Best Physiotherapist-Synapse Physio Care Group

CHONDROMALACIA PATELLAE

What is Chondromalacia patellae?

Chondromalacia literally means "softening of the cartilage", and Patellae means "the knee-cap". So Chondromalacia patellae means "softening of the articular cartilage of the knee-cap." The articular cartilage is the cartilage lining under the knee-cap that articulates with the knee joint. Under normal circumstances, it is smooth and shiny, so that it glides smoothly along the articular groove of the femur as the knee bends. When it "softens", it may break down, causing irregularities along the undersurface of the patella.

The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with chondromalacia patella frequently have abnormal patellar "tracking" toward the lateral (outer) side of the femur.

This slightly off-kilter 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: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface

What are the symptoms?

The typical patient is a teenage girl complaining of pain in the front of her knee around the knee-cap. She may also have pain that is deep-seated that may radiate to the back of the knee. The pain comes and goes, but usually with squatting, kneeling, and negotiating steps, especially going down the stairs. She may be engaged in strenuous sports, but experiences pain with repeated bending of the knees. Although girls are more often affected, boys can have this problem too.

At this stage, there is no breakdown of the articular cartilage of the patella yet, and is totally reversible. In fact, many doctors may not use the term "chondromalacia patellae" at this stage, because there is no actual softening or breakdown of the cartilage. A more appropriate diagnosis would be "Anterior knee pain syndrome" or "Patellofemoral stress syndrome". In fact, in the majority of patients, the pain comes and goes for a few years until growth is complete. At that point, the pain goes away permanently. In others, the pain gets increasingly worse during the teenage years, the articular cartilage of the patella may actually break down, and medical or surgical treatment may be necessary.

High-heeled shoes to be careful chondromalacia patella

In order to build their own more perfect proportion, like women wearing high heels, will feel that the recent knee pain and the time will be good and bad, such as the shares are facing a similar situation to pay special attention and care suffering from chondromalacia patella. Patella that the so-called ordinary people to his knees, was inverted triangle, is located femur (thigh) and tibia (leg), the patella in the day-to-day activities of the whole range of up to 7 centimeters mobile, and therefore if the long-term bear the weight of pressure, and by external forces Wear effects will feel pain in the knee and activities will be restricted.

It is characterized by the use of when a patient to the patellofemoral joint will have a wide range of knee pain before the phenomenon, which especially in the up and down stairs, running, or kneeling when it is aggravated. Patients usually describe the former will have a wide range of knee soreness, and this pain will be after the sedentary, stair climbing, mountain climbing, jumping or squatting more obvious after a long time.

Many female friends, accustomed to wearing high heels to go out, up and down stairs in high-heeled shoes to wear when the surface of the patella in fact suffered by the forces of body weight can reach 7 to 9 times. "Chondromalacia patella" their symptoms and general osteoarthritis similar because of cartilage bone loss caused by gum sulfide, out-patient generally nothing more than common causes of any of the following four kinds of circumstances ︰

(1) wider pelvis.
(2) deviate from the patellar position.
(3) 4 thigh gravis or too tight.
(4) have been knee injury.
Regarding the treatment of minor symptoms can by straight leg lift movement to enhance the quadriceps, and shares in the power of oblique in order to stabilize the patella, so that the patella to return to its normal position. In severe cases, symptoms when conservative treatment fails, it is necessary to consider surgical treatment, surgical methods, including joint lateral ligament relaxation techniques, soft tissue reinforcement, and even Osteotomy to make the activities of the patella in his knee only to maintain a normal track. Chondromalacia patella as a result of knee joints in patients with tight lateral organizations should do patella joint mobilization and deep massage, and then a special medical tape affixed to the knee to correct patellar position, the patient must follow the guidance of physiotherapists do four triceps exercise training and knee proprioceptive training.

Physiotherapy Treatment Protocol

Rehabilitation Philosophy Physical therapy is often recommended for treatment of pain and dysfunction associated with patellofemoral syndrome and chondromalacia of the patella. The physical therapist will evaluate the patient’s mobility, flexibility and strength with the purpose of determining the underlying cause of the abnormal stress on the patella.
The patient will be counseled on which activities he or she can safely continue and which should be avoided.
The physical therapist will teach the patient the proper exercises to reduce patellofemoral stress. In most cases this will include strengthening muscles about the hip and knee that are weak and stretching ones that are tight.

Rehabilitation **

The following is an outlined progression for rehab. Advancement from phase to phase as well as specific exercises performed should be based on each individual patient’s case and sound clinical judgment by the rehab professional.

** Phase 1 (Acute Phase) Goals Control Pain and Inflammation Begin Pain Free Flexibility Exercises Establish Quadriceps Activation Establish Pain Free Knee ROM Recommended Exercises Cycle with Minimal Resistance (if pain free) Range of Motion and Flexibility Heel Slides (in pain free arc) Lower Extremity Stretching (based on individual assessment) Rectus Femoris IT Band Hamstring Hip Rotators Gastroc Quad Sets (intensity and flexion angle guided by pain) Strength Guidelines Perform range of motion exercises daily. Do 2-3 sets of 15-20 Reps. Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each.

Phase 2 (Sub-acute Phase A) Goals Continued Protection of Injured Joint Continue to Improve Flexibility Begin to Strengthen Areas of Weakness/Instability Recommended Exercises Cycle (slow progression of resistance) Range of Motion and Flexibility Continue Flexibility From Phase 1 Begin Open Chain Strengthening (based on strength assessment) Strength Knee Extension (SAQ, If painful use LAQ in painfree arc) Straight Leg Raise Hip Abduction Hip Extensors Hip External Rotators Hamstring Curls Guidelines Perform stretching program daily. Hold stretches for 30 seconds and perform 2-3 repetitions of each. Cardio program should be performed no more that 3-5 times a week for 20-35 minutes. Perform strengthening exercises daily. Do 2-3 sets of 15-20 Reps.