How To Treat Chondromalacia Of The Knee

8892Chondromalacia of the knee, or simply inflammation to the underside of the knee cap (patella), can be very painful in some athletes and individuals.  Many times I see this condition due to the lateral quad muscles dominating the contraction of the quad as a whole.  I see this mainly in runners, jumpers, and certain water sports like water polo.

There are four muscles that make up the quad which basically extend the lower leg.  Of the four muscles, we are going to be focusing more on the inner quad muscle; particularly the origin of the Vastus Medialis or what is referred to as the VMO.

In certain individuals, the lateral quad muscles start to become more dominate when extending the knee which leads to a weakening of the VMO.  This will result in a slight lateral tilt or pull of the knee cap.  As the knee tracking (movement) is a little off, the cartilage of the knee cap will begin to rub, resulting in a softening of the cartilage.  This will lead to inflammation built up under and around the front of the knee.  This can become very painful even when simply walking up and down stairs.

Treatment: Many people will take the approach to try and strengthen the vastus medialis muscle as a means to fix the problem.  This would seem to make sense but I think you need to look a little deeper in treating this condition.  Strengthening the VMO will many times not solve the problem.  I believe the four quad muscles need to be trained neurologically to fire as a whole to extend the knee.  If over time the entire quad starts to contract as a whole; the tracking of the knee cap will realign itself so that the athlete no longer has any grinding sensation when the knee is flexed and extended.

The following three exercises explains what an individual should start doing to re-educated the quad.  Each exercise should be done once or twice a day, completely pain-free, for 2-3 sets of 7-10 reps.  Each exercise should be done lying down on your back not sitting up.

Isometric Hold: Lying flat down on your back, externally rotate your hip slightly, dorsi-flex your ankle (pull your toes/foot back towards your shin), and then tighten up your quad as tight as you can.  Focus on the entire quad contracting.  As you are doing this, reach down and with your fingers tap the vastus medialis muscle or the inner quad area just above the knee cap.  This will excite neurological activity to get the VMO more active.  Do this for a full 1-3 seconds before relaxing.  Repeat for the desired number of reps and make sure you are not over doing it.  It should remain pain-free.

Six Inch Isometric Hold: You will do everything the same as in the isometric hold except you will now have your foot elevated six inches off the floor.  This will actively get your hip flexors and hip adductor muscles fired up at the same time.  Ultimately this is very desirable as the quad will rarely just contract in movement without these muscles involved as well.

Lying Ball Extensions: Place something under your knee roughly 6-10 inches high (A volleyball or soccer ball works great).  As in the Isometric Holds, you will want your hip slightly externally rotated and your ankle dorsi-flexed.  Then contract your quads and extend your knee.  Squeeze very tight and hold for a second or two while tapping on the VMO.  Slightly start to lower the leg back down and repeat again.

These are a great way to get things taken care of.  Remember these are all to be done pain-free.  If you are unable to do any reps pain-free then you will need to hold off doing these and focus strictly on decreasing your inflammation conservatively first.  Also, stretching is a must.  Stretch the whole lower body but focus a lot of the stretching towards the hip flexor of the involved leg(s).

I have had nearly a 100% success rate over the years with this approach to treating chondromalacia.  I hope this helps whoever needs it.

To your health,

Jerry

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About Jerry Shreck

Division 1 Head Strength Coach at Bucknell University, Specialize In The Art of Injury Prevention Training Techniques God Loving Family Man (Wife-Trina & 2 daughters-Alexis & Aleyda)

168 Responses to “How To Treat Chondromalacia Of The Knee”

  1. Hi, Jerry,
    Your article is very helpful. I have technical questions.
    Why it is better to do exercises lying down? I cant reach my VMO, and i like seing my mucles contracting…
    I am 41, never exersised, 110, skinny. Got this problem after overusing my knees 2 years ago. My job is retail, always on my feet, very active. Was habitual high heel shoe wearer, even at work…not anymore…
    Got worse after international flight of 15 hours. My knee
    Cap was burning, at night got numb… it went away but accasionally, i have numbness and tingling radiating into lower legs… i would describe it more as discomfort… seems like neurological… knees get redish after activity, like under my skin…
    I know that any exersise with flexing cause pain on the next day… now i even seat with my legs straight…
    I got foam roller… i want to ask your opinion about using it? Why i have this burning sensation on top of my knees? Thank you…

  2. hi
    Dear Jerry
    im from Iran and i have very serious pain in my right knee for 4 month actually i hit my knee to table .doctor said me” u have chondromalcia”. im a 30 years old woman and im not very active at all.
    im very worry and sad.please let me know is it curable?

