My knee is killing me ?Theater Knees or Chondromalacia?

After being out of flying for 6 years I want to get back into it and I?d like to get into a Vans or a Rocket.

I?m suffering from what my Doctor calls Theater Knees or ?Chondromalacia? After a couple of hours sitting in my Viper my right knee is killing me and I need to get out of the car.

Of the Van?s AC what one would allow me to have a straighter leg extension? The more my knee is bent the worse it is. If I wrap my knee and pull the knee cap to the side this does help and gives me maybe another 30 mins or so. I?m 54 yrs old at 5?11?, 205 pds decent shape and I still lightly exercise 5 days a week. I?m thinking the 30 years of heavy weight training has done its damage and now I?m paying the price.

I like the centerline seating of the RV4 or the RV8 but maybe the side by side would be better.

Anyone out there suffering from this and what are you flying?

Thanks

Tim

Hi Tim:

Although never officially diagnosed, I used to suffer from the same thing.

You are very close to my size (6'0" and 192lbs). I can stretch my legs all the way out in my -7A. The great thing about the side-by-side RVs is you can turn a little sideways if necessary to stretch out your legs. When I'm solo and in cruise I'll frequently move my right leg over to the other side and stretch out.

I would recommend that you go sit in an RV that has been configured for someone about your same size.

I suspect the side by side seating arrangement of the 6, 7, or 9 would provide you with better leg extension/more area for your feet to go.

riobison said:

After a couple of hours sitting in my Viper my right knee is killing me and I need to get out of the car.

Click to expand...

Don't push on the gas pedal so hard.

Tim, after years of abuse and surgeries, my knees are seldom happy with me either. I have an -8 and have to move my legs around quite often to avoid cramping up. There's enough room between the rudder pedals for me to extend my legs (one at a time, admittedly) and prevent problems. I certainly wouldn't rule out a tandem model for that reason.

Tim, When I was about your age I had the same problem. Although I never had it diagnosed by a doctor, I could not fly a long time without pain in both my knees. Someone suggested taking the joint supplement glucosamine so I started taking it on a daily basis and no longer have that problem. Check with your doctor and see if he thinks that is a good idea. It may not work for you but then again it may.

Dan

riobison said:

....I like the centerline seating of the RV4 or the RV8 but maybe the side by side would be better.....

Click to expand...

Tim,

I am fortunate to fly a side by side (-6A) and a tandem RV (-8). While either configuration is comfortable to me, I do prefer the optional cockpit adjustable rudder pedals I installed in the -8. Sometimes you just want to stretch out your legs. Some guys say the cockpit adjustable option is not really needed because (they assume) that once the pedals are adjusted to suit, are rarely moved from that position. WRONG. On a whim, in cruise flight I can pull on the lanyard and shove the pedals forward to stretch out my legs. At 5'9" I am not all that tall so when the pedals are against the firewall, I can just barely reach them. But thats okay because that forwardmost position frees up the floor space and allows me to straighten out my legs fully which as you know can provide temporary relief for aching knees. I suggest that before you pull the trigger on a specific RV model, do yourself a favor and check out the cockpit adjustable rudder pedal arrangement for yourself.

I also have intermittent knee pain, and the glucosamine and condroitin really helps for me.

Good luck

Rick6a said:

Some guys say the cockpit adjustable option is not really needed because (they assume) that once the pedals are adjusted to suit, are rarely moved from that position.

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IMHO, The adjustable rudder pedals in the -8 ought to be standard, not optional.

In the RV-8 in my avatar, the owner is around 6'4" and flies with the pedals nearly all the way forward. I have short legs and need to have them full aft. The adjustability is a godsend.

There is a lot of legroom in the -8 with the pedals full forward. I'm only 5'7" and with the pedals full forward, my feet cannot reach them.

Hmm... I have never heard of that before, but the description tells me all I need to know. I have the same issue. I just never thought of getting it diagnosed.

I'm 6'2" x 230 and despite my frame, I really like to be up close to the controls. If I'm driving, I'm up closer to the wheel than you think. If I'm flying I'm further forward than you think. I just don't like being away from the controls and reaching out. I can feel the vehicle more if I'm up on the controls and not sitting back with my limbs extended near their limits.

