"If you're suffering from knee pain and you think it might be chondromalacia patella, check out these five exercises."
The condition we’re talking about today is one you may not have heard of, but many people experience its effects. Chondromalacia Patella is a painful disease involving cartilage in the knees. Today Dr. Keller Wortham, MD, will explain more about how the knee works and how this condition can affect it, and demonstrate five easy exercises that can help prevent it or bring relief. If you’re suffering from knee pain or know someone who is, make sure you tune in.
- 00:32: Chondromalacia Patella
- 02:11: Anatomy and Motion of the Knee
- 04:20: Symptoms of Chondromalacia Patella
- 05:04: Diagnosis
- 06:48: Chondromalacia Patella Grades
- 08:14: Five Strength and Alignment Exercises
- 15:45: Exercises to Avoid
- 16:46: Other Knee-Friendly Exercises
- 17:18: Reducing Inflammation
- 18:20: Wrap-Up
Chondromalacia patella is a disease of the cartilage underneath the kneecap that causes knee pain. The medical word for the kneecap is the “patella”. The term “chondro” refers to the collagen or the cartilage, and “malacia” indicates disease.
Chondromalacia patella causes pain and a burning sensation in the knees, usually in the anterior knee. Unlike the more traditional arthritis, this can happen in younger, and more athletic people. It's often referred to as “runner's knee” or “jumper's knee.” If you play a sport that has a lot of repetitive motion, and creates a lot of stress on the kneecap, you may be at risk of developing this condition.
While chondromalacia patella tends to be an overuse injury, it’s also one that can develop over time. There are a few things that can lead to an increased risk of this particular condition in addition to athletic activities that put pressure on the knees, including some alignment issues that could lead to the kneecap becoming irritated.
Anatomy and Motion of the Knee
There are several components that make up or surround the knee area: the femur (the upper part of the leg), the tibia (the lower part of the leg), and the kneecap, which is the fulcrum that allows you to get leverage across that joint. At the bottom of the femur, are some smooth mounds encased in cartilage, with a groove in the middle of them called the trochlear groove. The underside of the kneecap has cartilage as well, and it's supposed to glide in that trochlear groove to give you a nice, smooth range of motion, and the leverage that you need to move your leg.
Unfortunately, some people can start to get poor motion or range of motion of the kneecap in that little groove at the bottom of the femur. Sometimes that can happen because congenitally, they were just born with incorrect alignment, or perhaps the groove is just too shallow, so the kneecap isn’t able to sit snugly in it, and it can rub the sides.
Muscle imbalances can also lead to this. Sometimes people have weak hamstrings or weak quadriceps — the muscles on the anterior and posterior portions of the thigh. An imbalance may also exist in the abductors, which are the muscles that help you open and close your legs. Many of these muscles attach directly to the kneecap, so muscle imbalances can pull the kneecap out of its proper alignment in that groove. So, those are some of the anatomical things that can lead to it, as can repetitive motion from some sports, which can inflame the cartilage on the underside of the kneecap.
Symptoms of Chondromalacia Patella
If that cartilage becomes inflamed, it can get very painful. You might notice a little bit of a burning sensation, or feel a grinding sensation. Often, you might feel pain just sitting, especially for long periods of time, like in a car, or at the theater. That's because the way your legs are configured in that position puts more tension on the kneecap and holds it more tightly against the femur underneath. You may also notice a decreased range of motion or pain along that range of motion.
If you start experiencing these symptoms, the best thing to do is get to your doctor for an assessment. Your doctor will likely first do a physical exam — inspect the knee to see if it’s swollen or red. Usually, with this particular condition, you don't get a lot of swelling or redness, and your range of motion, although it's usually a little sore, is not quite so limited. However there is sometimes a grinding or cracking that you can hear and sometimes feel. So, if you put your hand on your knee and extend it, you might hear the sound, or even feel it vibrating under your hand, and your doctor will feel it as well. They might notice some relative weakness in parts of your quadriceps muscle, on the front of your thigh, or an imbalance in the muscles on the interior and exterior part of your thigh. They can also watch the way your kneecap tracks in that groove to see if it appears to pull to one side or another.
If any of these signs are present, you can then move forward and get some imaging to help confirm a diagnosis. Usually, that involves an x-ray to rule out other more serious conditions likearthritis. The best way to evaluate cartilage and inflammation in a joint, is Magnetic Resonance Imaging (MRI). That's where we can really see what's happening within the knee itself and specifically what's happening on the underside of the kneecap where that cartilage is. That imaging will help you determine how severe your chondromalacia patella is.
Chondromalacia Patella Grades
How serious this condition is, can be measured in grades.
- Grade 1 — there’s a little bit of a softening of the cartilage underneath the kneecap.
- Grade 2 — In addition to softening, there’s some kind of disruption or change in the texture and smoothness of the cartilage.
- Grade 3 — the condition is more advanced. Not only is there softening and a rougher texture, you’re also experiencing some cartilage loss or thinning of that protective cartilage.
