Runner's Knee

Tabassum Ali, DC, CCSP, CCCN

Pain found deep in the knee can be a symptom of chondromalacia patella, also known as patellofemoral pain syndrome (PFPS). The meaning of chondromalacia is literally chondro- cartilage and malacia- weakening. Anatomically the patella, more commonly known as the kneecap, is found in front of the femur and above the tibia. Due to the superficial location of the patella, it can often be involved in fractures and is at greater risk of injury in any high impact sporting event or trauma. Cartilage is found on the posterior surface of the patella, responsible for the smooth motions of the knee. The main function of the patella is to protect the knee and provide a frictionless flexion and extension of the knee. Chondromalacia patella is the most common problem seen in a sports medicine office, and affects 30% of athletes in some sports. Those who have difficulty running can possibly have a restricted joint in the lower extremity, but could also have poor biomechanics from a previous overuse injury of the cartilage. Any repetitive motion such as:

  • Climbing stairs

  • Running up hills

  • Squats or kneeling

  • Sitting for an extensive time with knees bent

 

can cause irritation of the cartilage and excessive wear and tear of the joint. Other causes of a dull achey pain under the kneecap or around the edges can be from trauma to the knee such as fracture and/or dislocation, or poor muscular control at the hip and knee involved with patella tracking. Major muscles involved in patella tracking can include the hip abductors, quadriceps, and hamstrings. Any athlete that plays a sport, in which a repetitive motion is required, will likely experience the symptoms of chondromalacia patella at some point. Symptoms of chondromalacia patella:

  • Pain that generally is dull and constant

  • Clicking/Popping of the knee upon motion

  • Swelling of the calf

  • Bruising of the muscle

  • Restricted motion

 

When observing the knee for motion, the patient may experience pain through the ranges of motion, which is a good indicator that there is some sort of restriction in the soft tissue or in the joint. To fully diagnose chondromalacia patella and the degree, imaging might be needed. The first source of imaging is X-ray, although it will not be able to show any soft tissue damage, it will help rule out other conditions such as joint degeneration, impingement from an osseous structure, or arthritis in the joint. If cartilage weakening is concluded, scar tissue will be built up in and around the joint, preventing full range of motion in addition to pain upon exertion. Possible treatments for a chondromalacia patella:

  • Rest and ice

  • Manual or instrument assisted myofascial release technique

  • Rehabilitative strengthening exercises

  • Taping or bracing the knee

  • Anti-Inflammatory pain medications

  • Surgery options of arthroscopy or realignment of osseous structures

 

Addressing the scar tissue and rehabilitation of the knee is very important. Skipping out on stretching can lead to further advanced conditions. A misconception that many runners have is, a tight muscle indicates a strong muscle- this is incorrect! Although a tight muscle can be strong, it is more common that the muscle is weak and spasming in hopes of remaining stable, and most likely on the verge of injury. Warm up is important before beginning any strengthening protocol and can be done with stretching. An example of a stretch for the quadriceps would be to place the top of your foot on the seat of a chair and while standing on one leg slightly kneel forward. Exercises to strengthen the muscles associated with chondromalacia patella:

  • Resistance band exercises

  • Eccentric exercises- calf raises

  • Proprioceptive one legged stance

 

Approximately 4-6 weeks of treatment will be needed, depending on the severity of the injury, to decrease the pain and strengthen the muscles. Most athletes find results with myofascial release resulting in decreased pain, increased range of motion, strength, and balance. The second phase of treatment is the most important aspect being strength and conditioning, to prevent future injuries.

In summary, to address chondromalacia patella:

  • Address the scar tissue in primary involved joint, and any associated muscle

  • Warm up and stretch the muscles

  • Strengthen and condition to prevent future injury (sport specific functional training)

Works Cited

 

Staff, Mayo Clinic. "Definition." Mayo Clinic. Mayo Foundation for Medical Education and Research, 05 Feb. 2013. Web. 06 June 2013. <http://www.mayoclinic.com/health/chondromalacia-patella/DS00777>.

 

Endo, Yoshimi, Beth E. Shubin Stein, and Hollis G. Potter. "Abstract." National Center for Biotechnology Information. U.S. National Library of Medicine, 30 Aug. 0005. Web. 06 June 2013. <http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445133/>.

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