How To Treat Chondromalacia Of The Knee
14. Apr, 2011 
63 Comments
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,
Jerry
Thank you for the information. I think this is exactly what is going on with my knee. Can’t wait to get started on these
exercises.
Pam,
Remember, it will take a while but really focus on being consistent and it will payoff. I have had tons of success treating chondromalacia this way.
Hey thanks for the video. I am training for a marathon and it is a month away. I have been experiencing the symptoms described. How long–while doing these exercises–do you expect it to take for my knee to heal? Should I stop running all together during this time?
Kevin it really depends on your level of inflammation.
Thank you so much for this information.
My sports therapist just diagnosed me with this condition in my right knee & I have an MRI scheduled in 2 weeks just to be sure.
In the meantime, he prescribed (3) VMO exercises but I had a feeling these exercises weren’t enough to heal my knee.
One question – can I do these exercises daily? I wasn’t sure if they are considered strength training exercises (to be done every other day).
Jeri,
Thanks for the comment. Yes, do these exercises each day as long as pain free, as described in the post. Might need to reduce number of reps at first and then build up your volume as tolerated.
I told my doctor about these exercises & he said they are too focused on the quad so they can’t really help with the tracking of the patella (especially for runners). What do you think?
George,
I would say it is time to find another doctor or maybe he/she did not understand the point of these exercises. For what you are trying to accomplish here; there is no difference if you are a runner, volleyball player, or lacrosse player. Also, if the quad muscles have nothing to do with tracking of the patella; please ask your doctor what does then and let me know.
George, what I would tell you to do is what you think is right and will benefit your the most. If one method does not work for you then try the other. What I do know is that these exercises (if done consistently) have had nearly a 100% success rate.
Hi Jerry, I have a very bad case of chondro from contantly squatting with this issue.
I have been doing these excercises for the last 8 weeks, and am no longer squatting at all. Though my knees seem to be getting any better it is very little progress and a very slow recovery.
I relaise this is a long term thing to try and fix but could you give me some more tips for fixing the very painful condition?
Also what strechs should I be doing daily?
Thank you very much, David
David,
Sounds like you have some advanced levels of inflammation. Yes, this is a long term fix, but if you are not seeing improvement within the next 3-4 weeks, I would recommend seeing an orthopedic for a full evaluation to look at your feet dynamics, hip/pelvis alignment, and your gait as you walk. Make sure you see someone who knows what they are doing. It is possible there could be another underlying issue contributing to your inflammation. Try to eliminate extra activities that are painful (pain= +inflammation). I will shoot a video this week on some stretches and home treatment alternatives you can do to help decrease your inflammation. I have been wanting to do a follow up video/post like this for a while.
Thank you very much Jerry.
As far as I can tell my onset was directly cause by my squatting volume and technique. I went from once a week to three times a week and continued through the pain for at least two months.
My onset started as theather knee(which I ignored as there was no pain during training) only to have a sudden onset of major pain when doing things like going up and down stairs, getting out of chairs and kneeling.
I will keep doing the excercises and keep an eye out for your streching video.
My last post may have been a bit over dramatic, there has definatly been an improvment but I will have days where I can still feel the pain in my knees and some days where it feels like there is an itch I just cannot relieve just under the knee cap.
Hopefully with more time and work I will be able to return to proper leg training.
Thanks a million for your videos Jerry and for all the insight, I would still be in pain every day if not for your video and help.
David
David,
I will work on that this week and yes I am sure you will return to proper leg training. Squatting 3 days a week might have been a bit much and then trying to train for 2 months through the discomfort only escalated your inflammation. I think you should get rid of all the inflammation first before going back to heavy leg training and when you do start squatting again, video yourself and I would be happy to critique your form and possibly give suggestions.
Thank you very much Jerry, I was very down in myself for a period thinking I would never be able to really train my legs properly again but your video and more so the attitude you give has really given me hope.
When I return to leg training Ill send you a form video and you can see what you think.
