Chondromalacia Patella

Chondromalacia Patella

 

Article by J.Miller, Z.Russell, A.Clarke

What is Chondromalacia Patellae?

Chondromalacia Patellae by definition means “soft cartilage under the kneecap”.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals with malalignment issues, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.

This condition often affects young, otherwise healthy athletes. Chondromalacia patella is one of the groups of conditions that cause anterior knee pain. When anterior knee pain or kneecap pain exists in the absence of cartilage softening is can be referred to as patellofemoral pain syndrome.

Patellofemoral Pain Syndrome

Chondromalacia patellae is a subgroup of conditions that cause kneecap pain. These conditions fall under the Patellofemoral Pain Syndrome conditions.

What are the High-Risk Sports?

The most common occurrence occur with sporting individuals, however, it can affect any member of the populations. It is common in footballcyclistsrowerstennisballetequestriangymnasts, volleyballweightliftingskiers, snowboarders and runners. In other words, any sport that involves running, jumping, squatting and landing.

Plus, the non-sporting person can even experience kneecap pain when descending or ascending stairs.

The condition usually results from either acute injury to the patella joint surface or from chronic friction between the patella and the groove in the femur (thigh bone) through which it passes as the knee bends.

Potential causes include tight lateral knee structures such as the ITB, weak medial quadriceps (vastus medialis oblique – VMO), overpronating feet and weak lateral hip rotator muscles. These muscle imbalances result in a rotational instability that causes the patella to be laterally aligned in the femoral groove, which causes pain for the malalignment.

The good news is that patellar mal-tracking is very quickly fixed with physiotherapy assessment and intervention. Commonly, patients can leave the clinic pain-free after just one treatment session. Please seek the advice of your physiotherapist.

Chondromalacia Patella Treatment

Researchers have confirmed that physiotherapy intervention is a very effective short and long-term solution for kneecap pain.

Over 90% of patellofemoral syndrome sufferers will usually respond favourably to exercise-based treatment. Becoming pain-free within six weeks of starting a physiotherapist guided rehabilitation program is commonplace.

For those who fail to respond, surgery may repair associated injuries such as severely damaged or arthritic joint surfaces.

Treatment aims to reduce your pain and inflammation in the short-term and then, more importantly, correct the cause to prevent it from returning in the long-term.

There is no specific time frame for when to progress from each stage to the next. Many factors will determine your injury rehabilitation during your physiotherapist’s clinical assessment.

You’ll find that in most cases, your physiotherapist will seamlessly progress between the rehabilitation phases as your clinical assessment and function improves. It is also important to note that you monitor each exercise progression. Attempting to progress too soon to the next level can lead to re-injury and the frustration of a delay in your recovery.

Phase 1 – Injury Protection: Pain Relief & Anti-inflammatory Tips

As with most soft tissue injuries, the initial treatment is – Rest, Ice and Protection.

(Active) Rest: In the early phase, your best to avoid all activities that induce your kneecap pain.

Ice is a simple and effective modality to reduce your pain and swelling. Please apply for 20-30 minutes each 2 to 4 hours during the initial phase or when you notice that your injury is warm or hot.

Pain-Relief & Protection. Your physiotherapist will usually apply kinesiology supportive taping, or similar, to provide instant pain relief. This assists with the initial patellofemoral joint realignment phase. The patellofemoral taping is normally immediately effective in providing you with pain relief.

Your physiotherapist will utilise a range of helpful tricks including pain-relieving techniques, joint mobilisations, massage, strapping and acupuncture to assist you during this painful phase.

Anti-inflammatory medication and natural creams such as arnica may help reduce your pain and swelling. Most people can tolerate paracetamol as a pain reliever.

Phase 2: Regain Full Range of Passive Motion

Your kneecap and knee must be able to glide through its full normal range of motion. Your physiotherapist will assess your movement and apply the necessary techniques to normalise your range of motion.

Phase 3: Restore Full Muscle Length

Your thigh, hamstring and calf muscles will require stretching is they are tight and are causing excessive tension or pressure on your kneecap. It is essential to regain reasonable muscle length to improve your lower limb biomechanics.

Phase 4: Normalise Quadriceps Muscle Balance

Your physiotherapist should assess your quadriceps muscle balance and its control. In most instances, you will require a specific knee strengthening program.

Your physiotherapist will prescribe the best exercises for you.

Phase 5: Normalise Foot & Hip Biomechanics

Patellofemoral pain syndrome can occur from poor foot biomechanics (e.g. flat foot) or poor hip control.

Your physiotherapist should assess your foot and hip control. In some instances, you may require a foot orthotic (shoe insert), or you may be a candidate for the Active Foot Posture Stabilisation program.

Other patients may require a hip stabilisation program. Your physiotherapist will happily discuss what you need.

Phase 6: Normalise Movement Patterns

Kneecap pain commonly occurs from poor habits, whether they be an abnormal gait, jumping, landing, running or squatting technique. To prevent a recurrence, please assess your walking pattern, jumping and landing technique, running style or squatting method, and correct as required.

Your physiotherapist will happily discuss what you specifically require.

Phase 7: Restore High Speed, Power, Proprioception and Agility

Most kneecap pain sufferers need to return to high speed or repetition activities, which place enormous forces on your knee. Your physiotherapist will guide you on your return to sports planning.

Balance and proprioception are both known to be adversely affected by patellofemoral pain. Both aspects need assessment and potential retraining.

Depending on what your sport or lifestyle entails, a speed, agility, proprioception and power program will be customised to prepare you for light sport-specific training.

Phase 8: Return to Sport

If you play sport and depending on the demands of your chosen sport, you may require specific sport-specific exercises and a progressed training regime to enable a safe and injury-free return to your chosen sport.

Your physiotherapist will discuss your goals, time frames and training schedules with you to optimise you for a complete and safe return to sport. The perfect outcome will have you performing at full speed, power, agility and function with the added knowledge that a thorough rehabilitation program has minimised your chance of future injury.

Patellofemoral Brace

An effective patellofemoral brace can be useful as an alternative to kneecap taping.

For specific advice regarding your chondromalacia patella, please consult your trusted knee physiotherapist.

Common Causes - Knee Pain

Knee pain can have many origins from local injury, referred pain, biomechanical issues and systemic issues. While knee pain can appear simple to the untrained eye, a thorough assessment is often required to ascertain the origin of your symptoms. The good news is that once a definitive diagnosis is determined, most knee pain quickly resolves with the correct treatment and rehabilitation.

Knee Ligament Injuries

Knee Meniscus Injuries

Kneecap Pain

Knee Arthritis

Knee Tendon Injuries

Muscle Injuries

Knee Bursitis

Children’s Knee Conditions

Other Knee-Related Conditions

Knee Surgery

For specific information regarding your knee pain, please seek the assistance of a healthcare professional with a particular interest in knee condition, such as your physiotherapist.

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