But this has resulted in a lot of knee pain over the years. I can temporarily relieve it by sliding my seat back and extending my legs, but if I can get out and walk for a good 15-30 minutes I'm good.

I learned something today. I don't think you can get more room than the RV-10, so that's a good thing for me.

I have the same problem and it has been almost completely debilitating on the past. Targeted weight lifting and weight loss greatly help me. Glucosamine doesn't seem to help me.

A side-by-side without the vertical control panel and with hanging pedals will give you the most freedom. I notice a little problem flying the -8 for long legs (but not bad at all) and suspect it might be an issue in the -3 (and a -4, if I ever fly one.

So, if the viper bothers you, think seriously about a -7, -9, or a more modern -6 (with the hanging pedals and no vertical panel).

Do to other injuries years past I have been taking glucosamine MSM and chondroitin. It helps but even with the supplements and Celebrex or Ibuprofen I?m still limited to about 2 hrs. In the car I as well need to be up close to have to most feel and control of it and I know that does not help the knee thing.

Getting out and walking around for 5 or 10 mins and then I?m good to go again but for less time the 2nd time around.

In the plane once in flight at altitude a guy can stretch out a bit and that would help a lot.

Are those adjustable rudder pedals available to retrofit to all of the models?

Thanks

Tim

I have knee trouble as well. Virtually no menisci left in the left knee. I do find that Glucosamine/Chrondrotin helps me and have been taking it for over 10 years. I usually require true scientific evidence of the effectiveness of such things (i.e. double blind reviews of experiments). Also, I don't accept the results of experiments that were funded by the drug company. However, no doctor I have asked has heard of such a study with Glucosamine/Chrondrotin. Nor have I found any such studies in my searches. However, I do notice a difference when I don't take it.

I also used to give my dog a version of the same drugs made for pets. She had arthritis issues. After I came back from a trip once, I noticed that the pet sitter had failed to give her the drugs while I was gone (about 4 days as I recall). My dog was noticably stiffer. She improved after a few days of being back on the drugs.

So, the point is there appears to only be anecdotal evidence of the effectiveness of Glucosamine/Chrondrotin. But, my personal experience is that it is helping me. So, I continue to take it.

I haven't made any long trips in my 8A so I am not sure how much of an issue it is going to be for me. I didn't go with the adjustable rudder pedals either. I may wish I had at some point.

Tony

Ill chime in

Chondromalacia is treatable. It is the softening and subsequent inflammation of the cartilage that cover the end of the Femur and underneath the Patella (kneecap). There are several things you can do to reduce the pain. First, control the inflammation (inflammation=pain). This is often done with NSAIDs, ice, prescription "arthritis" meds, and as stated previously through anecdotal evidence, supplements. You also need to stretch your quad muscles. These are the big long muscles in the front of your leg. The middle muscle is called the Rectus Femoris. This muscle crosses two joints, your hip and knee. As it crosses the knee is encompasses the knee cap and then attaches near the top of the Tibia (shin). The muscle uses the kneecap as a fulcrum creating more leverage to move the lower leg. Sooooo.... when you sit for a prolonged period of time the muscle is actually in its lengthened position and if it is tight then it applies a low load constant pressure to the cartilage, eventually causing Chondromalcia. The pain subsides when you move your kneecap or straighten your leg because your moving or decreasing the pressure point.
hope this helps.

i have taken out the add. it is not any fun dealing with pain. help is out there with new findings. fly more. enjoy your RV.


As you grow older, age-related stiffness and discomfort in the joints becomes a fact of life. Activities once routine become a challenge as limited mobility hampers your every move.

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As to the original question, my side by side 6A allows for pretty long legs, and the hanging pedals allow my feet to slide underneath to allow me to straighten my legs out somewhat in cruise (I'm 6'4")

As far as chondromalacia goes, I deal with the problem every day as a physical therapist. First, the softening and breakdown of the patella-femoral cartilage usually results from poor tracking of the patella in the groove of between the condyles of the femur. Most commonly, the patella is pulled laterally (to the outside) This happens because your hips are further apart than your knees, meaning the femurs are not completely vertical, but rather are angled in somewhat, like so \ /. The tibia below ARE vertical, however, which creates an angle at the knees (called the Q angle) which pulls the kneecaps outwards. This is why wrapping the knee and pulling the patella sideways provides relief.