Thanks again for all the help, you have made all the difference for me in a very bad situation.
Thanks David for the kind words. This is exactly why I put this website together in the first place!
Hey Jerry,
I was diagnosed with Grade IV of chondromalacia patellae and currently on glucosamine & chondroitin suppliments & CH Alpha veals. is it curable without any surgery? Doc says 70% of chances are to recover without a surgery. Just want to know if these exercises can be helpful in treating Grade IV of chondromalacia. Also is it advisable to carry on with my new job in the field which requires sometimes supporting/lifting heavy tools etc or walking and standing for long durations? is it ok to start working out at gym on other parts of the body? any suggestions/advice shall be highly appreciated
Amjad,
I personally do not think Glucosamine & Chondroitin supplements will be very beneficial for treating chondromalacia and yes is can be cured many times without surgery. I would try these exercises out first and get second opinions before surgery. I am not going to comment on your job-just be smart on how you are handling heavy items and the ways you move. As far as working out in the gym on other parts of your body-absolutely! Remember, if it causes pain to your knee you are increasing inflammation which will result in more discomfort later. Focus on all pain-free exercises.
Hello Jerry,
Thanks for the reply. I was going through information on the internet and read in some places that CMP can’t be treated/cured completely but all the treatement/exercies do is to relieve the pain etc. Is it true? does it mean I can’t play any sports like earlier?
Thanks again
Amjad,
That may be the opinion of some and I believe they would say that because it is human nature to want to get rid of pain and discomfort. Once they get rid of the pain, they stop doing the exercises, and then they just go back to doing what originally caused it to happen in the first place. Guess what, inflammation comes back. I have had tons of athletes whose pain and inflammation does not come back, but they are also doing the corrective exercises to keep the knee tracking properly. Identify the problem, treat the problem, correct the problem, and then keep doing the little things to keep the problem from coming back.
Hi Jerry..I have had ongoing knee issues for ten months now. I am a kickboxing/weight training instructor and I am pretty sure overuse/under developed quads contributed to my issues. Started with a case of ITB syndrome, then bursitis, then they finally think I have bilateral chrodomalacia. I completely stopped working out for six weeks and rested and iced, slowly went back to the gym using elliptical trainer, treadmill and stationary bike and started lifting again and my pain came right back, I am EXTREMELY frustrated with my lack of improvement and how drastically I have had to alter my workouts. I am used to two hour a day high intensity workouts and am losing my definition. My question is….where would you go from here? Ortho and physical therepy says they can not do anything else for me.I went through nine months of quad strengthening PT. My entire life has been altered, not only can I not do my job, but my daily life is affected. Does is take this long to go away? Will I ever be able to “up” my workouts again?
Rebecca,
As you probably know kickboxing is a lateral quad dominate activity, so taking my approach to treating your condition would be the first thing I would recommend to you. If an Ortho or PT tells you there is nothing else they can do for you….stop going to them because that is crap! If you pushed through the pain for 10 months, I would be slightly concerned with the potential of damage to the underside of your knee caps. The major problems I always see with PT and this condition is they always try to treat it with quad strengthening exercises. Re-education of the quads to all contract together as a whole is the focus I normally take. Neurologically, this takes a lot of reps and will be done slowly over time. Normally, 8-12 weeks improvement is seen. This will depend on the amount of inflammation that has been acquired and any other supporting structures that might have been inflamed as well. A very good friend of mine (PT & Inflammation Specialist) once told me that the amount of time a person pushes through the pain, it will take them twice that long to get rid of and fix it. I am shooting another video today that will address advanced levels of inflammation for the knee. Watch for it because I do not believe there is nothing that can be done for you. Help yourself by staying positive, re-focusing, and start a little different approach.
Thank you so much!!! I am going to try the excersizes you suggest and look into getting some second opinions!! Thanks for giving me a glimmer of hope that I might be able to get rid of this and get back to my workouts.i will keep my eye out of the new video. The tip that it will take as long to get rid of as it took to get to this point is good to keep in mind too. Thanks again.
