Chondromalacia patella

Question
QUESTION: I am a 30 eyar old woman. I have always participated heavily in sports and usually run at least 30 minutes a day. In Feb 2011, I hiked a 4500 m mountain. I descended all in the same day in about 12 hours. My knees hurt horribly, but I continued anyway. One knee went back to normal and the other continued to hurt. Four days later I ran a 21 k race uphill half the way and then downhill without any training. Ever since then (end of Feb) my knee has had problems. I have rested it for over 8 months. I am really tired of being unable to exercise. i have been to multiple doctors and physical therapists. This week, I decided to play some football using a brace. Now, four days later, my injured knee hurts and the other one is hurting now as well. Any advice? I really want to get back to exercising and this chronic pain is really despressing me.

Thanks!

ANSWER: I'm really sorry about all of your knee pain Devon.  First of all don't just ignore the pain. If you ignore it further damage will occur.  Please read "Pain, Pain, Pain" for more on what pain is telling us. My second advice is to find an expert on the knee.  Pain while doing something that is normal and natural to do is telling us that we're doing it wrong.  The problem may be as simple as strengthening a muscle in your hip or running with a straighter back.  Without being able to see you run and do some tests it'll be impossible for me to know, but someone very knowledgeable is able to help you.  Make sure to continue to look for someone with more knowledge on this subject than the previous doctors ans physical therapists you've seen.  Standard training that they have received obviously isn't good enough to fix your problem. Finally, I've seen many ankle, knee, and hip problems alleviated by switching running styles to a forefoot or a midfoot strike.  This video shows them running barefoot, but the strike can be performed in regular shoes as well.  Here's the youtube video to teach you how to do it: The Barefoot Running Professor. Good luck and please keep me updated of further developments or what helps alleviate the pain.

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QUESTION: Thanks for the concern and the advice. Of course, I would like to see a good doctor that can help me, however, I am currently living in Egypt and this does not seem to be very possible. So, is there any advice you can give me on how to exercise without further damaging my knees? Or if I should just fully rest until I can see a doctor in the US? Additionally, do you think that the more time goes by the more permanent the condition will be?

Thanks so much!

Answer
I did notice you were in Egypt which definitely presents a problem.  

1) Incorporate more upper-body exercise.  This will allow you to exercise more without inflaming your knee.  Also, try squats and lunges to exercise the legs unless it causes pain as well. (It very well could, but you should test it.)  Further, swimming is fabulous exercise that will allow you to exercise without inflaming the knee.

2) Hopefully you won't need to fully rest it.  Continue to try to find movements, exercises, posture, etc. that don't hurt it.  

3) If you continue to aggravate it the condition will get worse.  The pain will get worse as you damage your body more.  Pain from incorrect movement almost always comes before damage so you don't want to push through this pain day in and day out.

Hopefully this answers your questions. Please let me know if you need further guidance.