Runner's Knee (aka Chondromalacia Patella)

Chondromalacia patella, also known as Runner’s Knee, is the softening and breakdown of the cartilage that lines the underside of the kneecap.  It is a very common problem that develops in runners, tri-athletes, cyclists, and other athletes.

Causes, Incidence, and Risk Factors

Chondromalacia of the patella occurs in adolescents and young adults.

The condition is more common in females. It can be related to the abnormal position of the knee.

Your kneecap (patella) sits over the front of your knee joint. As you bend or straighten your knee, the underside of the patella glides over the bones that make up the knee.

Strong tendons help attach the patella to the bones and muscles that surround the knee. These tendons are called:

·         The patellar tendon (where the kneecap attaches to the shin bone)

·         The quadriceps tendon (where the thigh muscles attach to the top of the kneecap)

Problems begin when the kneecap does not move properly and rubs against the lower part of the thigh bone. This may occur because:

·         The kneecap is in an abnormal position (also called poor alignment of the patellofemoral joint)

·         There is tightness or weakness of the muscles on the front and back of your thigh

·         You are doing too much activity that places extra stress on the kneecap (such as running, jumping or twisting, skiing, or playing soccer)

·         You have flat feet

Chondromalacia of the patella can also be a sign of arthritis of the kneecap, which is usually seen in older people.

Symptoms of Chondromalacia Patella

·         A grating or grinding sensation when the knee is flexed (moved so that the ankle is brought closer to the back of the thigh)

·         Knee pain in the front of the knee that occurs when you get up after sitting for a long period of time

·         Knee pain that worsens when you use stairs or get out of a chair

·         Knee tenderness

Signs and tests

A physician will perform a physical examination. The knee may be tender and mildly swollen, and the kneecap may not be perfectly lined up with the femur (thigh bone).

When you flex your knee, you may feel a grinding sensation below the kneecap. Pressing the kneecap when the knee is straightening out may be painful.

X-rays are usually normal, although a special x-ray view of the kneecap may show signs of arthritis or tilting.

Treatment

Temporarily resting the knee and taking nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, naproxen, or aspirin may help relieve pain, as well as electrical muscle stimulation of the quadriceps muscles. Being that there is a problem with the tracking of the patella, VMO (vastus medialis obliquus) retraining is very important.  Chiropractic adjustments of the lower extremities will help remove any restrictions to the kinetic chain.  Stretching the muscles on the back (hamstrings) and front (quadriceps) of your upper leg is also important.  If you are overweight, trying to reduce your body weight by as little as 10% can make a drastic difference.  Orthotics for your athletic shoes and kinesiotaping of the patella can help prevent symptoms.

In regards to exercise, utilize these tips:

·         Avoid running straight down hills; walk down instead.

·         Bicycle or swim, instead of running.

·         Reduce the amount of exercise you do.

·         Run on a smooth, soft surface such as a track, rather than on cement.

Also, make sure your running shoes:

·         Are made well

·         Fit well

·         Have good cushion

Lastly, if the pain does not improve and there are signs of arthritis developing around the kneecap, surgery may be an option.

Remember:

The first step in fixing chondromalacia patella is determining whether you in fact have that condition.  Visit a health professional that specializes in musculoskeletal health such as a chiropractic physician or an orthopedic physician to get an accurate diagnosis.