In my practice, treatment is usually focused on strengthening the vastus medialis oblique (VMO); the part of the quadriceps on the medial (inside) aspect of the thigh. It pulls on the kneecap at an angle and when its strength is in proper balance, helps to hold the kneecap in against the outward pull caused by the angle. This muscle can be selectively strengthened by working the knee in the last 30 degrees or so before the knee is completely straight; this is the range that the VMO primarily works in. As for glucosamine, it can be effective, and there HAVE been controlled double blind studies confirming its effectiveness in the past few years; sorry I don't have the references handy.

Sorry to be so windy, but we all try to contribute what we can on the forum, right? Since I get so much from others who know so much more than I do about RV's, I thought I'd contribute from my area of expertise to give a little back. PM me if you want more info, and have fun flying! By the way, I'm a little jealous of your Viper, although my 350Z is a lot of fun on the track

Chondromalacia Supplementation Considerations

Regarding Chondromalacia Patellae, I will briefly address the state of supplementation science, my clinical experience with supplementation for joint pain, and then go over the bigger picture of body inflammatory state, hydration, and neuro structural considerations. This information is not a substitute for seeing your health care practitioner; and is my opinion.

Joint Supplement Science

There are actually a handful of controlled double-blinded studies on glucosamine, chondroitin, MSM and Boswellia. Here is a recent one: Adv Ther. 2011 Oct;28(10):894-906. Epub 2011 Oct 7
The problem is that the vast majority are for Osteo Arthritis, which is a very advanced and difficult to treat form of joint damage. They also never exclude NSAID use, and NSAIDS inhibit cartilage repair. With any sort of inflammatory disorder the supplement with the greatest quantity and quality of science behind it by far is fish oil. EVERYONE should supplement with fish oil.

Joint Supplement Clinical Observations

I have about thirty years clinical experience with the various supplementation schemes for joint issues. Here are my observations:

Chondroitin and Glucosamines - These sulfur-bearing biological polymer building blocks rarely give good results; and I have seen allergic reactions too often. This likely due to high sulfite content and the fact that most are derived from shellfish. I never recommend these anymore.

Boswellia works well for some people, but is definitely hard on the gut. Many people have gut issues taking Boswellia. It is a less strong cyclo-oxygenase inhibitor and seems to have a similar action to NSAIDS, anti-inflammatory but doesn't seem help joint rebuilding directly.

Kaprex - A hops, rosemary and olive leaf extract that works well for some people, but not others. I believe this to be due to variations in the underlying cause - If you have chondromalacia patellae due to an underlying pro-inflammatory state then Kaprex works great. No gut problems with Kaprex, but it is expensive.

Aloe Vera - The allantoin in Aloe has been shown to increase cell turnover. This can be helpful to speed up cartilage repair.

Runner's Edge - An antioxidant enzyme supplement that will clear grit out of joint fluid in the knees if you give it time.

ACUTE - Another effective enzyme supplement, this one focused on breaking down the protein signaling molecules to mitigate the inflammatory cascade. A great alternative to NSAIDS without any liver or kidney toxicity.

Vitamin D - Best from the sun, essential for normal immune function.

Hayaluronic Acid - Pulls moisture into the tissues. Best from food.

MSM - Methy Sulfonyl Methane - basically a highly-bioavailable form of Sulfur. My favorite, about 80% of people who use it notice a positive improvement. Easy to use, just buy it in bulk and mix with water. Inexpensive too, but just don't bother with the chinese-sourced stuff, not worth it. If you aren't low in sulfur, MSM may not help. People who respond to chondroitin/glucosamine typically respond even better to MSM by itself. If you are, it will soften up and hydrate scarred-up and thickened connective tissue and improve cartilage repair rates.

The above is not a complete nutrient list for cartilage repair - other known nutrients for cartilage repair include vitamin C, zinc, copper, and manganese.