Hi Jerry,
Thanks for your tips and video. I suffer from Patellofemoral Pain in both my knees since 8 years, right more than left. It first started after lots of running without proper build-up. Running for more than 10 secons is still impossible. Since a few years a picked up cycling and this goes ok as long as I don’t use too much force.
I had several therapies like ultra sound and shock wave but this did not help. My therapist also tried Mcconell taping, but this caused more pain and made my knee ‘click’ a lot more. What does give me a lot of relief is a patella brace which gives pressure just below the knee cap.
Since a month I train my quad muscles a lot with lunges, squats and leg extensions. I tried the exercises you described, but especially the Isometric hold exercise with my leg extended gives me a lot of irritation behind my kneecap, where lunges and squats go relatively ok.
Based on the above, do you have any thoughts or recommendations for further treatment?
Thanks,
Albert
Albert,
Sounds like you have some advanced inflammation. I am surprised that you can do squat and lunges without pain or increasing the inflammation. I am curious as to how many reps you can do with the isometric hold exercises until you feel discomfort? Also, I would recommend you go to my “How To Treat Knee Inflammation” post found in the “Injury Prevention” area. This is what I start athletes off with if their inflammation is so advanced that they are unable to do the prescribed exercises.
Jerry
Hi Jerry,
after some 10 to 20 reps of the isometrec holds it really starts to hurt and this then lasts for several days and then even walking hurts when my leg gets extended.
I’ve iced my knees each day since a few weeks and also do the stretches you described in the post you mentioned.
I will get a MRI scan tomorrow, will keep you posted.
Is it normal with Patellofemoral Pain that Mcconell taping causes more pain iso relief?
The taping is meant to re-align the knee cap for tracking purposes when bending the knee. With advanced Chondromalacia inflammation this will normally cause some pain because it will pull the knee cap down slightly. The strapping around the patellar tendon just below the knee cap usually will provide a little relief from the discomfort but is not a “fix”. In very advanced cases and after rehab and treatments have failed surgery could be an option, but this would be a worst case scenario. Would love to know your results of the MRI. I will try to help and give advice as much as I can. Sometimes this can be very frustrating for athletes.
Hi Jerry, I believe you are correct that the pressure on my knee cap is the cause of the pain with both the Mcconell taping as with the Isometric holds.
Excersises where my legs are not going to full extension are much easier to do, like with squats or lunges.
Would Isometric holds with my legs just slightly bended be as effective as with fully extended legs?
Not as effective but would be a good start. That reminds me, I have a post on isometric lunge holds you might want to check out. Just remember to concentrate on trying to get all the quad muscles to contract together.
Hi Jerry,
I got the MRI results from my orthopedist today. Good news is that there is no significant damage to the patella cartilage. There is some damage (grade 1 or 2) to the cartilage in the groove in the femor bone. The pain is caused by friction of the patella, especially with full leg extensions with my toes towards me. He did believe that this is caused by a tracking issue. He didn’t believe surgery would help and advised a certain brace for stabilizing the patella and try to find the right patella tracking adjustment by try different settings of the brace. The pain I had with the Mcconell taping was probably caused by pushing the patella too much inside. He also recommended biking with light resistance to smoothen the cartilage.
In the meantime, I’ve worked hard the last few weeks to strengthen and stretch my quads with squats, lunges and leg extensions. The isometric holds still hurt a lot, so I’ve avoided these. Do you think I should start doing them again?
Albert,
This is great news for you, awesome. I would let the inflammation decrease and get under control first and then start up with the exercises. All exercises should be pain free, otherwise you will just be creating more irritation and inflammation.
Hi Jerry,
I did some further testing with taping and noticed that when I tape my knee inwards, like with mcconell taping, the pain and ‘clicks’ get worse, but when I push my kneecap to the outside the ‘clicking’ is gone and pain reduced. Could it be possible that my kneecap tends to move too much to the inside iso to the outside? If so, would some other excersises would be better for me?
