Chondromalacia Patella Treatment
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Chondromalacia patella is a softening and degradation of the cartilage of the patellofemoral joint. It is a progression of runners knee pain with damage to the joint. There are 4 grades of severity for chondromalacia patella, each with distinct characteristics, which can be seen on MRI imaging for accurate diagnosis. You can read more about this pathology, symptoms, epidemiology and diagnosis in our related article: Chondromalacia Patella.
James McCormack is a Physical Therapist who specializes in foot & ankle injuries. james-mccormack.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.
Before considering the best treatments to do, it is important to know what you already do that can aggravate your symptoms. Running and other high impact exercise can irritate the patellofemoral joint as it has to withstand high compressive forces with each stride, lunge or jump.
It may not be sport that makes the knee pain worse. Activities such as walking, ascending or descending stairs, or prolonged sitting with knees bent, can all be aggravators. Alterations in your activities and habits are necessary to reduce inflammation and pain. It is good to have a period of reducing pain before starting rehabilitation.
A period of complete rest may be necessary for some people. Relative rest will be adequate for others, where activities that aggravate symptoms are significantly reduced, in terms of duration, frequency or intensity.
Neither heat nor ice will have a significant impact on the recovery time or healing process of chondromalacia patella. However, ice is effective for pain relief as it slows down the conduction speed of the nerves, resulting in a numbing effect of the local area. Never apply ice directly to the skin, use a layer of material between the ice and the skin to prevent ice burns. Heat is often less soothing as the joint might feel warm already.
Chondromalacia patella is a structural degradation of the cartilage which results in inflammation of the joint. Non-steroidal anti-inflammatories, such as ibuprofen, can be effective for pain relief and for reducing inflammation in the non-acute phases. Some inflammation in the first few days can be helpful, so it is best not to take this medication for the first 48-72hours.
Chondromalacia patella treatment can be guided by a physical therapist. Following an assessment, the specific biomechanics that you have that might have contributed to the development of, or affected your recovery from, chondromalacia patella can be identified. Common biomechanical issues are:
You can read more about useful exercises for these biomechanical contributing factors in our related article: Chondromalacia Patella Exercises.
As well as rehabilitation exercises, a physical therapist can help to reduce symptoms in the acute phases with hands-on treatments. Massage can relax muscles such as the quadriceps, and patella gliding exercises can help mobilise the kneecap to enable it to move more freely.
With a correct diagnosis, appropriate rest from aggravating activities, and a specific exercise programme, most people will feel a reduction or resolution of their symptoms within 4-6 weeks. The level of improvement will depend on the severity and duration of symptoms and the grade of chondromalacia damage that has occurred.
In most cases continuing rehabilitation exercises at home for several months after physical therapy treatment is advisable. If the level of damage is moderate to severe, a maintenance programme of exercises will be necessary to continue on a long-term basis.
A knee brace or compressive sleeve will not fix chondromalacia patella but can help with proprioception and symptom relief.
Our recommendation for the best knee brace for patellar chondromalacia, offers stability around the patella to aid patella tracking, and elasticated straps to make the whole joint feel more support.
KT tape, also known as Kinesio tape, is an elasticated tape that can be useful for symptom relief of various knee injuries. Patellofemoral joint pain, patella maltracking and chondromalacia patella can all be taped in a similar way. Taping can improve proprioception of the knee, which is the awareness of its position, which can aid movement, and it can reduce symptoms and make the knee feel more supported, for some people. Here is a video to show you the taping technique.
While orthotics cannot cure chondromalacia patella, if there are biomechanical factors contributing to the development or persistence of chondromalacia patella pain, orthotics can help. Orthotics can offer additional support at the foot to effectively reduce overpronation and knee valgus, which are risk factors for this condition. And therefore can have an impact on healing time.
In many cases of chondromalacia patella, the prognosis is good if it is managed well with activity modification, assessment of biomechanical factors and appropriate prescription of rehabilitation exercises. The additional support of taping or the use of a brace, and or some people medication, will help to reduce symptoms in order to be successful in completing these exercises. Unfortunately, in some cases, if symptoms are not getting better with conservative management then additional intervention will be offered.
There is a range of interventions that can help chondromalacia patella, from cortisone (a type of steroid) or hyaluronic acid injections, to operations such knee replacement. Surgery for chondromalacia patella is not recommended unless symptoms and damage is severe, typically only when Grade 4 with complete wear of the cartilage surface to expose the underlying bone.
This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.