Hi Doug,

in a game of gridiron i was hit in the knee by a defender. The report from the MRI had a couple of things in it that the doctors didn't explain very well.

"The pattern of injury is very suggestive of lateral patellar dislocation/relocation. The configuration of the patellar and the corresponding shallow femoral sulcus are likely to be predisposing factors."

"A 6mm loose body is noted in the medial suprapatellar pouch. The donor site is likely to be from the patellar cartilage. Small effusion noted"

Two questions: is it likely that my other knee has the same "structure" (ie. shallow femoral sulcus) as the one that was examined by the MRI? and is the 6mm loose body a concern/how do I get rid of it?

Also, I've been told that I'm going to need a patello-femoral joint reconstruction. Is 5.5 months long enough for recovery before I get back to training camp?

Cheers,

Tim
**************************************************************************************************** Tim,

Yes, there's a good chance that your other knee will have the same or similar structure - shallow femoral sulcus. A loose body, in your case, is the chunk of cartilage broken off the under side of the patella. The only way to get rid of it is through surgery. The fragment may irritate your joint causing intermittent swelling and pain. In terms of recovery time, it's hard to say without seeing you and testing your leg. I know five and a half months seems like a long time but often, it is 9 months or more when there is a cartilage injury.

Hello,
Your advice on your website and in your "Fat Burning 101" dvd, and in your strength training cd have made me very aware of strength training myths from bodybuilders and personal trainers, and you've led me to books by McGill, which have made a big change in my "don't do" list. The talk/sing test has been very helpful and simple. You should self-publish a book!
Do you have any other references for strength training, or other exercises that are essential besides the planks, bird-dogs, pushups, one-legged squats (these have saved my knees and increased my glute strength--I never would have guessed!)?

Thank you,
Mike
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Mike -

Thank you for your note and kind words. I'm pleased you find our resources helpful and that you have improved your physical function.

There are a number of great resources for exercise information. One of my favorite texts is by Tudor Bompa. This text does a great job of explaining how to design training regimens. The Chek Institute has some interesting ideas as well.

There are thousands of exercises, drills, etc. to choose from but the issue is what are you trying to accomplish? Then, the exercise prescription becomes paramount. Strength, endurance, balance, coordination, cardiovascular, power, speed, etc. require slightly different mixtures of repetitions, sets, resistance, and fatigue levels as I discussed in the strength training CD.

Keep up the good work.

Dr. Kelsey,

I came across an article you wrote on January 9, 2005 while looking for information on Patellofemoral syndrome and had a question. I am training for a marathon (this is my first and only), and have recently been having really bad knee pain. It used to be limited to just when I run, but now is continuing on for days afterwards, especially after my long training runs. It now hurts to walk, lift my daughter sometimes, the most is when I have to walk down stairs. Sitting for a long time or crossing my legs hurts, and I don't know what to do. I went to the doctor today and she told me it sounded like patellofemoral syndrome. I thought I came across some great info when I stumbled across the about.com article you referenced, and felt ridiculous when I read yours. I asked a friend at work who has run several marathons and he suggested taking some time off and alternate using ice and heat. I am a Marine and am on my feet almost all day, have been running for a couple of years, and I don't want to take too much time off b/c I do want to finish the marathon at the end of the month. Could you recommend something to help? My husband suggested going to the gym and doing strength training, but I don't have time for the gym. Are there exercises or stretches I could do at home to help? I would appreciate your help.

Thank you,

Emilie

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Emilie,

I'm sorry to hear about your knee pain and can understand your worry and concern. From your description it sounds like you injured the articular cartilage - the cartilage that lines the end of your bones. I suggest contacting a physical therapy practice in your area and ask about how they handle an articular cartilage injury. Until then, read this article or consider purchasing our CD on Runner's Knee for more information about cartilage injuries.

Arnica is a topical cream used to reduce pain, aching, and bruising. It's made from the flower, arnica montana. In the topical form, there are no known side effects although some people may experience skin irritation with prolonged use.

Apply a thin layer of the cream to the painful region two to three times per day for temporary pain relief.

In Austin, you can find Arnica at Whole Foods Market or Central Market.

We just completed our free lecture, "Neckonomics: Solve Your Neck Pain Without Breaking the Bank." With a full house, there were several good questions from the audience:

1. Of all the natural anti-inflammatories, which one should I start with?
2. Which position is best for the neck?
3. Is it ok to take an anti-inflammatory before I go to the gym?

Natural inflammatories include bromelain, an enzyme found in pineapple. Bromelain has been found to be an effective anti-inflammatory (similar to Advil or Aleve) with no known side effects. Suggested dosage is 500 mg, three times per day for two weeks. Some people who are sensitive/allergic to honeybee venom, latex, birch pollen, carrot, celery, fennel, cypress pollen, grass pollen, papain, rye flour, or wheat flour may also have an allergic reaction to Bromelain. If you have any signs of an allergic reaction, stop taking Bromelain.

The best position for the neck is one that creates balance between the head and the body.

1. Sit on the edge of chair and sit up tall and as straight as you can.
2. Take a pencil and hold the eraser end on your cheek bone just below your eye.
3. The other end of the pencil should point directly at your upper chest or sternum (sometimes referred to as the breastbone). If you extend an imaginary line from the end of the pencil, that line should run directly into the breastbone (notice in the image how far forward the red line is from the woman's upper chest - this is too far).
4. If the pencil's imaginary line extends farther down your body, you are not sitting up straight enough.

I answered the final question with a question. "Would you be able to go to the gym and do your workout without taking an anti-inflammatory?" If you must take an anti-inflammatory in order to exercise, you should change your exercise routine such that you can perform it without symptoms. In some cases, you'll need professional help to create such a routine.

Our next lecture is September 19, 2006 covering the topic of shoulder pain. See you there!