Albert,
I personally have never seen an athlete with medial knee tracking issues. When taping the knee cap inwards, if the lateral quads are tight and over dominate, it will pull the knee cap down into the grove when it is in the correct position. This will cause discomfort and “clicking” under the knee cap. The inflammation needs to be reduced more before that taping will have any positive benefits/relief. When you push the knee cap laterally out of the normal line of tracking it is not rubbing so there is reduced pain-do not do this as it will cause you more long term issues. Strapping/tapping around the patellar tendon will probably give you the best benefit/relief at this stage.
Hi Jerry,
I am 32 years old and It has been 5 years that I have been diagnosed with chondromalacia. I used to ski and play volley ball and table tennis a lot but I cannot do any of them anymore. Every time I try to do these exercise for treatment, my knees become so painful that I finally quit. The doctors told me that it is hereditary and it will be only fixed with surgery. I will appreciate your comments on my condition. It has been a week that I can hardly even walk.
Thanks for your help
Pia
Pia,
This obviously is a chronic problem and not something that has come on suddenly. Can you give me some more background info as to rehab you have done, what you do for pain and inflammation management, what a typical day looks like for you (job), is this condition in both knees, etc… Look forward to your response.
jerry
i had these knee pain for about four months and not cured with these excercises is it necessary to have a surgery.
thnks
Asma,
Have you seen any improvement at all from when you started? Also, have you been diagnosed by a doctor so you know what you are dealing with is chondromalcia? How long have you had this inflammation?
hi Jerry,
I’ve been doing these or similar exercises for over six mos. I have made progress but still have nagging mild/moderate discomfort. I developed condromalacia 3 mos. after meniscus surgery (one yr ago)when I bumped my knee hard. I guess what i’m wondering is, can i make any more progress or is this as good as it gets??? I was in PT for a while, any adding of weights always made it worse. I can now walk for 45 min to an hour but most days have some mild to moderate discomfort. I just want to walk and hike like normal. Thanks!
Deb,
It is great to hear that you are progressing-do not give up. When you were doing PT; did they diagnose you as having Chondromalacia? I am concerned that you might have bursitis. Did this discomfort start right after you bumped your knee?
Thanks for quick response! Severe pain started about a week after I bumped the knee, started gradually then blew up into extreme pain could barely walk for 5-6 mos. My surgeon I think was guessing chondromalacia flare up, as some was seen during my meniscus surgery tho it never bothered me before. I did great for the 3 mos. after surgery until i bumped it. It seems to get easily aggravated. Acupuncture does seem to help but I’m never aable to get back to “normal”………………..i seem to be able to bear weight oK but have burning and soreness……………..surgeon had given me a cortisone shot after bumping it, since i was in such pain, i had terrible reaction to cortisone………that was about a year ago so not willing to go that route again. I do take meloxicam daily; it does help. Maybe i need to see surgeon again ??? Will have to research bursitis. Everything i read on chondromalacia seems to fit is bursitis very similar re: symtoms? Thanks!
Deb,
Bursitis symptoms can be similar. What got me thinking that is because you can get bursitis easy from a direct bump you are describing. When you bend and straighten your knee do you feel a clicking or grinding sensation under your knee cap with discomfort? Or can you describe the pain and symptoms you have with movements?
