Weight bearing exercise with knee in flexed position

Chondromalacia patella - Weight bearing exercise with knee in flexed position Factor

The SOP requirements here are:

Reasonable hypothesis:

• Undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with the knee in a flexed position, at a rate greater than six METs, for at least four hours per week, for at least the one month before the clinical onset/clinical worsening of chondromalacia patella

Balance of probabilities:

• Undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with the knee in a flexed position, at a rate greater than six METs, for at least six hours per week, for at least the one month before the clinical onset/clinical worsening of chondromalacia patella.

RMA definition

A "MET" means a unit of measurement of the level of physical exertion.  1 MET=3.5ml of oxygen/kg of body weight per minute or, 1.0 kcal/kg of body weight per hour, or resting metabolic rate.

The RMA does not define 'weight bearing exercise', but it means exercise when weight is being borne through the joint.

Further information

The exercise must involve weight bearing involving forceful loading of the knee joint in the leg affected by chondromalacia patella, and the knee must be in the flexed position (bent to 90 degrees).This would need to be an activity such as weight lifting involving squats. Working out on a rowing machine at the gym would not satisfy this factor.

Weight bearing exercise at a rate greater than 6 METS can be described as being of a 'vigorous intensity' - intense enough to represent a substantial challenge to an individual and refers to a level of effort in which a person should experience:

• large increase in breathing or heart rate (conversation is difficult or "broken"), and
• the effort a healthy individual might expend while jogging (8km/hr), mowing the lawn with a hand-mower, participating in high-impact aerobic dancing, carrying more than 10 kg up a flight of stairs, standing or walking with more than 30 kg for example.

MET ratings for common activities

Investigative Documents

Preliminary questions [42019]

41997 there is some evidence that undertaking weight bearing exercise with the knee in a flexed position may be a factor in the development of the condition under consideration.

42011 the veteran undertook weight bearing exercise with the knee in a flexed position as specified in the Statements of Principles requirements at some time.

42027  the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and VEA service for chondromalacia patella.

42028   the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and VEA service for the clinical onset of chondromalacia patella.

42030  the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and operational service for the clinical onset of chondromalacia patella.

or

42031  the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and eligible service for the clinical onset of chondromalacia patella.

or

7334     the clinical onset of the condition under consideration occurred after the end of the veteran's last period of VEA service.

7335     the condition under consideration permanently worsened.

42029   the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and VEA service for the clinical worsening of chondromalacia patella.

42032  the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and operational service for the clinical worsening of chondromalacia patella.

or

42033  the veteran has established the causal connection between undertaking weight bearing exercise with the knee in a flexed position and eligible service for the clinical worsening of chondromalacia patella.

Clinical onset and operational service [42030]

42013 operational service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than six METs, for at least four hours per week.

41993 operational service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than six METs, for at least four hours per week, for at least the one month before the clinical onset of the condition under consideration.

Clinical onset and eligible service [42031]

42016 eligible service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than six METs, for at least six hours per week.

42001 eligible service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than six METs, for at least six hours per week, for at least the one month before the clinical onset of the condition under consideration.

Clinical worsening and operational service [42032]

42004 operational service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than six METs, for at least four hours per week, for at least the one month before the clinical worsening of the condition under consideration.

41995 the weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than 6 METS, for at least four hours per week, for at least the one month before the clinical worsening of the condition under consideration commenced after the onset of the chondromalacia patella.

Clinical worsening and eligible service [42033]

41988 eligible service made a material contribution to the veteran undertaking weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body  in a flexed position, at a rate greater than six METs, for at least six hours per week, for at least the one month before the clinical worsening of the condition under consideration.

42009 the weight bearing exercise involving forceful loading of the patellofemoral joint with side and site of the body in a flexed position, at a rate greater than 6 METS, for at least six hours per week, for at least the one month before the clinical worsening of the condition under consideration commenced after the onset of the chondromalacia patella.