Ester Burgess column: Tips for dealing with knee pain

Published 12:00 am Saturday, February 3, 2007

By Ester Burgess

For The Salisbury Post

Q. I have a daughter who plays soccer. She has had trouble with her right knee off and on. After an MRI, our doctor said that she has a mild case of chondromalacia, and said it is common in girls. She should grow out of it. If the pain persists, she may need to quit soccer! Do you know about chondromalacia, and any recommendations you may have?

A. Chondromalacia is due to an irritation of the undersurface of the kneecap. That surface is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint.

In some individuals, the kneecap tends to rub against one side of the knee joint, the cartilage surface becomes irritated, and knee pain is the result.

One of the reasons can be due to an imbalance either through weakness or tightness of the lateral ligaments, making the patella (kneecap) move toward the outside. As the knee bends, the tension increases which can cause pain with bent knee activities.

Chondromalacia often strikes young, otherwise healthy, athletic individuals. Women are more commonly affected with chondromalacia. Why this is the case is unknown, but it may have to do with anatomical differences between men and women, in which women experience increased lateral (side) forces on the patella (kneecap).

It is also often called a “runner’s knee.” Fortunately, most of the time, the pain around the patella usually can be resolved with non-surgical treatment with an exercise program lead by a physical therapist. It is important to have a physical therapist guide your daughter (or whoever deals with this issue after you have been diagnosed by an orthopedic surgeon!) because they are knowledgeable about surgical procedures, treatment goals, musculoskeletal anatomy, and will tailor their efforts to improve the well-being of the patient. He or she is also knowledgeable of your daughter’s limits to ensure a successful outcome.

If surgery is necessary, one of the more common procedures is an arthroscopic lateral release. It is aimed to release the tight lateral ligament, thereby decreasing the abnormal pressure on the underside of the patella.

Common preventative and/or recovery exercises can be:

* Stretching: Stretching is vital to maintain or achieve good range of motion (ROM) around the joint. After an injury or surgery, scar tissue forms and soft-tissue contracts; this is when stretching is most important.

* Strengthening: Strengthening exercises are performed to help improve the function of their muscles.The goal is to improve strength, increase endurance, and maintain or improve range of motion.

* Ice and heat therapy: Ice and heat are useful to warm up and cool off the muscles. It also can stimulate blood flow and decrease swelling. These can be important aspects of the therapeutic process.

* Ultrasound: Ultrasound therapy uses high-frequency sound waves to stimulate the deep tissues within the body — in this case, the knee joint. Deep tissues are stimulated by vibration of the sound wave. This leads to warming and increased blood flow to these tissues.

You have taken your first step. Your daughter saw an orthopedic doctor; he/she ordered an MRI and diagnosed the problem.

Your next step is for your daughter to work with a physical therapist and do the exercises given, including the exercises her therapist will give her to do a home. There’s a great chance that she’ll be back on the soccer field in no time!

Contact Ester Burgess at 704-636-0111 or eburgess@