Patella Chondromalacia and Runners Knee
Learn what patella chondromalacia (runners knee) is and what causes it, plus treatment and prevention tips.
by Brad Walker | First Published June 2, 2006 | Updated September 13, 2017
Patella Chondromalacia, or runners knee, is a condition where the articular cartilage, located underneath the kneecap (patella), starts to soften and break down.
This cartilage is usually smooth and allows the knee joint to move freely as the knee bends. However, as patella chondromalacia worsens, the cartilage breaks down, causing irregularities and roughness on the undersurface of the patella, which leads to irritation and kneecap pain.
If you suffer from patella chondromalacia or are seeking to prevent its occurrence it is important to follow the information in this article. In addition, adding a few simple stretches to your fitness program will also help. To get started on a safe and effective stretching routine that’s just right for you, check out the Ultimate Guide to Stretching & Flexibility.
Anatomy of the Knee
The anatomical picture is a front-on view of the bones, tendons and ligaments that make up the knee joint. In the very center of the picture is the patella, or kneecap.
The blue structure that runs downward from the patella to the tibia (shinbone) is the patella ligament, and located underneath the patella is the articular cartilage.
What causes Chondromalacia?
Overuse (or doing activities that your knees aren’t conditioned for), is the major cause of chondromalacia, or runners knee. Activities that involve a lot of running, jumping or rapid change of direction are particularly stressful to the knee joint. Participants of basketball, volleyball, skiing, soccer, tennis and other running related sports are particularly vulnerable to runners knee.
Other factors also contribute to chondromalacia, including: being overweight; pronation or inefficient foot mechanics; and insufficient warm up before exercise.
Although chondromalacia can occur to anyone at any time, there are two distinct age groups that are most susceptible.
- The over 40’s; where general wear and tear of the knee joint is occurring due to age and degeneration.
- Teenagers; (especially girls) where rapid growth is causing structural changes to the legs and knees.
Signs and Symptoms of Chondromalacia?
The major symptom of patella chondromalacia is pain in the area around the kneecap. Activities like walking, running and especially squatting, kneeling or jumping will cause increased pain and discomfort.
The initial treatment for chondromalacia is the same as any other soft tissue injury. This involves the application of R.I.C.E.R. (R) rest, (I) ice, (C) compression, (E) elevation and obtaining a (R) referral for appropriate medical treatment. The following two points are of most importance.
- Rest & Immobilization: Once chondromalacia is diagnosed it is important that the affected area be rested immediately. Any further movement or stress will only aggravate the condition and prolong recovery. It is also important to keep the injured area as still as possible.
- Ice: By far the most important part. The application of ice will have the greatest effect on reducing swelling and pain. Apply ice as soon as possible after the injury has occurred or been diagnosed.
How do you apply ice? Crushed ice in a plastic bag is usually best. However, blocks of ice, commercial cold packs and bags of frozen peas will all do fine. Even cold water from a tap is better than nothing at all.
When using ice, be careful not to apply it directly to the skin. This can cause “ice burns” and further skin damage. Wrapping the ice in a damp towel generally provides the best protection for the skin.
How long, how often? This is the point where few people agree. Let me give you some figures to use, as a rough guide, and then I will give you some advice from personal experience. The most common recommendation is to apply ice for 20 minutes every 2 hours for the first 48 to 72 hours.
These figures are a good starting point, but remember they are only a guide. You must take into account that some people are more sensitive to cold than others are. Also, be aware that children and elderly people have a lower tolerance to ice and cold. Finally, people with circulatory problems are also more sensitive to ice. Remember to keep these things in mind when treating yourself or someone else with ice.
Personally, I recommend that people use their own judgement when applying ice to themselves. For some people, 20 minutes is too much. For others, especially well conditioned athletes, they can leave ice on for up to an hour at a time. The individual should make the decision as to how long the ice should stay on.
My personal recommendation is that people should apply ice for as long as it is comfortable. Obviously, there will be a slight discomfort from the cold, but as soon as pain or excessive discomfort is experienced, it is time to remove the ice. It is much better to apply ice for 3 to 5 minutes a couple of time an hour, than not at all.
During the first 24 to 72 hours after an injury, be sure to avoid any form of heat at the injury site. This includes heat lamps, heat creams, spas, Jacuzzi’s and saunas. Avoid all movement and massage of the injured area. Also, avoid excessive alcohol. All these things will increase the bleeding, swelling and pain of your injury. Avoid them at all costs.
Although it is important to be able to treat chondromalacia and runners knee, prevention should be your first priority. So what are some of the things you can do to help prevent chondromalacia?
- Warm Up properly: A good warm up is essential in getting the body ready for any activity. A well-structured warm up will prepare your heart, lungs, muscles, joints and your mind for strenuous activity.
- Avoid activities that cause pain: This is self-explanatory, but try to be aware of activities that cause pain or discomfort, and either avoid them or modify them.
- Rest and Recovery: Rest is very important in helping the soft tissues of the body recover from strenuous activity. Be sure to allow adequate recovery time between workouts or training sessions.
- Balancing Exercises: Any activity that challenges your ability to balance, and keep your balance, will help what is called, proprioception: – your body’s ability to know where its limbs are at any given time.
- Footwear: Be aware of the importance of good footwear. A good pair of shoes will help to keep your knees stable, provide adequate cushioning, and support your knees and lower leg during the running or walking motion.
- Strapping: Strapping, or taping can provide an added level of support and stability to weak or injured knees.
- Strengthening: Instead of me trying to explain these, I simply found a great web site that has clear pictures and a good description of four effective quadriceps exercises. These four exercises help to strengthen the major muscles and tendons located around the knee joint.
- Stretching: To prevent chondromalacia, it is important that the muscles around the knee be in top condition. Be sure to work on the flexibility of all the muscle groups in the leg.
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About the Author: Brad is often referred to as the "Stretch Coach" and has even been called the Stretching Guru. Magazines such as Runners World, Bicycling, Triathlete, Swimming & Fitness, and Triathlon Sports have all featured his work. Amazon has listed his books on five Best-Seller lists. Google cites over 100,000 references to him and his work on the internet. And satisfied customers from 122 countries have sent 100's of testimonials. If you want to know about stretching, flexibility or sports injury management, Brad Walker is the go-to-guy.