# Cartilage wear on medial femoral condyle and patella



## qi-tah (May 12, 2007)

Hi all;

I'm recovering at the moment from an arthroscopy on my left knee, and had my post surgury check-up with my surgeon the other day. He informed me that although my meniscii are intact (yay!), i'd had significant (grade II/III) wear and tear on the surfaces of the medial femoral condyle (the bottom inside end of the femur) and patella (knee bone). I asked about what exercises i should avoid to prevent further damage, but he was predictably vague, although he did say that roundhouse kicking where you pivot on yr standing leg (like Mauy Thai) is not great for it. This shouldn't be a problem as there aren't that many kicks in Ba gua zhang (my main art). My questions to you all are:

1) Has anyone else had this injury/problem? What do you do to manage it?

2) Does anyone with biomechanical knowledge have any suggestions as to exercises to avoid, or conversly, exercises that would be good for this type of injury?


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## Kembudo-Kai Kempoka (May 14, 2007)

Stuff I need to know first:


How old are you?
Male or female?
What exercise activities do you regularly engage in?
What were the identifiable mechanisms of injury that got you to where you needed your knee scoped in the first place?
What activities do you do now?
What leg and trunk exercises do you do regularly, and which weak-links have you noticed in your training?
How many times per week do you do physical activities involving the lower extremities, and at what intensity & duration?
What stretches do you do, how intensely, and for how long?

Let's start here, and see where it develops.

D.


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## qi-tah (May 14, 2007)

Kembudo-Kai Kempoka said:


> Stuff I need to know first:
> 
> 
> How old are you?
> ...


 
Thanks D. 
	

	
	
		
		

		
			





I'm 36, female, practice CMA, also do a lot of hiking and cycling (when i'm fit!). I've been out of action for nearly 10 weeks now, what with waiting to see the surgeon and then get the op done, so my left quads have wasted quite a bit. All i've been good for during that time has been sit-ups, arm free weights and stretches. 
	

	
	
		
		

		
		
	


	




 I guess i do about 50-100 sit-ups and about 20mins stretching a day, and idley twiddle with the 3-5kg weights when watching telly (deltoids, biceps, triceps). Nothing too intense. 
As far as to what led to the knee packing up, it could be a range of things i guess. Probably the Capoeira i did 6 years ago is the chief culprit - after a year of jumping up and down on hard concrete, my knees were so sore that i could hardly walk for months. I also did a bit of Muay thai kickboxing after that, so perhaps i wasn't kicking properly. I've also done quite a bit of low horse stance over the last 5 years. But i've also played soccer and had my left knee blow up from damaging the bursae whilst playing that, and also been a wicketkeeper in cricket for a number of years. Oh, and when i was playing rugby union, we had these ridiculous exercises in training where we had to frog jump the entire length of the field and then duck walk back carrying another player on our backs! My knees wern't too happy about that either.
What exercises would i normally do in Ba gua... well, lots of lower hip walking (sinking yr body whilst walking and pushing out yr stride length), waist flexibility exercises, Shaolin kick flicks (low kicks at waist level, toes pushed out), picking up the dust exercise (putting whole chest over one foot, then transferring weight to other leg whilst keeping chest as close to the ground as possible - it's also called swallow touching the water), all the 5 stances, horse, bow or archer, drop, empty or nail and the twisted up one with one knee under the other. I also do a bit of Sun and Yang style taiji. When fully fit, i get in 4-5 sessions a week of about 90-120 mins each, one class and 3-4 sessions by myself.
Weak points... my upper and middle back are very stiff and inflexible. Also my left hamstring had a bad tear about 18 months ago and only recently (before this little episode!) regained much of the power that it lost at that time.

Interested to hear your thoughts.


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## Kembudo-Kai Kempoka (May 15, 2007)

You're active; that's good. Now stay that way; if you quit for any great duration, you're apt to get more creaks and groans then you knew you had coming.

One more question: High arches, or flat feet? But not just the arch. Look at the bottom of a pair of sneakers.

In a normal gait, our heel should strike the ground just slightly to the outside of center (towards the blade of the foot), then the foot should roll to the great toe. Is the wear pattern on the bottom of your shoes near the heel notably to the medial or lateral side of center?

When you stand naturally, is there a straight line down your shin and over the top of your foot, or is there a slight lean at the ankle, either distributing the weight a bit towards the blade, or a bit towards the middle? Particularly on the left side?

Dave


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## qi-tah (May 15, 2007)

Kembudo-Kai Kempoka said:


> You're active; that's good. Now stay that way; if you quit for any great duration, you're apt to get more creaks and groans then you knew you had coming.
> 
> One more question: High arches, or flat feet? But not just the arch. Look at the bottom of a pair of sneakers.
> 
> ...


 
I think my feet are somewhere in the middle as far as my arches are concerned. They are certainly not flat! The wear pattern on my shoes are on the lateral side of the heel.

Not sure what you are asking in the last para, standing naturally (evenly distributed wieght) my knees are pretty much dead over my feet, is that what you mean? But i often shift from one leg to another if standing for extended periods of time, which would shift the load-bearing knee to the medial side.
Umm... not sure if it is a consideration, but i also have quite short, bowed legs...my calves in particular don't meet in the middle if my knees and ankles are both touching each other. I'm also slightly pidgeon toed, but am not sure whether this is learned behaviour or not.

Thankyou btw, for taking the time to help me out. I really appreciate it.


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