Chondromalacia Patella, also sometimes referred to as “runners knee” is pain that presents at the front of the knee caused by degenerative changes occurring on the undersurface of the patella (knee cap).
These degenerative changes can include softening or fraying of the cartilage under the patella, and/or swelling of the patellofemoral joint itself. Sclerosis, which is an abnormal increase in density and hardening of bone, can also occur to the underlying bone.
Chondromalacia Patella Grades
Chondromalacia Patella can range from mild to severe, which can be graded from 1-4 depending on the amount of bony changes found from a scan. The scale is shown below:
grade 1 - cartilage signal abnormality, but appears architecturally intact
grade 2 - surface fraying or focal defects involving less than 50% of cartilage thickness
grade 3 - defects involving more than 50% of cartilage thickness, without bone oedema
grade 4 - full-thickness cartilage defect/loss with associated bone marrow oedema
Chondromalacia Patella Anatomy
The patellofemoral joint is the site where Chondromalacia Patella occurs. This joint comprises the patella and the femur, where the patella articulates with the femur in a section of the femur called the trochlear groove.
The patella glides over the trochlear groove, which allows for efficient movement of the knee joint. This happens every time you use your knee including walking, running, sitting down/standing up, stairs and jumping. Therefore, a healthy patellofemoral joint is essential for everyday activities of daily living.
Who is at risk for Chondromalacia Patella?
Active teenagers and young adults that engage regularly in high-impact sports are the most at risk of developing Chondromalacia Patella. This is because these kinds of activities put the most force through the patellofemoral joint.
Chondromalacia Patella is also more prevalent in older adults diagnosed with arthritis, or in individuals that are overweight.
How do I prevent Chondromalacia Patella?
Keep lower limb muscles that support the patellofemoral joint strong so that they can cope well with any exercises that you may regularly do
Stretching or foam rolling of the gluteal/quadriceps/hamstring/calf muscles regularly or as required based on how the region is feeling
Practicing proper techniques for exercise and sporting activities
Undertaking fitness programs to develop strength, control, and lower limb stability
Gradually increasing the intensity and duration of training
Allowing adequate recovery time between workouts and or training sessions.
Seek treatment at the beginning of any persisting knee and/or leg pain.
What is the best way to manage Chondromalacia Patella?
The best immediate way to manage Chondromalacia Patella is to deload the joint - that is if you are experiencing knee pain you should rest from exercise or aggravating activities. Once pain settles a graduated return to activities will be necessary, a physiotherapist can guide you through this.
Exercises and stretches are also recommended to prevent and manage Chondromalacia Patella symptoms, as well as other types of anterior knee pain.
Below are some suggestions of the types of exercises and stretches that can be used to manage this condition. A physiotherapist will be able to tailor an exercise and stretching program to your specific symptoms and capacity level.
Strengthening the muscles that support the patellofemoral joint can help to ease pain associated with Chondromalacia Patella. Strengthening exercises may also prevent further deterioration of the patellofemoral joint and ensure your knee is able to cope with regular activities of daily living or sports. Some of the key muscle groups to include in a strengthening program to rehabilitate Chondromalacia Patella are as follows:
Low intensity cardiovascular exercises are also safe as they put very little strain on the patellofemoral joint. Some examples of these exercises are:
Bike riding (as long as the seat is adjusted correctly to ensure the knee is in a comfortable position)
Stretching the muscles local to the knee joint can help to aid symptoms of Chondromalacia Patella. This can include stretching the anterior, posterior and lateral thigh muscles or stretching the hip muscles.
Care must be taken to ensure that the stretches you choose do not increase knee pain, as stretching some of these muscles can involve bending the knee joint. If stretching is causing pain, foam rolling these muscles may be more appropriate.
How can Physiotherapy treatment help Chondromalacia Patella?
First of all, a physiotherapist can confirm the diagnosis of Chondromalacia Patella, as there are many other conditions that can be going on with similar symptoms.
Once confirmed that it is indeed Chondromalacia Patella, a physiotherapist can help with providing the right immediate management advice and the correct level of deloading. A tailored rehabilitation plan can then be created to strengthen the patellofemoral joint, prevent flare-ups and get you back to your goals.