Pro Inflammatory State and Knee Pain

Sometimes the knee is just where the inflammation is being expressed. A diet high in Omega-6 fatty acids and refined carbohydrates and/or excessive calories are all associated with a pro-inflammatory balance. Some other factors that promote inflammation in the body include food allergies, impaired detoxification pathways, acidity, and chronic infections.

Hydration

You need both general hydration and local hydration. By local hydration I mean inside the cartilage itself. Two known factors here. One is Hayaluronic
Acid, it pulls moisture into the tissues. Best food source known for hayaluronic acid is any stock made from bones (also available as a supplement). The second factor is the mechanical action of the joint. Joint cartilage, known as Hyaline cartilage is a like a very smooth and slippery sponge. Like all connective tissue it is living cells within a non-living matrix:

You can see that in this matrix the cells have a little space like a pool that they live in called lacunae. Important fact: Hyaline cartilage contains no blood vessels! The only way those cells get the oxygen, blood sugar, and nutrients they need to survive and thrive is to absorb the joint fluid directly:

This is called imbibition, the direct drinking of water. When you put weight on your knee, it compresses the cartilage "sponge" and squeezes water and waste material out. When you pick up your leg, it de-compresses the "sponge" allowing it to absorb water and nutrients again. This is essential for the normal nightly burst of cartilage repair in the body.

Neuro-Structural Integrity

If you knee is misaligned, it can be compressed in one area and not another. This spot will have accelerated cartilage wear, and reduced repair because it is not decompressing and getting the imbibition it needs. Often knee alignment is secondary to hip and low-back alignment, which is secondary to neck alignment.

If your neck is missing it's natural curve, that puts tensile stretching forces on the spinal cord, which usually increases nerve tension throughout the body. Since nerves cross joints, and the spinal cord is more important tissue than a knee, the body will compress the knee trying to reducing the pulling on the spinal cord. In this case the entire knee may not effectively decompress at all.

It may sound strange how having a good chiropractor work on your spine can improve knee pain, but I hear my clients tell me how much better their knees are time and time again.

Review

So I have discussed the science of joint supplementation, my clinical observations with joint supplementation, as well a discussion of other factors like the overall tendency to inflammation in the body, hydration, as well as effects of loss of neuro-structural integrity.

One last point: The side-by-side RV knee straightening factor is real, and makes a big difference.

Yours in Health,

Chondromalacia patella

Yeah, I see 3-4 of these a day and I pretty much agree with Gerry. It seems that strengthening the VMO helps with the pain by improving the tracking of the patella in the patellar groove on the front of the femur. The lateral shear forces on the patellar cartilage is what contributes to the destruction of the articular cartilage. Neoprene knee sleeves with a lateral patella buttress can also help somewhat. You could wear one of these when flying to see if it helps. Cortisone injections or Synvisc injections are also a consideration.

Glucosamine and chondroitin are the two of the protein substrates that make up articular cartilage. I could go into the pathophysiology of osteoarthritis but I think you would all be bored to tears with that. I have included an article from the website of the American Academy of Orthopaedic Surgeons (of which I am a fellow) for those who want controlled double blind studies. Bottom line, glucosamine and chondroitin seem to have a beneficial effect on stabilizing articular cartilage but not restoring it. The current positon of the AAOS is that it probably helps but certainly doesn't hurt. You can visit the website of the American Academy of Orthopaedic Surgeons to view patient information on this: www.aaos.org


Glucosamine, Chondroitin Sulfate Clinical Trials
An analysis of clinical trials on glucosamine and chondroitin sulfate for treating osteoarthritis has shown that these compounds may have some efficacy against the symptoms of this form of arthritis.

The study, by Timothy E. McAlindon, DM, and colleagues at the Boston University School of Medicine, located 37 studies of the compounds in osteoarthritis by a thorough review of the scientific literature published over more than three decades. Of these, 15 trials published between 1980 and 1998 met their criteria: double-blind, randomized placebo-controlled trials that lasted four or more weeks, tested glucosamine or chondroitin for osteoarthritis of the knee or hip and reported data that the researchers could extract on the effect of treatment on osteoarthritis symptoms.

