact, hence the name of the well-known QUADricep. There’s the Rectus femoris, the Vastus intermedius, the Vastus lateralis, and the Vastus medialis, the last of which corresponds to where I feel the pain when I’m hiking. Some additional research led me to this simpler website and this more complicated one, both of which seem to describe me perfectly. So in addition to the flexibility/strengthening exercises the therapist is giving me, I’m going to add the exercises of the vastus medialis that the website prescribes. Can’t hurt right?

In my poking around the internet I also found a reference to the “Terrible too’s” which probably explain my injury – too much, too fast, too soon, too often, with too little rest. Maybe the too often doesn’t apply, but the rest probably describe my last 2 training hikes. The next will definitely need to be low mileage and focus on gear. I’ll also have to put double the focus on starting my hike slow – no more than 8 miles a day for the first week, maybe even two weeks.

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