Yes, have clicking and grinding quite a bit. Top of kneecap somewhat sore to touch, and around rt side of kneecap at times. AM stiffness and sometimes have a “burning” feeling not unlike right after surgery. As i said any exercises with weights cause trouble so I’ve stopped that. Mostly walking for exercise, did an hour several days in a row and can feel it today but not too bad. Doing your exercises in moderation. Had been doing lots of straight leg lifts from PT, calf stretches, hamstring stretches, hip exercises etc. HOt water soaks seem to help. I do not seem to have any swelling or puffiness at all. I do see a little hard lump, smaller than a pea,just above knee cap which i can see when i flex knee.It took me a while to notice this. Don’t know if that is any kind of “clue”…..but it doesn’t hurt when I press it. Will bursitis show on an Xray? PT said this all could just be “arthritic changes in knee” since surgery. Some arthritis was shaved off during surgery. But i think ongoing issues related to bump. I’ve not seen my surgeon since the cortisone shot a year ago. When i called a while back saying still having issues, their response was “Xrays and MRI were clean, so you may just have to modify your exercise lifestyle”……. PT said Synvisc might be next step but i really hesitate to try that since had such a bad cortisone reaction……. and I CAN walk for enjoyment so it’s not like i’m an invalid but it’s always “touchy”, I can’t walk on uneven ground, do hills, etc. i”m always thinking about my knee and very conscious of trying to protect it…….and who wants to think about their knee all the time?! Wondering if i should add 1/2 a tramadol to my meloxicam, wondering if i’d be more comfortable?? Tho had withdrawal issues with tramadol before surgery tho was taking 2-3 per day for five weeks. So i’ve stayed away from that so far but maybe just 1/2 a day wouldn’t be an issue. I could try and see. Thanks again for all your input!
Deb,
I am no doctor so I don’t want to comment on your medication. No bursitis is not going to really show up on an x-ray. Exactly how hard did you “bump” your knee and was it directly to the knee cap? Could there be a possibility that you got a small hairline fracture in the knee cap? Sounds like you have some calcification there. I really think you need some direct answers. I would recommend making an appointment with a good orthopedic doctor and get your knee re-evaluated. That way you can know for sure what is causing you inflammation. Also, if you don’t mind me asking, How old are you and what does a typical day for you look like (activity)?
I’m assuming my Xray right after the bump ruled out a hairline fracture. I hit it pretty hard on my wooden desk. Also had MRI. I am 60, not overweight at all,(110 lbs) sit at desk 8-1 but try to walk 45 min to an hour 4-5 times/week at least (moderate pace) plus my PT exercises. NOrmally I am more active, more and faster walking, horsebackriding but since knee surgery and the bump, have only been able to do some walking. I think riding is out of question as it puts a lot of stress on the knees. Maybe I need a second opinion other than my ortho surgeon…… his credentials are impressive and I do think he’s a good Dr. but who knows???
Hey Deb, sorry for asking so many questions. Without me actually seeing you and taking a full history and evaluation it is hard to sometimes give advice. I am trying to figure out if what you are dealing with is more than just a condition of chondromalacia. At this point, if you had a hairline fracture it should be pretty much fully healed (no a hairline fracture will not necessarily show up on a x-ray), but that might help explain why you have had so much pain and discomfort without much resolve for such a long time and that might also explain the calcification that has developed. Are you currently working directly with a PT or just doing the exercises that were originally prescribed for you?
Doing the quad strength/hip/hamstring exercises at home, that I learned last summer in PT. After being unable to add weights without soreness, and biking attempts made it sore, PT then had me do some pool therapy. I had about 12 sessions in all, not a lot I know but was becoming cost prohibitive (insurance isn’t the greatest). Then I did improve to the point of being able to start walking. Not sure why, maybe the acupuncture helped me or just the time factor (about five mos. post – bump)??? I am able to use the equipment at the therapy center by joining their “wellness club” so i will use treadmill in bad weather, have tried to bike several times (recommended by surgeon), anything over ten minutes seems to aggravate, and hip abductor (using very lite wt.) can aggravate too! Not sure if I should keep trying to bike despite the resulting soreness.PT did not seem to want to continue things that caused soreness. (Which was fine with me!)Pool PT was very difficult for me – keeping my balance in the deep water – for some reason I was really uncoordinated in pool! Was good for a lot of laughs. I had to wear ankle weights to try to balance, and those made my knee sore! Surgeon described my arthritis as “not uncommon for my age group” and said I have good joint space. The only hint I ever had of knee problems before the torn meniscus was some pain when I did some wall squats. The meniscus tore just from sitting w/knee bent under me for too long – no twisting or anything like you’d expect. So maybe I just have bad/degenerating cartilage made worse from the bump? If I thought more PT would help I would probably do more. I so appreciate your help/input……so ask away as much as necessary!
