How To Treat Chondromalacia Of The Knee
Chondromalacia 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,