Chondromalacia Patella

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The knee is a hinge joint that is responsible for weight-bearing and movement. It consists of bones, meniscus, ligaments, and tendons. The knee is fully designed to fulfill various amounts of functions, including the following below:

  • Provide enough stability.
  • Helps lower and raise your body.
  • Allows twisting of the leg.
  • Makes walking much more efficient.
  • Supports the body in an upright position without the need for muscles to function.

Additionally, the knee is also one of the most complex joints in the human body – it connects the thigh bone (femur), to the shin bone (tibia), and also includes a smaller bone, the fibula, which is located next to the tibia, and finally, the kneecap (patella).

Chondromalacia patella is an abnormal softening of the cartilage of the underside of the kneecap. Chondromalacia patella injuries are one of the most common causes of chronic knee pain. Chondromalacia patella result from degeneration of cartilage due to poor alignment of the patella as it slides over the lower end of the femur. This process is sometimes referred to as a patellofemoral syndrome.

Chondromalacia patella, which can also be a catch-all term for disorders that include bursitis, tendonitis, tendon strain, ligament strain cartilage irritation, may eventually lead to chronic bone injuries. Chondromalacia patella is increasingly prevalent in sports. It is an actual softening, erosion, and cracking on the back surface of the kneecap. Generally, the pain may be present by jumping or running sports and at times from prolonged sitting or walking downstairs. Some athletes who always run on the same side of the road may experience pain in the kneecap resulting from the tilt of the road and the continuous flattening or pronation of the foot.

Causes & Symptoms

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Chondromalacia patella can occur for unknown reasons; however, it usually is caused by improper tracking of the kneecap as it slides over the bone of the thigh. This misalignment leads to degeneration of the cartilage underneath the kneecap and results in localized knee pain. The patella is normally pulled over the end of the femur in a straight line by the quadriceps muscle. Patients with Chondromalacia patella frequently have abnormal patellar tracking toward the lateral side of the femur. This slightly-off pathway allows the undersurface of the patella to grate along the femur, causing chronic inflammation and pain. Certain individuals are predisposed to develop Chondromalacia patella, such as females, knock-knee or flat-footed runners, or those with an unusually shaped patellar undersurface.

Symptoms of Chondromalacia patella are generally a vague discomfort of the inner front of the knee, aggravated by activity (jumping, running, climbing, or descending stairs), or by prolonged sitting with knees in a moderately bent position (also known as “theater sign” which involves pain upon arising from a desk or theater seat). Some patients may also have a vague sense of tightness or fullness in the knee area. Occasionally, if chronic symptoms are ignored, the associated loss of quadriceps muscle strength may cause the leg to give out. Besides an obvious reduction in quadriceps muscle mass, mild swelling of the knee area may occur.

Other symptoms linked to Chondromalacia patella include dull and aching pain that is felt behind the kneecap, below the kneecap, and on the sides of the kneecap; as well as a feeling of grinding when the knee is flexed. This can happen when you are either doing knee bends or running downhill.

Overall, there are a total of four grades that designate the severity of Chondromalacia patella, which are described below:

  • Grade 1 Chondromalacia patella – The severity indicates softening of the cartilage in the knee area.
  • Grade 2 Chondromalacia patella – This indicates a softening of the cartilage along with abnormal surface characteristics. This typically marks the beginning of tissue erosion.
  • Grade 3 Chondromalacia patella – Grade 3 shows thinning of cartilage with active deterioration of the tissue.
  • Grade 4 Chondromalacia patella – Known a the most severe grade of runner’s knee, grade 4 indicates exposure of the bone with a significant portion of cartilage deteriorated. Bone exposure means bone-to-bone rubbing is likely occurring in the knee.

Who gets Chondromalacia Patella?

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Chondromalacia patella can be caused by several risk factors, including one or a combination of the following below:

  • Training errors – A sudden increase in the volume or intensity of training may place excessive stress on the patellofemoral joint. Likewise, inadequate recovery time or excessive hill work may affect the same way.
  • Gender – Women have an increased risk of Chondromalacia patella, as women have wider hips and different knee alignment than men.
  • Age – Adolescents and young adults are more prone to this condition. During growth spurts, the muscles and bones develop more rapidly, which may contribute to short-term muscle imbalances.
  • Excessive body weight – Being overweight can cause unwanted stress on the knees. When walking across level ground, each step places 1.5 times an individual’s body weight worth of pressure on their knees.
  • Focal weakness – Weak or underdeveloped thigh or hip muscles can cause the patellofemoral joint to bear a larger stress burden with activity. Over time, this may lead to the development of Chondromalacia patella.
  • Flat feet – Having flat feet may place more stress on the knee joints than having higher arches would.
  • Flexibility – Particularly tight quadriceps, gastrocnemius, iliotibial band, or hamstrings may predispose someone to Chondromalacia patella.

How Does it Affect You? How Serious is it?

