Patellofemoral Pain, Chondromalacia and second opinions

kneesmallPatellofemoral Pain or Patellofemoral Pain Syndrome (PFPS) is pretty much pain that is felt in and around your knee cap. It is also known as runner’s knee due to a prevalence in runners. PFPS is a relatively new way of looking at knee pain whereas an out of date consultant may look at your knee and consider it to have degenerative chondromalacia which is basically damage to the cartilage behind the knee cap that wont get better and will only get worse with use.

I only mention this as I have recently had a rather negative experience with a knee orthopaedic surgeon, resulting in a search around for a second opinion and a day out in London yesterday.

The first surgeon listened to my description of the issue and examined my painful knee. He listened when I told him what I did for fun, nodded and said that he has happy to have me as a patient. He then ordered some MRI and X-Ray images which took a couple of weeks to get sorted before I returned for my follow up consultation. This is where it all went a bit wrong. Ultimately I was advised that I had degenerative chondromalacia in my right knee cap, it wasn’t bad enough to merit surgery, and that I should seek some physio. I was told that the issue would never get better, that I should massively reduce my running mileage and that I should wear heel lifts. I was then rushed out of the door, very bewildered, with my entire lifestyle being turned upside down on the whim of this knee “expert.” To say that I was unhappy was an understatement.

When I got home I thought about the matter and the advice simply didn’t sit right with me. It wasn’t just that I had been told news that I didn’t want to hear, but it contradicted the research that I had done into knee pain. The rushed nature of the second consultation also didn’t feel right. I decided that I needed a second opinion but it would have to come from a knee surgeon that was used to dealing with athletes. How on earth would I find one that I could trust?

For me the answer turned out to be quite straightforward. I asked my coach, Neil Scholes of Kinetic Revolution, who turned to his contacts to get me a name. Neil also backed me up fully, provided some valuable insight, and prevented me from panicking about the whole thing. The name that Neil came back with was Jonathan Bell from Wimbledon Clinics who came highly recommended and has the tag line “Keeping the active active” on his twitter feed (@jonathanbell.) I spoke to Bupa, who handle my medical insurance, and they were happy to cover his fees. I made an appointment and yesterday I finally met Jonathan.

Prior to my second opinion I had thought things through multiple times and decided that if Jonathan Bell gave me similar advice then that would be good enough for me. I wasn’t simply going to carry on hunting for an answer that I wanted that didn’t match reality. I was also fully prepared to postpone my running plans for next year if I needed to take the time out to make my knee better for the long term. As it turned out, I need not have worried.

I had a 45 minute slot with Jonathan and straight away his approach was different to the one that I received before. He didn’t look at me as if I was an idiot when I said that I was an ultra marathon runner and iron distance triathlete. He didn’t bat an eyelid when I mentioned that I was planning on running a one hundred mile ultra next year as part of my UTMB qualification. Instead he knew what the UTMB was, as he had frequently been a spectator on it, and he was interested in my problem and wanted to help fix it. Jonathan then examined both knees very thoroughly, asked loads of questions, drilling through my waffle to eek out the information that he needed. He told me his conclusion and explained it fully while we also went over the aforementioned MRI and x-ray images. In short my issue is centred around my knee cap, it is far from irreversible, doesn’t need surgery and should be fixable with a bit of physio.

Jonathan then asked me if I already had a good physio, I didn’t, and he told me that his wife, Claire Robertson (@clairepatella on Twitter) solely focuses on PFPS. I had already decided that I wanted to see the right person to resolve my problem regardless of travel limitations, so we looked at Claire’s calendar to see when she could fit me in. There were gaps next week which suited me, so we headed out to reception to get me booked in. As we walked out the receptionist was just phoning Claire’s 1230 patient who was a no show and I managed to pretty much walk straight into her office. How lucky was that?

Speaking to Claire it turns out that she does a lot of research into PFPS, it is her sole professional focus, and she was exactly the right person to see. Claire was every bit as professional as Jonathan and as we went through the exam it was obvious where I needed to do some extra work. Claire gave my some stretches and strengthening work to do, patiently answered my inane questions and was happy to write to my sports therapist so that she could contribute to my rehab. As we went through the exam it was also obvious to me how many problems I had already fixed through the stretches and strengthening that I was already doing.

I have gone into quite a lot of detail on this and feel that there are several important lessons to take away from it:

  1. Get a second opinion. Especially if you are given advice that is going to significantly impact on your lifestyle.
  2. Stretch now, before it is too late. My issues largely come from having not spent time stretching over the last 20 years.
  3. If you are athletic then see a consultant that specialises in athletes, and don’t take their word on it. Ask around and get an appropriate recommendation from another athlete that has used them.
  4. Consider running away if someone mentions chondromalacia!

In the meantime my plans are now back on track for next year. I will be making a massive effort to stretch and strengthen in the appropriate places through the winter, and intend on being fit, healthy and fast for my ultras next year. I can’t wait and am more excited than ever at the prospect of doing the UTMB at some point in the future.

I am not a medical expert, so any mistake in the above article is mine and mine alone after interpreting the advice that I have been given. If you do notice anything incorrect then feel free to get in touch.

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