DEAR DR. DONOHUE: My son is an all-round athlete. He plays football, basketball and baseball and is on the school track team. He has complained of knee pain for the past two weeks. My brother-in-law, who used to be a trainer, says it is chondromalacia, something I’ve never heard of. He says it is due to the knee cartilage. Does that mean torn cartilage that has to be repaired? – W.S.

Chondro” means “cartilage,” and “malacia” means “wasting away.” Here, “chondromalacia” refers to the cartilage that covers the back of the kneecap. The covering allows the kneecap to freely glide up and down when the leg is bent. It has nothing to do with the cartilage inside the knee joint.

The protective kneecap cartilage begins to fray. If the process continues, fissures appear in the cartilage, and if it continues further, the cartilage can flake off the kneecap.

Overuse is one cause of chondromalacia. If the knee doesn’t stay put in the groove that nature provided for it, that too can cause this cartilage problem. So can feet that turn too far inward when they strike the ground. That’s called overpronation. And, as always, there is the “idiopathic” category. It means the cause is unknown.

People with chondromalacia put their hands over the kneecap when they are asked to localize their pain. They tell you that activity increases the pain and, surprisingly, that sitting for too long also brings on pain. When the knee is kept bent, the cartilage-damaged kneecap kicks up a fuss. That is called the moviegoer’s sign. Climbing up and down stairs is another painful situation.

The prospects for your son needing an operation are infinitesimal. Usually rest heals the affected cartilage. Anti-inflammatory drugs can hasten healing and can relieve pain. Aleve is an example.

Let’s not go overboard here. I am sure your brother-in-law is a reliable person, but have a doctor make a diagnosis. There are too many other conditions that cause similar pain, and they have other treatments.

DEAR DR. DONOHUE: In our sunny and year-round-warm town, skateboarding is an obsession with the kids. My son is a skateboarder, and he is also a casualty of it. He broke his arm just above the wrist while skateboarding. He’s not the only kid with the exact same injury. Are broken arms more common now, or is skateboarding the reason for the broken-arm epidemic? – K.P.

Independent of skateboarding, there is an increase in fractured arms in children and young adults. In one locale, for instance, the number of broken arms increased 32 percent in boys and young men and 56 percent in girls and young women in the past 30 years.

The reason for the rise is as yet undetermined, but people have their pet theories. One is that soft drinks have replaced milk as children’s primary drink.

Others feel that it is the diminution in physical activity that makes children’s bones more susceptible to breaking.

Both of the above might be true. However, the most important factor for bone breaks in skateboarding has to do with the nature of that pastime. It is hard to imagine any endeavor where balance, agility and lightening-fast reflexes are called into play more than they are in skateboarding. That makes it a natural hazard for bone breaks. The most important preventive measure is to insist that all participants wear all the protective equipment available.

DEAR DR. DONOHUE: I am an avid golfer and, at times, play in tournaments. I also practice regularly. Does it help or hurt for me to practice on the day before or the day of a tournament? I don’t think my body is tired, but it just might be. I would appreciate your opinion. – J.M.

You have to answer this for yourself, J.M. Many athletes do better by resting the day before and the day of a tournament. That is not a rule written in concrete. Experiment. Don’t practice before tournaments as you have in the past. Try it three or four times, and you’ll have your answer.

DEAR DR. DONOHUE: For 14 years my wife and I have received our water from a community well. The water passes through a water softener. Are we at risk from drinking softened water? – R.K.

Hard water is hard because it contains calcium and magnesium. Hard water leaves rings around the bathtub, stops soap from sudsing and does not wash laundry well. A water softener exchanges the calcium and magnesium for sodium. Water with sodium is soft.

Only if you are on a strict, sodium-restricted regimen could soft water present a problem. The average softener adds around 278 mg of sodium to every quart (liter) of water. The daily sodium intake should be only 2,400 mg, and for someone on a salt-restricted regimen, it would be lower than that. Healthy people would have to drink 9 quarts of softened water to reach the daily limits.

People on a rigorously salt-restricted diet would have to find out how much sodium their water softener adds to the water and how much sodium they get from all other sources – food and drink.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.

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