Six of the 15 trials involved glucosamine and nine used chondroitin. The team used only trials of four or more weeks in duration because of evidence that it may take several weeks for the compounds to have a therapeutic benefit. Only one of the 15 trials was completely independent of manufacturer support.

The team's analysis of the trials had two key facets: a quality assessment to evaluate each of the clinical trials and a meta-analysis, which enabled them to integrate the data from different trials. The trials studied had many methodological flaws and biases, including those that tended to inflate the benefits of the compounds. The team was also concerned that trials having small or negative effects might not have been published, but after contacting study authors and other experts, they could locate no unpublished negative results.

Based on data from the trials, the researchers calculated an overall "effect size" for the two compounds: the figure 0.2 is considered a small effect; 0.5, moderate; and 0.8, large. The researchers calculated an effect size for glucosamine of 0.44 and for chondroitin sulfate of 0.78, but reported that these values "were diminished when only high-quality or large trials were considered."

The study was published in the March 15, 2000, issue of the Journal of the American Medical Association (JAMA). Dr. McAlindon recommends that additional, rigorous, independent studies be done of these compounds to determine their true efficacy and usefulness.

Dr. McAlindon said he would not discourage patients from trying these compounds, "but there is a possibility that they might not work," and that substances labeled as these compounds might not even contain them, due to a lack of regulation. Patients with osteoarthritis are urged not to stop proven treatments and disease-management techniques and to let their physicians know if they are considering use of these compounds.

"About 21 million adults in the United States have osteoarthritis," says Stephen I. Katz, MD, PhD, director of the National Institute of Arthritis and Musculoskeletal Skin Diseases (NIAMS). NIAMS funded this study and helped launch a major clinical trial on the compounds in osteoarthritis, along with the National Center for Complementary and Alternative Medicine (NCCAM). Both are part of the National Institutes of Health (NIH).

In March 2000, NIAMS and NCCAM announced they would jointly initiated the largest multicenter study to date of glucosamine and chondroitin sulfate in order to provide definitive answers about their effectiveness for osteoarthritis. The University of Utah School of Medicine is coordinating a nine-center effort in over 1,000 patients.

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Four professionals

This thread has heard from four professionals (two Physical Therapists, Chiropractor and an Orthopedic Surgeon), all providing excellent education regarding the causation and treatment of chondromalacia. Treatment for this condition has been supported through research and case study which would likely involve information given from all four. The point being, If you have suffered from this then I highly urge you to speak to your trusted health care provider as this condition is not uncommon and treatment is highly effective.

Gee, I feel left out here. Doesn't anyone wanna talk about root canals or gum disease?

just had my teeth cleaned. no root canals or gum disease?

dont forget the d3 vitamins for aches and pains.

Pain!

I felt pretty good sitting down to read this thread. Now I ache all over!

Thanks

Well guys I do appreciate the input. I will modify my supplements a little. My quads are plenty strong from over 30 yrs of body building but I can try to isolate the VMO. My hams are tight and the back problems with damaged L4, L5 and S1 I gather are not helping at all. 200 to 400 mg of Celebrex a day gives some relief to the back but not much to the knee.

Trust me on this you can get broke up just as bad on 1 horse power as
you can on 200 HP.

I had a ride in a RV 6 from Springbank this summer and I was impressed with it. I will lean towards the side by side RV but I still need to try out a tandem when I?m home in the spring.

Again, thanks for the help

Tim

If you are ever out in Moose Jaw we can hook you up in a 6A (mine) and an 8 (my hangar partner Laser's). Not uncommon for a 7 to be hanging around on weekends too. Good luck with your search!

Thanks Gerry, will do.

Tim

So thats what it is. By the time I fly coach from Miami to Dallas I'm in agony. I get it a bit in the plane when I have a passenger. If I'm solo not at all. I made a center console that supports my entire body weight. It squares up your frame by supporting the side of your leg. With A/P engaged my R leg is on top of the console and my L. foot is under the pedal. If the seat would go back it would be barkalounger-esq.

Leg over

Flights under 2 hours in coach is all I can manage than after that it's up in Buss.

I'm thinking I might have to give up on the Tandem idea and get into the side by side seating so I can get my leg over to stretch out.

Thanks all for the knee information. Never know what you might find here.