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Chondromalacia Patella

You'll often hear this injury referred to as runner's knee. Pain develops when your kneecap doesn't track properly in the groove in your thigh bone (femur) or when there is muscle imbalance. As a result the cartilage underneath your patella (kneecap) becomes inflamed and eventually softens and can then deteriorate. This is a very common injury that accounts for 25% of the overuse injuries treated in sports clinics.

Signs and Symptoms

If you have runner's knee, you'll feel pain and hear cracking and popping noises beneath or on both sides of the kneecap. Symptoms are most prominent when you kneel down, climb stairs, do squats or do activities that extend your leg against resistance.

Stiffness may occur simply from prolonged sitting or descending stairs.

Pain usually increases gradually over a period of time, often a year or longer, until it becomes severe enough that you finally seek medical attention.

Causes

Overpronation: The lower leg rotates inward due to the unstable pronated foot (where the foot rolls excessively inward). The kneecap is pushed to the outside, causing increased pressure.

Weak quadriceps: The thigh muscles normally aid in proper tracking of the knee cap, so weak thigh muscles could contribute to the problem.

Muscle imbalances: The most common imbalance occurs when the muscles on the outside of your leg are much stronger than those on the inside of your leg. Women usually experience this problem more because their thigh muscles lean toward their knees at a larger angle than in men, who have a narrower pelvis. This "Q Angle" increases the chances of your kneecap being pulled to one side.

Direct or repeated trauma: This could include a fall or blow, or a pressure from a prolonged load on your knee, such as during weight training.

Running in the same direction: You may experience pain in the "uphill" knee if you continually run along the same side of the road. The tilt in the road accentuates the pronation of the foot thus resulting in the abnormal tracking of the knee.

Rx Measures

Decrease activity: While recovering, try swimming or other exercises that don't put weight on a bent knee.

Rest: If the knee is painful or swollen, stop activity and rest.

Ice: Use ice treatment for 15 minutes twice daily, including after activity to reduce pain and inflammation (see the article on cold and heat therapy).

Take anti-inflammatories: Try aspirin or ibuprofen to reduce swelling and pain.

Use a brace: Neoprene braces are often helpful to wear during sports or exercise to maintain normal patellar tracking. They are sometimes referred to as stabilizing braces.

Crosstraining: While still recovering, try swimming, rollerblading or biking.

To Avoid Future Problems

1. Begin a therapeutic exercise program. This includes stretching and strengthening exercises for the quadriceps, hamstrings and calves. Aim to strengthen the quadriceps muscles especially with straight leg raises.

2. Use orthotic devices to correct abnormal foot mechanics. These can be invaluable to individuals who overpronate.

Safe Alternative Training: Always let your body be your guide, but biking with a raised seat (but not to the point where you're completely straightening your knee), swimming using a flutter kick and cross country skiing are some examples of exercises you might try. The aforementioned exercises are designed to place less stress on the patellar region while still incorporating the legs into the exercise.

Suggested links to learn more about chondromalacia patella:

Copyright, The American Running Association.