By Jared S. Ernest, MPT
Why you should fear knees that go creak in the night. It could be a sign of chondromalacia patella.
What is chondromalacia patella?
In order for your knee cap to work normal it must move up and down in a groove in the thigh bone. This motion happens over and over as you bend and straighten your knee throughout your daily activities. What occurs with chondromalacia patella is the cartilage (cushioning) on the back of the knee cap starts to soften and wear down. Now the thigh bone and knee cap rub together and cause friction. This motion is an abnormal movement in the joint and leads to pain. Imagine if your car tire started to rub on your wheel well and this gives you an idea on what is going on in your knee.
What causes Chondromalacia Patella?
Anything that may change how the knee cap should move in the normal groove of the thigh bone causes this to happen. This function is called Patella-femoral tracking. Below are listed the causes of chondromalacia patella.
- Prior knee injury to include fracture and dislocation.
- Female secondary to hip angle
- Flat footed biomechanics
- Runners, bicyclists’, soccer players and individuals that exercise often.
- Unusually shaped undersurface of kneecap
- Weak Thigh muscles or the VMO of the quad muscle.
- Workers that climb and kneel frequently.
These factors put undo stress on the kneecap and can be a causative factor to Chondromalacia patella.
What are the signs of Chondromalacia Patella?
-Initial dull, aching pain in front or behind the knee cap.
– Pain that increases with running, jumping, climbing or going down steps.
– Sitting for longer periods with knees bent that cause pain.
– Crunching sounds with movements of the knee.
What happens if Chondromalacia Patella is left untreated?
-Loss of strength and muscle wasting of thigh muscle.
-Localized swelling around the knee cap.
-Buckling of knee with upright activity and steps.
– Pain occurs sooner with activity and even at rest.
It is important to address the issue early to limit the development of more chronic inflammation and wearing down of cartilage on the back of knee cap.
What should I do if I feel I am developing Chondromalacia Patella?
Your first course of action should be to try and limit stressful activity that may be causing the problem. Next it is important to schedule an office visit with and orthopedic specialists such as the MD’s at JOI. The doctor will be able to perform specific manual test to determine if it is chondromalacia patella. More importantly your doctor can rule out another issue at the knee that may be the actual cause. X-rays and MRI may also be performed to confirm the diagnosis. Your doctor may prescribe a knee brace like the Shields Brace pictured below.
What sports tend to increase the risk of Chondromalacia Patella?
What are the exercises I should avoid?
The flowing exercises should be avoided as they place increased stress on the knee’s;
- Deep squats
- Leg extension machine
- Stair stepper machine.
What exercises are safe cardiovascular exercises for Chondromalacia Patella?
The quick answer is these exercises are effective since they put low stress on the knees.
- Water Aerobics
- Elliptical trainer
- Low Impact Yoga/Pilates
- Cycling with high seat.
- VMO Strengthening.
What type of treatment can help Chondromalacia Patella?
A Physical therapist is the medical professional who can help you navigate your return to normal knee health. At JOI Rehab we have the skilled, experienced PT’s and PTA’s who have successfully and frequently rehabbed this condition.
Your JOI Therapist will devise and implement a treatment program that is unique to you the individual and focus on the following:
- Strengthening and correcting muscle imbalances and weakness.
- Stretching of the hamstring, quad and IT Band
- Addressing biomechanical issues.
- Elimination of pain and inflammation.
- Education for long term management with do’s and don’ts
What other options for Chondromalacia Patella treatment are there?
Bracing: A Knee brace that helps control and correct the movement of the knee cap can be an effective asset. A brace can off load pressure on the knee cap.
Taping: Proper application of special medical tape to control the movement of the knee cap can be helpful. This taping helps just like a brace but with the advantage of being less bulky. It is highly recommended to utilize a professional trainer or therapist. JOI Rehab can show you how versus a You -Tube video. This taping application if done wrong can do more harm than good.
Injections: Your orthopedic surgeon may offer a cortisone type injection for pain and inflammation. However, you still must correct the tracking of the patella.
ProloTherapy: Injection of a special solution into the knee to act as irritant. This process actually acts to jump start the body’s own healing process.
Physical Therapy is the most important aspect of managing Chondromalacia and Patello-Femoral Issues. Stretching of the hamstring and IT Band and strengthening of the VMO or quad muscles. To schedule with JOI Rehab for physical therapy or for a brace, please call 904-858-7045.
Why is it important to seek professional help for chondromalacia patella?
Chondromalacia patella left unchecked will continue to limit your level of ability to enjoy the activities you enjoy in life. Also left untreated it will continue to damage the cushioning substance of the knee cap that can not be regenerated. Please call 904-564-2000 or click below.