Deb,
Always follow the rule-if it hurts it is causing more inflammation and avoid it. Stay with pain-free walking for now, biking will increase knee bending and with high knee bending repetitions will cause inflammation if your irritation is not ready for that. When you use the hip abductor machine where exactly does it hurt (be as detailed as possible) and does it hurt if you use the adductor machine as well? Also, if you did a wall squat currently and held it there in an isometric contraction (no movement, 90 degrees at the knees)-Is that pain free once you are in that position or does discomfort(pain, not muscle burn-that is normal) increase the longer you hold it and if so where is that discomfort located exactly?
After my hip abductor session of 30-40 reps with lite wts, I had generalized soreness all thru knee (how’s that for detail – ha!). After that is when I had pain while doing wall squat holding a ball between knees. Today I just tried a wall squat (no ball) and didn’t feel pain holding for 30 sec. only tho. Even good knee feels a bit ouchy this week – weather affecting me????We went from quite chilly to warm. Good knee is usually pretty good except for sometimes a strained feeling down inside of it. I don’t worry about that one normally but think it’s interesting both are ouchy this week….. PT said weather can really affect what goes on in joints?? PT didn’t have me doing the hip adductor for some reason, said maybe we’d add later. Will be in Tucson next week want to see if hot dry weather has any effect on my comfort level………..
Deb,
I find it interesting that your PT only had you doing abductor work and no adductor work. If anything, I would think he/she would have had it the other way. If you would, please do no abductor work and only focus on adductor work on the machine-keep it simple 3 sets of 10 reps and then do 2 sets of wall sits for about 30-45 secs, follow that up with a nice slow paced 15-20 minute walk. I would like to know if that causes you any discomfort when you are finished and if it does-when did the discomfort start and what you were doing when it started?
Weather and barometric pressures can make joints a little more sensitive (I can sometimes tell you when a bad storm is coming in my knees). I would not get to concerned with this thought process. Just be aware of it. Just think of it as your own personal weather station!
Maybe i stated the wrong exercises adductor vs. abductor……anyhow i was dong the one pushing out w/knees not in. Anyhow, both knees blew up here on vacation in Tucson! Don’t know why……….didn’t think i was doing all that much walking…….but maybe did more than I thought??? Had ouchiness for a while before i got here, then after two days the burning throbbing started and got really bad, BOTH knees! I am starting to think bursitis??? The good knee had swelling above the knee cap (bursa pad???) super painful. Settling down now but not great. Taking my anti-iflamms, icing a LOT and trying to rest them………so much for my theory re; Tucson weather would be good for me. But maybe too much walking??? So guess I have to start over being very cautious w/my exercise as you recommend. Our friends here swear pool walking w/cuffs should really help me…..????
Once home on Sun., and if inflamm. is down i will follow your adductor/wall sits advice and let you know and hoping to add slow walking……….
Deb,
Yes, let the inflammation decrease first. Pushing the knees out is abduction, knee inward is adduction.
Hello everybody, here every person is sharing such experience,
thus it’s pleasant to read this blog, and I used to go to see this website all the time.
Hi Jerry. I was diagnosed with runners knee in February. I was doing strengthening exercises, biking and swimming. Two weeks after my diagnosis I was pain free while squatting and was told I could slowly start building up my running. I stayed at 0.5 to 1 mile, but one day I did 1.5 and my knees started hurting again. That was three weeks ago and since then I have only been biking, swimming, and doing squats. Last week I even focused only on the squats and swimming, but on Friday my knees got pretty bad again. I have been resting, icing, and foam rolling since then. I feel like they are worse then last time, as now they are grinding with every movement. Do you have any advice?
