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Tuesday, October 16, 2007
Chondromalacia patella refers to irritation or arthritis involving the cartilage of the kneecap. Cartilage is the cushioning material on the surface of bone within a joint. Chondromalacia patella results in pain along the back side (i.e., the posterior part) of the kneecap. The term, "chondromalacia patella," suggests softening of the cartilage of the kneecap, but this is a bit of a misnomer. The cause may be short-term irritation of the cartilage of the kneecap, but it could also be due to wear-and-tear arthritis that has developed over the years (i.e., wearing away rather than "softening" of the cartilage).
Chondromalacia patella is also referred to patellofemoral pain syndrome, because the discomfort is felt between the kneecap (the patella) and the distal thigh bone (femur). Also, this condition has often been called "runner's knee", because this is one of the more common types of knee injury experienced by runners. Chondromalacia patella can occur in adolescents and young adults, particularly as a result of overuse. It is more common in females. In older adults, chondromalacia patella is often related to arthritis.
The main symptom of patellofemoral pain syndrome (chondromalacia patella) is anterior knee pain, especially when the knees are bent. Prolonged sitting, such as in a movie theater or an airplane, can cause patellofemoral pain to flare. Often, there is not much swelling.
Normally, the patella slides with a groove in the front of the front of the thighbone referred to as the trochlea. If the patella cannot slide normally in this notch, it may lead to chronic irritation and development of chondromalacia (patellofemoral pain). It has been postulated that malalignment of the patella within the trochlear groove can be produced by several factors, including such things as low arches of the feet and uneven pull of thigh muscles.
Most individuals experiencing mild symptoms of chondromalacia patella can control their symptoms by conservative measures. Nonsteroidal anti-inflammatory medication, such as ibuprofen, can help pain associated with chondromalacia. Rest is crucial. Avoid activities or movements that elicit knee pain. A physical therapy program to develop the muscles of the thigh and improve flexibility is usually helpful. In the gym, avoid exercises that require bending of the knee past 90 degrees, such as leg extensions on a seated machine or deep squats. Avoid sitting or kneeling in the bent knee position for long periods of time. Icing your knees after activity can help minimize pain.
If you have been running and developed patellofemoral pain syndrome, stop. Wait until you are pain free for one week before restarting your running program. When you do restart your running program, start with low mileage at a slow pace and gradually work up to where you were when you stopped running. Allow yourself twice the amount of time that you have had to recuperate to get back to the weekly mileage that you were doing when you stopped running. Cross-training is a good idea. Swimming is a good exercise to maintain aerobic fitness while giving the knees a rest.
When using a bicycle or an exercise bike, make sure that peddling resistance is not set too high. The seat should be at an appropriate height. Having the seat too low can aggravate symptoms of patellofemoral pain syndrome. Keep the bike seat at a height that when the leg is on the downstroke, there is only a slight bend left in the knee.
Foot issues, such as a low arches or overpronation of the feet when running may precipitate chondromalacia patella. Overpronation refers to excessive collapse of the arch and inward rolling of the foot when running or walking. Your healthcare provider or a podiatrist can help ascertain whether this is a contributing factor. If you are a runner, remember to change your running shoes every 300 to 500 miles. Old running shoes lose their support. The loss of support & cushioning of the shoe often occurs well before the tread of the outsole is significantly eroded. For people that overpronate, there are running shoes that are designed to offer more support for the arch and to minimize overpronation.
Some individuals find that their symptoms are less if they wear a sleeve that stabilizes the position of the knee cap or a strap that secures the patellar tendon, a vertical band of tissue just below the knee cap, that connects the knee cap to the shin bone.
For patellofemoral pain that does not respond to conservative measures, there are some surgical options which can be considered. If you had pain in the knee for more than a week or if you have pain that results in limping, see your healthcare provider.Read more about chondromalacia patella/runner's knee: