Don't let chondromalacia stop you
Anterior knee pain, or chondromalcia, is a degenerative condition where the back side of the patella (kneecap) fails to track smoothly over the trochlear groove at the bottom of the femur (thighbone).
- Burning and pain around and behind the kneecap after exercise.
- After long intense exercise or use followed by motionless rest, the kneecaps may not slide well when knees are flexed or extended.
- Pain and mild to severe "crunching" noise in the joint behind the kneecap when leg is extended with foot off the floor in a seated position.
- Pain behind the kneecap when ascending or, even worse, descending stairs.
- Kneecap pain when standing up from a low seated position like a low chair, a squatting position, or a low car seat.
- Arthritic pain, stiffness and reduced range of motion after sitting with knees bent for long periods of time, e.g., long car rides, plane rides, movie theaters seats, concerts, and watching sporting events.
- If your kneecap is tracking very poorly it may even slip out of its groove, usually laterally and feel stuck. This can happen when standing with legs straight too long and then flexing the knees suddenly. This "stuck kneecap" situation can result in damage to the articular cartilage behind the kneecap. When you feel your kneecap stick when bending, stop bending and straighten the leg again. Massage the outside (lateral) side of the patella tendon vigorously and gently try to bend (flex) it again.
- Overuse. This chronic injury usually develops over time as a result of intense repetitive use, usually in conjunction with another pre-existing knee injury like an ACL tear or major meniscus damage. Also, jobs that involve incessant kneeling may cause this condition.
- Acute trauma. Damage to the articular cartilage in the trochlear groove and to the backside of the kneecap can also be the result of a traumatic injury involving kneecap dislocation or blunt force trauma.
- Knock knees, giving your knees a valgus angle.
- Moderate to severe over-pronation. Your foot takes most of its load on the inside of shoes. This contributes to knock-knees.
If your chondromalacia is only mild then it is not too late to prevent extensive damage. Avoid situations where you may be exposed to the causes listed above. Also:
- Don't kneel for extended periods.
- When seated for extended periods, keep your legs close to, or completely straight. It is bad to be active and then sit for a long while with knees bent.
- Diagnose whether you have knock-knees and/or severe overpronation of your feet. Get shoes that give you a lot of arch support and address overpronation. I suggest Asics Gel Evolution or Brooks Beast.
- Get a knee "jumpers strap" that velcros just under you kneecap at the top of the patella tendon and use the edge of the raised underpad to push your kneecap medially (inside).
- Get a physical therapist or knowledgeable trainer to tape your kneecap area for chondromalacia.
- Don't play sports that are notoriously deleterious to the knee joint like football, rugby, or even indoor soccer or squash/racketball.
- Be sure to vary your workouts and avoid doing just one thing all the time with intensity like road cycling. Bicycling with intensity puts tremendous load on the kneecaps. (Many cyclists are addicted to their road riding workouts and find themselves riding as their only fulfilling exercise. If you are truly hooked on road biking and only want to ride then be sure to mix in some mountain bike riding too. Your knees will appreciate the variety).
- You are done with heavy squats and the leg extension machine. Be sure to limit your flexion to no more than 40-45 degrees in any exercise.
- Avoid repetitive motion exercises with little variation like road running, a treadmill, and road riding or spinning.
Long term rest is not the answer
Unfortunately, skeletal injuries involving cartilage damage do not just heal over time with extended rest the way intra-muscular tears and injuries do. In fact, most often staying off an arthritic knee and minimising use will only result in: decreased range of motion, decreased ease of movement, and rapid strength loss due to muscle atrophy. You have to take baby steps. Listen to your body and find out what works.
Treat Your Knee Cartilage like it is your Prized Lawn
If your kneecap pain/chondro is worsening then you must change your current routine and institute a new exercise regimen. Let me start by trying to explain your ailing knee/s with an analogy. Try to think of healthy articular cartilage on the back of the kneecap and in the trochlear groove as if it is the expansive, lush, campus lawn in the main quad of a college. It is the head groundskeeper's job to keep this lawn healthy, green, and lush with no ruts or dead patches. One day you notice that the grounds crew has roped off the main lawn. Meanwhile, a large group is still playing ultimate frisbee inside the ropes. You ask the groundskeeper why the frisbee game is OK, but students can't traverse the lawn on their way to class or the dining hall. He explains that pedestrian commuting across the lawn results in "regular" and repetitive foot patterns that steadily kill grass and wear dead patches into the lawn. On the other hand, the "irregular" foot patterns of an ultimate frisbee game, actually serve to massage and stimulate the grass and its soil like a mild aeration. No specific area of the grass is getting dug up or worn out. Sorry for the long analogy, but think of your articular cartilage like a lawn you are trying to keep healthy. Vary your activities and don't do the same motions, over and over for long durations.
