T Nation

Chondromalacia Patella

Hello all.
I have a Chondromalacia Patella problem in my knees. As part of the martial art training (Which is what I do to earn
my living, BTW…) I’m required to reach deep angles of knee flexion, sometimes on one foot only, and on the toes.
I’m aware that this position is not recommended to people with my problem, nor to anyone who wants to keep his
knees in a healthy state.
What can I do in order to help decrease the damage done to my Patella, and improve the state of my knees?
Any kind of special prehab, or exercises to strengthen soft tissues? Biomechanics tips?
By the way, some individuals are capable of reaching such deep postions, on their toes with no problem what so
ever, their whole lives! Kind of makes you jealous…

Many times Chondromalacia Patella is caused through improper patella tracking. Improper patella tracking is related to muscle imbalances in the knee, usually a weak VMO. Hopefully that might give you some direction as to what the underlying cause may be. Around 5-10 grams of MSM and 5 grams of Glucosamine may help a little.

Isometric exercises to strengthen the hams and quads have proven beneficial in some cases, as have Neoprene sleeves on the knee. I’d say give them a shot and see how they work out.

There is a tape job you can get on your knee to alleviate the pain. The names of the tape you need are McConnel Tape and Leuko Tape. If you know a trainer have them do it, if not the idea is to pull your patella in a medial direction. So, spray some adhesive on your knee, attach the mcconnel tape to the lateral (outside) of your patella, and as you pull the patella medially (towards the inside), pinch the skin on the medial side of the patella. Attach the McConnel tape, then cut the leuko tape and place it over top leaving about a quarter inch on either side. For strengthening, isometric quadricep contractions will strengthen and tighten the vastus medius, which in turn will pull your patella back medially, alleviating some of the PFC pain. Hope all that helps!

Thank you for the replys!
I’ll go about using more step-ups inorder to strengthen the VMO. Taping is something I always didnt feel comfortable with, but I’ll also give it a try. Thanks again!

Step ups may well make things worse. If you’ve got a severe imbalance, you need to place the load directly on the VMO to bring it up to snuff. Try this – sitting on a chair, straighten out one leg, turn your foot outward (rotate at the hip to turn your foot out), and bring your toes up (toward your knee). You’ll feel this DIRECTLY in the VMO. Hold for a 15 count, relax, and repeat. This is something you can do several times a day (and is something I do often at my desk). If you’ve already got a tracking problem, then doing step-ups will only make it worse.

Look first off you need to have someone who knows what they are doing in the strength and conditioning field correctly diagnose you. Chondromalacia Patella is the name for the severe degeneration of cartilage on the underside of the kneecap brough about by incorrect patellar tracking. It is only really diagnosable by an x-ray or mri varient. You probably have patellofemoral syndrome which is also an incorrect tracking of the patella, but before cartilage degeration takes place. You need to have someone with experience in the field figure out where exactly your strength imbalance is coming from (there are many you could have, patellofemoral syndrome is caused by VMO weakness, VMO tightness, adhesions in the medial hamstrings, improper lumbro-sacral mechanics that cause pelvis tilt, etc.) Once you have been evaulated and feel certain that you understand where the strength imbalance lies, then you can begin rehabiltation. As a general guideline, stretching the various quadricept muscles seems to work well for helping releive PFSymdrome pain (stolen from charles stanley). Ignore the advice on taping the patella, it’s poor advice because it is just a quick fix to the problem that will result in more askew biomechanics.

I’m sorry to say that my resources are poor
when it comes to athletic trainers and other
specialists. I live in Israel. The sports scene here is very poor and undeveloped comparing to the US. I’ll try to get a diagnostic exam from a sports MD, though, hoping he knows what he is talking about…
Any other advice?

Forgive my ignorance.

What does VMO stand for?

Thanks: Nelson

As far as ignoring my taping advice . . . I’ve been doing athletic training since my junior year in high school . . . If you want to compete you need to tape, if you want to take it easy and rehab then good. But I know what I’m talking about, though you do need to get an expert opinion on your condition that is definitely true, I was assuming you’d already done that.

VMO is vastus medialis, or the tear-drop shaped part of the quad just above the kneecap, and to the inside (medial side) of the leg. Of the four quad muscles, this is the only one that attaches from a medial angle through the kneecap.

Cleric has the best response so far. Avoid the taping…it doesn’t work. It only increases patellar compression on the femur. Avoid exercise bike. Promotes tight adductors and hip flexors. This will increase valgus forces at the knee. If you do have a tracking problem (which is questionable), the valgus forces will increase. Actually the best thing to do is avoid painful activities for a period of time and get evaluated by someone who knows what the hell they’re doing. I recently experienced recommendations by an “expert” orthopedic specialist who recommended short arc (0 to 50 degree) open chain knee extensions to “cure” the problem. This of course increases patellar irritation. You best bet is to squat. Start very shallow and avoid pain and simple work your way down. There is also new research that demonstrates increased VMO recruitment with a wide stance squat with slight internal rotation (30 degrees) if VMO is a problem. If you would like more info, Mel Siff’s Supertraining group at Yahoo has a great deal of research posted as well as recommended exercise regimines. Hope that helps.

I’ve got to second BillPT’s advice: avoid leg extensions if you’ve got knee trouble. Sure, it’s one of the few “tall guy (i.e., has knee problems for sure) friendly” exercises but it also irritates the kneecap in the short arc. Likewise, my MD recommended doing those almost exclusively. Squat instead, try to go ass-to-grass, but if that’s prohibited only go to below parallel and gradually work your weights up. Again, whenever someone says that an exercise is “not recommended” I have to question why, e.g., as my doc said: “Squats have a great potential for injury.” He didn’t say that they would or do hurt me, but that they could. Likewise, walking across a busy street has great potential for injury, but he didn’t tell me to stop doing that. My chiropractor, who runs regularly and works with a lot of athletes, recommends doing squats and leg extensions, but only doing the last 30 degrees of the leg extension. Likewise, most research points to this same plan. I would find out why deep knee flexion is prohibited and then see what to do.