The Sport Factory Chondromalacia Patella in Runners and Cyclists

Chondromalacia Patella in Runners and Cyclists

Chondromalacia patella or Patellofemoral Pain Syndrome (PFPS) is a term given to �kneecap pain� or �anterior knee pain�. PFPS is due to an irritation of the undersurface of the patella (kneecap). The undersurface of the patella is covered with a layer of smooth cartilage, which normally glides effortlessly across the knee during bending of the joint. However, if the patella tends to rub against one side of the knee joint, and the cartilage surface become irritated, knee pain can be the result.

Why does this happen?

One likely cause of PFPS is a muscular imbalance. The patella is normally pulled over the end of the femur (thigh bone) in a straight line by the quadriceps (thigh) muscles. If the medial (inner) and lateral (outer) quadriceps muscles are not pulling equally, this creates abnormal patellar tracking toward the lateral side of the femur; essentially pulling the patella out of the groove it is supposed to track in. When an area becomes inflamed the muscle fibers can �turn off,� or not fire properly. Since 3 of the 4 quadriceps muscles pull the patella laterally, and one holds it medially (VMO), weakness in the Vastus Medialis can cause or contribute to the condition.

Who is at risk?

PFPS most often strikes young, otherwise healthy, athletic individuals.

� Runners tend to be the most commonly effected, and even more, runners that pronate.

� Improper bike fit/cleat position- while a small degree of side-to-side knee motion may be acceptable and normal, excessive knee motion may increase the cyclist�s risk of developing painful knee symptoms.

� Women are more commonly affected secondary to their anatomical shape- wider hips in relation to the knee (Q angle).

How Is It Treated?

The primary goal for treatment and rehabilitation of PFPS is to create a straight pathway for the patella to follow during quadriceps contraction.

Treatment:

1. Initial pain management

� Avoid motions that cause pain (it may be necessary to avoid running if that is the cause, etc)

� Ice- to reduce inflammation

� Anti-inflammatory medication (Ibuprofen: Advil/Motrin or Naproxin: Aleve)

2. Strengthening � Isometric quad sets- seated or supine with the knee extended straight, contract the quadriceps by pushing the back of the knee into the floor. Hold for 10 seconds and repeat several times per session and several sessions per day � Half sits at wall- stand with back to a wall with knees bent to a position halfway between standing and sitting, while squeezing an object such as volleyball between the knees. The squeezing of the object between the knees is important since this recruits the adductor muscles and selectively strengthening the VMO relative to the other quadriceps

� Side or reverse step-ups- when symptoms improve sufficiently to allow completion of it pain-free.

Machines

� Seated Knee Extension- Concentrate on the top 20 degrees ROM and firing the VMO.

� Half squats or Leg Press- No lower than 45 degrees at the knee or less initially

� Hamstring curl

3. Stretching

� Quadriceps

� IT band

� Hamstring

� Calf

4. Examining form and equipment � Examine running shoes for proper biomechanical fit- Orthotics may be a necessary addition � Analyze pedal stroke and cleat placement when cycling

5. Return gradually to previous activities

As symptoms subside and normal function through appropriate stretching and strengthening exercises is achieved

� Gradually re-introduce biking with intensity and frequency varied depending on symptoms and comfort.

� Gradually start back with a walk-run program on flat surfaces only, at a very modest pace. If you can avoid concrete, do so -- training on sand, dirt trails, or treadmills might be the best place to start.

� Hill training should be the last aspect to include again, since this creates the greatest stress to the knee joint.

Patellofemoral Pain Syndrome is relatively easy to treat and resolve if you follow these protocols. If you are susceptible to this condition a regular strengthening regimen targeting knee stability and VMO strength will help considerably. As athletes we are trained to work through pain but readily treating the initial inflammation can help nip this condition in the bud.

Jen Adley earned her BS in Biology and a Masters degree in Physical Therapy. She is a practicing board certified physical therapist for Body Pros Physical Therapy and is coaches athletes for The Sport Factory. She is licensed by USA swimming with over 10 years coaching experience. Jen has twice received an honorable mention ranking from USA Triathlon.

Published in: Training News