Thank you.
Olivia,
Sounds like you got a pretty good flare up. I would be very conservative for at least a week or two to try and get some of that inflammation down and under control. Go to the injury prevention section and look at the post “How To Treat Knee Inflammation” for some ideas and suggestions.
Jerry,
Thank you for the advice. So I should not do any of the above exercises for one or two weeks? Would swimming be ok? I have been reading a lot about people who have not been able to cure this. Does this have anything to do with severity? I’m only 20 and would love to be able to run again in the future.
Thank you
Olivia,
I would let things calm down first. Swimming would be OK but pull with the arms when swimming and not much kicking. Getting in the water and just moving around in the water may actually be good for it just don’t swim or over do it. If it hurts-you are causing inflammation. Yes, I believe you can get rid of this and correct it, especially at your age. There is no quick fix for this condition and you will need to hold back on doing certain activities until you get control of the inflammation.
Great information Jerry. I am 37 years old and I used to be long distance runner and soccer player when I was younger, I never had any knee injuries until 2 years ago, my doctor said chondromalacia grade I or II in the right knee, the same problem on the left one but it doesn’t hurt.
I understand I must exercise quads the rest of my life using your suggestions, but what about gym routines for legs? should I exercise legs twice/week at gym? now I am biker and swimmer too because my doctor asked to stop running but I want to run again and another problem appeared these days, muscular pain after too much training legs.
Luis,
First, I am going to assume you have your inflammation under control currently in both knees. As far as training in the gym-YES, just be particular about form and technique and monitor how your knees react to training loads & volumes. Pain-free means no inflammation. Enjoy that muscular pain from training and know you accomplished something, now focus on recovery. As far as running, if you are symptom free then go ahead but don’t try to run for miles right out of the gates. This is exactly what many people do wrong and guess what-inflammation come back as their quads start to fatigue, lateral pull takes over and you are right back to fighting inflammation again. START slow with very low distance. This might even only be 800 yards. Always monitor how your knees are reacting to every workout. Back off when you need to and advance correctly.
Jerry,
I am competitive bodybuilder. About 2 years ago my right knee started flaring up badly and causing me to cut short my quad workouts. I tried to work around as best I could but the problem got worse til my knee was sore all week long. I was diagnosed with chondromalacia by a very good PT and he helped me recover with a stretching and VMO strengthening program. I took 2 months off weight training on my quads except for some VMO work and TKE’s. I started back slowly and used a Patellar tracking brace for 6 months. For quads I’ve found that I can do leg press Fairly well, box squats, lunges and even hack squats and front squats. Leg extensions seem to aggravate it the most which is kinda surprising. The problem is that I have a fear that I will never get back to heavy squatting, front squats and hacks which were always part of my bread and butter for thigh mass. If I go too heavy on squats, anything above 315, it seems to aggravate my knee! Same with hacks. I can do leg presses just fine with 800+ but I don’t feel like those alone will be enough to get my legs stage ready. Now after a good workout which causes no noticeable pain during the workout seems to cause some possible tenderness in the knee the night after and the next day. I’ve taken so much time off already and lost a fair amount of strength and quad mass that I hate to take more time off. It seems fine as far as stability and strength are concerned and I have been smart about not pushing too hard. This is kind of a shot in the dark question but i do feel like I’m getting stronger and more confident with the knee but the recent flare up from going too heavy on squats or leg extensions makes me worry. Do u think i will ever be able to get my quads stage ready again and what would u do in my situation to give me the best shot of that? Thank you very much
Taylor,
From what you are describing, I think you are doing the right things and yes I think you can get stage ready. I personally am not a fan of leg extensions at all. I know many use it for training the quads but I will be honest-I have trained body builders and figure competitors and I did not put much if any focus on leg extensions. I don’t like the tension it places on certain aspects of the knee.