- Grade 4 — at this stage, you are actually seeing a bone underneath that cartilage. So, you've lost so much cartilage that the bone is now exposed. When it starts to rub on other areas or other bones, that's when you really start to get into advanced arthritis and pain.
Five Strength and Alignment Exercises
There are some techniques that you can do to help correct for those alignment issues if you have any, and help strengthen some of the muscles that might be weaker. These five exercises can help correct chondromalacia patella and strengthen your legs.
Straight leg lift
- Start by lying down on the floor or a mat.
- Keep one leg just bent with your foot flat on the floor
- Extend the other leg out, keeping the foot flexed
- Raise the leg at the hip joint, about 45 degrees, and hold for about two or three seconds
- Lower it back down, keeping your movement controlled
- Repeat 20 times on each side
This should engage the quadriceps and strengthen the anterior part of your thigh. You don't want to go fast. That doesn't really help you. You're using a lot more energy and getting a lot more strength if you perform this exercise slowly, with control.
This movement will really strengthen the adductors and abductors of your legs.
- Lie on your side to start, with your knees bent
- Open your legs and raise the upper leg up, keeping the knee bent. Your knee should now be pointing at the ceiling.
- Hold it there for two or three seconds
- Slowly go back down, again, with control
- Repeat 15 times on each side
Roller Leg Lifts
The third exercise is a little bit like the first one, but in this case we're going to use a roller, or a rolled up towel under your knees. You can do it just under one knee if you don't have a long one.
- Lie on your back, legs extended, with the roller or towel under your knees
- In this exercise, you're just extending at the leg. So, you've got a little bit of a bend in the knee this time and the extension is happening not at the hip but within the quadriceps to raise the lower part of the leg.
- Hold this for 5 or 10 seconds
- Lower back down with control
- Repeat 10 or 20 times per side
You could alternate sides, but you may get more continuous use of the muscle and build more strength by doing all reps on one side before switching to the other.
- Find a wall and stand with your back to it. Place your feet about six inches to a foot away from the wall, hip-width apart and your bottom against the wall. You can place your hands against the wall as well.
- Slide down the wall, until you reach a 45-degree angle. You don’t have to go all the way to 90 degrees, and if you have issues with your kneecaps, definitely don't go that far.
- Hold that 5 to 10 seconds, and then push yourself back up the wall slowly
- Repeat 10 to 15 times, holding 5 to 10 seconds a piece.
This sixth exercise is a little more intense, so if you do have bad knees or are a little bit worried about form, be a little more cautious with this one.
- Stand with your feet hip-distance apart, holding a dumbbell in each hand. You can use whatever weight you think is comfortable for you.
- Bend over at the waist, leaning forward with your chest and head up, making sure that your knees do not go in front of your toes
- Come back up.
- Repeat 10 to 15 times
This is not a squat. You don't want to be sitting back on your heels and going into deep squat. This is leaning your chest forward, bending your knees, again, about 45 degrees, holding it, and then, pushing back up, tightening your core, tightening the small of your back, and your abdomen. If you're keeping your alignment strong — your knees safely over your second toe and not in front of your toes, holding it, and then you're pushing back up slowly — this exercise is going to strengthen a lot of those muscles in your thigh, and upper leg, that are going to basically help balance out and protect the alignment of your kneecap.
You can do all five of these easy exercises you can do at home. Most of them take no equipment, and they can help strengthen the muscles of your legs and your thighs to help keep your kneecap in alignment.
Exercises to Avoid
Some things that you definitelydon't want to do if you're working with knee pain or chondromalacia patella include:
- Deep squats where you're going down past 90 degrees. That puts a lot of pressure on your kneecap.
- If you're at the gym, be very careful about the leg extension machine. Especially when it's coming from a very low angle, that's a lot of fulcrum pressure on your knee that puts a lot of stress on the underside of the kneecap. Some of these machines are adjustable, so if you can position the bar so that you’re only doing the last 10 to 15 degrees, that would be okay.
Other Knee-Friendly Exercises
Other healthy activities include yoga and Pilates. You might have to modify some of the poses, so make sure that you're working with a teacher who can instruct you there. Swimming is also great for the knees. It's very low impact and doesn't put a lot of pressure on the kneecap at all. But you want to avoid things like running, jumping, and sports like volleyball and basketball that put a lot of impact on your knees. You want to make sure that you get the kneecap well balanced and healed before you start putting additional stress on it.
You can also add some nutritional products to your regimen, to help reduce inflammation and improve joint health:
- Curcumin, a natural inflammation-fighter, which is the active ingredient in turmeric.Smarter Curcumin is formulated with curcumin in its most active and bioavailable form. This is a great option for people who prefer natural inflammation fighters to NSAIDs, which have someserious side effects.
- Smarter Joint Food is another natural supplement that can nourish and increase the health of your cartilage, and improve joint mobility.
We hope this overview of chondromalacia patella was helpful. If you're suffering from knee pain and you think it might be chondromalacia patella, check out these five exercises, try them at home, and go see your doctor!