by Ester Marsh
For the Salisbury Post
“Runner’s knee” is the nickname for Chondromalacia, which 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, and 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 towards 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 they think that it has to do with anatomical differences between men and women, in which women experience increased lateral (side) forces on the patella (kneecap). Another reason for chondromalacia is too much too soon too fast, for example starting a running program too hard, too long and too high of a tempo. Or, start playing a competitive sport such as soccer or basketball and don’t have a “base” (lack of conditioning). Even doing it the right way, you still might end up with chondromalacia. Fortunately, most of the time, the pain around the patella usually can be resolved with non-surgical treatment with an exercise program led by a physical therapist. Of course, that is after first being diagnosed by an orthopedic surgeon — it might be something completely different. The orthopedic surgeon is knowledgeable about surgical procedures, treatment goals and musculoskeletal anatomy, and will tailor their efforts to improve the well-being of the patient.
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. I know that is a lot of information.
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 ROM.
• 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 (not within the range you can hear) 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.
To find out if you have Chondromalacia, you need to be diagnosed by an orthopedic doctor. You can then set up a treatment plan. Hopefully, sessions with a physical therapist and a regular exercise program will prevent you from having surgery. And if you do need surgery, do what the doctor tells you. They can only fix the problem and guide you with a treatment plan; you are the one who is responsible for doing it.
Ester H Marsh, ACSM Cpt Health and Fitness Director JF Hurley Family YMCA
by Ester Marsh