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If Chondromalacia patella is left untreated, the condition can eventually limit your daily life and ability to participate in exercise and sports. In severe cases, it can develop into longer-term knee problems, like arthritis. In addition, moving around with a severely developed runner’s knee could pull fragments of the cartilage into the joint causing larger knee issues which could require more significant surgery in the future. Surgery can be done by performing an arthroscopy, however, there are several complications that can occur after surgery has been dealt with, such as the following below:

  • Infection – All surgeries require incision; cuts that allow surgeons to open an area of the body and make repairs. Therefore, this means there is a chance of infection, but it’s an extremely small possibility. When infections do arise, they’re considered serious and sometimes life-threatening.
  • Longer-term knee stiffness – It’s normal to feel stiff and swollen for a few months after surgery. However, sometimes that stiffness can last longer than usual. Longer-term stiffness is typically caused by excessive scar tissue. Oftentimes, lack of use or exercise can cause scar tissue to build up in the soft tissue around the joint.
  • Persistent knee pain – Some discomfort immediately after surgery may be normal. The pain usually lessens after two or three months, however, some patients can continue to have persistent knee pain after surgery.

Recommended Treatment & Rehabilitation

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During a diagnosis of Chondromalacia patella, a physician must rule out other conditions, such as patellar tendinitis (jumper’s knee), meniscus tear, and iliotibial band friction syndrome. If symptoms appear consistent with Chondromalacia patella, your physician must determine the root cause. While important, determining the precise cause of patellofemoral pain can be quite challenging, and include an entire review of your medical and sports history, physical examination, imaging tests, and bio-mechanical evaluation.

In order to determine the specific nature and severity of the injury, your physician will ask questions, such as when did the pain begin, how did it begin, and what types of movement made it worse. Afterward, a physical exam will test the stability, motion, and function of your knee. Your physician will evaluate the knee for symptoms such as swelling and stiffness, observe tracking of the patella, and palpitate the knee, using his or her hands to feel for any abnormalities. Strength, flexibility, and movement patterns of the hip, foot, and ankle may also be examined, as they affect the motion of your knee.

If your physician hasn’t been able to determine a specific cause of Chondromalacia patella pain through a physical examination, then more comprehensive imaging tests may be required. In order to help identify the right cause of the problem, your doctor will usually use one of the two common methods:

  • X-ray – If your physician suspects that the problem causing Chondromalacia patella pain is an improper movement of the patella over the femur, an X-ray will be the initial method of imaging. This imaging test will allow your physician to visualize the location of the patella on the femur, identify potential bone spurs, or detect arthritis.
  • Magnetic Resonance Imaging (MRI) – Unlike X-rays, MRIs provide an image of the knee’s soft tissues. Your doctor will most likely use this method if he or she suspects a problem with the meniscus, tendons, or ligaments of the knee.

 

If Chondromalacia patella is diagnosed, a physiotherapist will develop an exercise and rehabilitation program to help you recover sooner. Some of these treatment programs include the following:

  • Taping – Your physiotherapist may teach you how to apply tape to your knee, which may improve your ability to perform exercises that would normally be painful. However, taping along will not resolve your knee injury. It must only be used along with your exercise program.
  • Shoe inserts – Your physiotherapist may recommend shoe inserts to help reduce your pain when exercising. But inserts alone, like taping, will not treat Chondromalacia patella.
  • Coordination training – Based on your activity level, your physiotherapist may help retrain your hip and knee movement patterns to reduce your knee pain. This type of training is effective for athletes, in particular, and may focus on movements such as stair climbing, squatting, running, and jumping.

Your physiotherapist will then teach you exercises to help strengthen the muscles around the hip and the knee itself. Therefore, here are some exercises you can try:

 

Mini squats

First, stand with your back against a wall, with your shoulders and head against the wall. Your feet should be shoulder-width apart and one foot from the wall. Next, bend your knees slightly to bring your buttocks toward the ground. Stop at about 15 degrees of bend, feeling the muscles in your thighs working. Hold this position for 10 seconds, then repeat for 2-3 times a day at a slow pace.

Hamstring heel digs

Lie on your back with your knees bent and feet flat on the floor. Afterward, flex your feet so only your heels are touching the ground. Dig your heels into the ground and slowly slide them about 4-6 inches away from your body. Bring your heels back toward your body, returning to your starting position. Repeat this method 8-10 times a day.

Leg extensions

Sit on a sturdy chair or bench with your feet flat on the floor. Flex your right foot and lift your foot off the floor, straightening your right leg. Next, slowly lower the foot back to your starting position. Repeat this exercise 10 times on the right side, then once again on the left leg 2-3 times a day.

Alternative & Homeopathic Treatment

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Home remedies and lifestyle changes can generally be enough to relieve pain and stiffness for Chondromalacia patella. Resting and recovering after any exercise can help you reduce your risk for a new knee injury or worsening symptoms from a current. So, here are a few alternative treatments that you can try homeopathically:

  • I.CE. – The RICE principle (rest, icing, compression, and elevation) may be advised to reduce the initial symptoms of Chondromalacia patella. This protocol will be particularly important if the symptoms are manifesting for the first time.
  • Non-steroidal anti-inflammatory drugs (NSAIDs) – Anti-inflammatory medications such as ibuprofen and naproxen can be used to help with pain and swelling.
  • Herbal ointment – Some studies have shown that there are pain-relieving effects of a salve made of cinnamon, mastic, sesame oil, and ginger. They found the salve was just as effective as over-the-counter arthritis creams containing salicylate, a topical pain-relieving treatment.
  • Ginger extract – Ginger extracts are available as supplements and ginger tea. These are used to help reduce arthritic pain.
  • Willow bark extract – Some patients sometimes use willow bark extract for joint pain, as it may help relieve pain and inflammation. However, it is recommended to check in with your doctor before the usage of this extract.