  3. Hey jerry your video is full of great information. I was diagnosed with chondromalacia a little under a year ago. I am a college shot putter and discus thrower and I need to get back training normal asap. I was wondering if you had any tips or any exercises I should not do. My first meet is in 6 months and Some of the pain has subsided. Thanks so much.

    • Hayden that’s awesome that you are improving. Easy-Any exercise that creates pain is going to increase inflammation; so try to avoid those or modify to a pain-free range of motion. Keep us posted and good luck this season!

      • Jerry, it has been over a year and my pain in my left knee due to chondromalacia has went away. I started doing your exercises and a lot of stretching. As crazy as it sounds I started back squatting with 135 and did high reps. The muscles around my knees have gotten stronger and I am back to my daily activities. I am on track to compete in nationals this year and set the school record in discus. I just wanted to let you know your routines are great, and no matter how much pain you are in there is always light at the end of the tunnel. So whoever is reading this there is always hope for pain free knees.

  4. Hi Jerry,

    I am a 30 year old male from Pakistan. I stumbled upon your website and will definitely give your exercises a try. Just to give you a brief history I regularly ran for about 2 years (with flat feet). Everything was going fine but all a sudden I started getting discomfort in my knee; pain with crepitus – creaking noises when climbing up and down stairs. As long as I do not exercise (run or cycle) things improve and the pain gradually subsides (although the creaking prevails).

    I have been diagnosed with “chondromalacia patella”. This condition has pretty much made me a couch potato. I have already been to the following:-

    1. Podiatrist – suggested me to wear shoes with inserts for flat feet. I shifted to motion control shoes, didn’t solve the problem.

    2. Orthopedic Surgeon – Prescribed VMO exercises along with glucosamine, chondroitin and NSAIDs. This didn’t solve the problem as well.

    3. Rheumatologist – prescribed a different NSAID and Vitamin D. This too did not solve the problem although the NSAID did temporarily provide relief from pain.

    It’s been over a year and a half since this problem began and all of the three treatment options above have not produced any significant results. I have been told by docs that my knee cartilage has deteriorated. As long as I don’t do any kind of exercise everything is fine. But the moment I cycle or run for even for a day or two things start to get messy.

    I am bummed by the fact that I cannot exercise (run) any longer due to the condition.

    What course of action would you suggest?. Will I be able to return to running ?

    Best Regards & Thanks

    • Ehsan,
      Try doing the exercises which are posted here for at least 3-5 weeks and make sure they are pain free while doing them. Then go for a short run and I mean short-like maybe a half mile. see if there is improvement as you train your quads to contract together. Interested to hear if this helped.

  5. Dear Jerry,

    Shall I do these exercises just with the painful leg or both of them?

  6. I have been diagnosed with condromalacia. Basically have stopped working out legs for a month now. How often should I be doing these exercises? And should I be also working out my glutes, hamstrings, and hips in a somewhat similar fashion?

    • Start just with these exercises and they should be done at least once a day. When movement begins to improve pain free other exercises can be introduced again but everything must be pain free or inflammation will return and set you back.

  7. Pleasr help me

    I havr knock knees, and chondropalacia patella im 17 can i br cured .im 17 only
    Im only walking and doing exercises which doctor told .like lying plat holding leg 30 degree above ground and toes away and towards holding 5 secs and kepping bottle under knee and pressing it can i be cured tell me

  8. Hi Jerry,

    Thank you for writing this article. I’m doing similar exercises for my vmo (not lying down) and my knee pain would get worse after. Is this normal? Is it like an initial phase until the muscles strengthen?
    By the way I ALWAYS feel discomfort if not pain in my left knee (from the right side, below vmo).
    I want to try your exercises but I’m worried about pain.

    I appreciate your help thank you!