Strengthen your VMO - Vastus Medialis Oblique
Exercise Progression to get Your Chondro Knees Working Best
Assuming you are truly stuck and you feel that pretty much every type of exercise you try is hurting your knees and setting you back You need to get enough regular activity going to strengthen your quad muscles enough to get your kneecaps tracking better and more quietly. Specifically, you need to try to work the VMO (Vastus Medialis Oblique) section of your quads pictured at right. Here is a simple progression to get you going.
- Sitting up in a chair, simply extend one leg out and hold it for 5 seconds. Don't extend it so hard that you are pinching things though. Alternate legs.
- Lying on your back in a bed or soft floor or mat, with legs perfectly straight, raise each leg about 2 feet slowly and then lower it slowly. Alternate legs.
- On days when you have had a setback and really need to rest your legs just go out and paddle a boat or kayak for some upper body aerobic exercise.
- Get a moderate impact pilates video of 30-50 minutes. I recommend Winsor Pilates. Skip any movements that hurt.
- Swim with fins and a kickboard. Swimming vigorously with fins can really get your quads and hamstrings going with low impact.
- Start hiking on dirt trails in rolling hills. Uneven trails really help. Mix in mild jogging on the flats.
- Once you are moving a bit better, try some low-intensity ultimate frisbee or join in with a little kids soccer game. Keep the intensity way down to start.
- If you feel your knees can tolerate some load, try putting some light weight on a ram rack or leg press machine. Extend your knees with your toes pointed out at 45 degrees to stimulate your VMO quad. Don't flex your knees past 40 or 45 degrees.
Surgery is often not the solution, but here are your options:
- lateral release. Orthopedic surgeons may suggest a lateral release. This can release some of the lateral pull on your kneecap and can be effective but will leave a severe indentation next to your kneecap.
- microfracture. Depending on what kind of healer you are, microfracture for chondromalacia can be more debilitating and injurious than the actual symptoms you are trying to treat. Recommend against it. If you pursue this aggressive and experimental procedure, be sure to do it just one leg at a time.
Don't give up
No matter how bad your arthritic knees may be, there are ways to still get out and exercise. Don't ever give up looking for those ways.
This content is accurate and true to the best of the author’s knowledge and is not meant to substitute for formal and individualized advice from a qualified professional.
Pradeep on May 23, 2019:
CATHERINE COCKEY on October 30, 2017:
Reading these recommendations really elevated my spirits. So many good suggestions. Walking up hill or down hill on dirt trails made my knee feel worse, though. My knee prefers flat areas such as on a runner's circuit.
KS on March 26, 2014:
Great summary. I have both knees that are losing patellar cartilage; one surgical option that can be considered is a fulkerson osteotomy, which decreases pressure under the patella, and shift weight to healthier cartilage. During the procedure, a cartilage substitute such as DeNovo can be considered as well to fill the missing cartilage if the damage is full-thickness.
If damage is at early stages - change activities and lose any excess weight you may have = less pressure, less continuing damage. That may be the biggest positive effect you can make. Strengthening the VMO in isolation is pointless and the targeted exercises physio may recommend can in fact accelerate damage.
Kitt on June 10, 2013:
I really want to try that hiking suggestion but last time I climbed hills a lot my knees got louder!
mariazeyn from Ontario on September 15, 2011:
i had a bad fall a few years ago and since then i have experienced several painful knee mishaps. i feel like the bone inside moves off its place everytime that happens. my friends have been telling me to go to a doctor for months but i haven't gotten around to do that yet. maybe i should.
very good article by the way :)
Smart is Good from Lima, Perú on September 15, 2011:
My mum has chondromalacia, and she had surgery 6 months ago, this was a very nice hub that I showed her and I vote it up!