    Best regards,

  9. Dear jerry
    I was going for aerobics from last 1 year
    Now having sudden chondromalacia …
    Will I be able to rejoin my dance n aerobics with these exercises

  10. Hello Jerry!!

    Thanks for this great video and article. I am a 51 year old male. I recently made a very poor training decision on the week of my 51st birthday. I was not walking regularly, and really overdid my walking that week!:( Basically I walked about 52 miles over 5 days! Honestly, I felt great during each walk. Never sore, etc. I never had knee pain in all my very competive years as an athlete in high school or college.

    The pain started when I returned to work where I sit as a financial analyst for 8-9 hours a day. I started getting burning pain in my knees like a ” blowtorch”! My orthopedic said it was PFPS or chondromalacia.

    It’s been 8 weeks, and still has been very rough. I just started PT this week. They basically said you did the terrible “Too’s” Too much, too long, too soon, etc. They said my knees were not conditioned for 5 consecutive days of that mileage..

    Jerry, it’s been very hard physically, BUT emotionally too! I knew better than too overtrain the way I did, and am very hard on myself at the moment..

    My Question: Is there light at the end of the tunnel if you do these great exercises? Or is it only going to get worse, over time. I’ve read that once you get this condition, it can’t be reversed..:(.

    Your honest opinion would be great!! Thanks for all you do!! God Bless You!!!

    Kevin

    • Kevin,
      Yes, In most cases the condition can be improved and reversed abck to normal. You must be patient though as it is a very slow process. Stay consistent with the exercises and you will have better days than others based on the volume and activities you did that day.

      Jerry

      • Hi Jerry,

        Thanks for getting back to me. My orthopedic doctor said I also have mild arthritis. I just received my 3rd Orthovisc shot yesterday. He said these should help ease the pain. Basically, just putting the lubricate fluid back in the knee, to reducing the grinding, etc. I do feel some benefit after the first 2 shots. He says it can take up to six weeks after 3rd shot to get full benefit.
        Jerry, I have to get back to your exercises. I was getting so depressed and frustrated, that honestly, I have not been persistent with my rehab. Hearing from you is a Blessing, so I will be back to your exercises tomorrow!!:)
        I also met an amazing Osteopath that works with professional Olympic athletes..He said he believes he can also help the recovery process by breaking up the fascia, that a lot of elite athletes need done..

        I hope all is well with you..and I will keep you posted!!

        Tomorrow is a new day..:)

        Thanks Again!!

        Kevin

  11. Hi Jerry!

    Thanks for getting back to me! The most frustrating part is sitting at my desk at work all day, 8-9 hour days. Or sitting at restaurant eating. That 90 angle is tough on the knees. Get a little sore for sure.

    Also, I think my nerves around the kneecap are overstimulated. I rather deal with normal pain, than nerve pain!!

    Is this common with this condition? Will the sensitive nerves calm down eventually also??

    Thanks Again!

    Kevin

  12. Hi Jerry. I am a 49 year old Zumba instructor. Mostly my classes were very high impact until th CMP started in both knees (sometimes I would teach four one hour classes a day!) since diagnosed I have started with the exercises. I limit myself to no more than two classes a day but usually just one. If I am consistent, ice my knee right after class. Lower the intensity will I be able to continue with my passion for Zumba? Having to quit would send me into a deep depression.

    • Kelly,
      I hope you are seeing some improvements; remember if you are inflaming it routinely the inflammation is not going to reduce and you will not see improvements.
      Jerry

  13. Hi Jerry,

    I am 27 yo male and I been bodybuilding for years, for some reason I got sudden pain in knees about a year ago, it laste for couple of weeks, hurted really badly, barely slept some days during those couple of weeks. I was diagnosed chondromalacia stage 2 in both knees, I’ve also got suplasyn shoots and done some psychical therapy and pain has gone away for most part. But I do have hard time walking downstairs (upstairs is fine), It’s odd feeling I can’t explain, it is bit of pain but mostly it feels like my knee doesn’t want to bend, stiffness of some sort.

    Anyway, I’m quite hopeless so I’ll try doing your exercises for couple of weeks and see if that can gets me going (I want to squat again in future, but for now I want to be able to least ride indoor bike a bit).

    I tried that like few a weeks ago, but when I cycle I have this grinding feeling in knee, it sounds horrible, doesn’t hurt though.

    • Adrian,
      Stop cycling for now. Be consistent with the exercises and let us know if you see improvement. Remember it takes time and consistency to achieve the results. If you are a body builder, I am sure you understand this.

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