You will be able to do a lot of weight on leg press with not much pain mainly because of the foot placement. Do your regular squats with as much weight as tolerable as long as you are not causing inflammation. Then if you have access to a safety bar, work on safety bar squats. You should be able to squat more with that bar with less chances of inflammation developing.
Now for increased hypertrophy and that definition you are looking for I would work on Isometric exercises for the quads. If you do not usually use isometric exercises, working them into the end of your workout-almost like a “finisher”. This will be intense and there should be some major muscle burn-almost to the point where you can’t walk directly afterwards. This is how you can achieve what you are looking for without causing inflammation in the knees from chondromalacia. Normally 1-3 sets will be enough depending on how your workout is set-up for that training day. Hope that helps! Keep us posted on your progress and what your thoughts are for trying this.
Also, if the leg press is completely pain free with pressing-try lowering the weight some and do rep sets for 2 minutes straight. This is a favorite of mine when we are a few weeks out from competition for definition and cutting. You will hate and love it at the same time!! I would not jump right into that-maybe work on 45 seconds to 1 min first and see how the knee reacts to that.
Jerry,
Thank you very much for the quick response. I think it’s great that you are on here taking your time to help us out with your knowledge and expertise. I have found that doing some TKE’s on cable pulley with the strap behind my knee really gives me a very solid contraction in the fully extended position which I will use in place of the leg extension machine. I like the closed-chain aspect of this exercise and it seems to strengthen my knee while leg ex machine aggravates it. One thing I used to do for rectus femoris detail was to lie as far back as I could on the leg ex machine and keep my toes pointed down so I’m looking for ways to hit the upper quad region for detail and separation without the leg ex. I’m curious about the isometric contractions you mention. Are you describing holding the just short of lockout position on a leg press while flexing the quads hard for a given time period? How do you go about doing the isometric work for quads? Again, I love the optimism here on your site. It’s easy to do a google search on chondromalacia and find sites which describe it as a chronic issue with no cure that will eventually lead to TKR!! Thank you for your help and giving us all some hope that we can do the things we love.
Taylor,
Thank you for the kind comments. I put this site together to help answer people’s questions about training and possibly give them some ideas to help them in positive ways. My site is not the most popular site out there but it has gotten a bit of a following through word of mouth and/or computer. I always believe that if you don’t BS people and put “real” information in front of them then you are doing the right thing. I work many hours a day training athletes so this is kinda my on the side gig to help anyone looking for it.
TKE’s are great. There are many ways to do isometric work for the quads. I would recommend starting with just standard wall sits and squeeze a medicine ball between your knees. Then do a wall sit and place a band around the legs and push the knees out into the band. As for upper development for the rectus femoris, try doing manual resistance (you will need a partner for this). I am planning on doing some new post this week and into next week. Maybe I will do post’s on these exercises to help you out and show you how to do them. Make sure you are signed up on the newsletter so you get an update from me when I post up new training info.
Hi Jerry,
I am 57 and feeling very despondent about my situation. I have had cp for 15 years no, but have successfully managed it with quad strengthening. I had to stop running when I was 40, but can hike mountains and I bike 20 miles a day. 2 months ago I hit the side of my knee on my steering wheel and – 2 months and a course of physio later – I have had an MRI which shows no visible damage; they just noted stage 2-3 cp. My doctor told me I had “awakened a sleeping dragon” and he has put me in a brace with no follow up physio – “you know all the exercises”. It does not feel the same symtoms though I can feel the familiar pain under the knee cap, it is much more debilitating this time. as I had before and I have the added point tenderness on the knee cap and on the side of the patella. I really want to believe that I can fix this. All possible fractures have been eliminated though the tenderness never goes. I don’t want to be in knee brace – it does support me but does not really change the pain – I am usually very patient – but I feel overwhelmed with this one. Dp you think if I persist, I will get this under control? I can’t walk more than 10 steps without the knee cap discomfort kicking in. Also, though it has been 2 months, should I continue to ice? It does help/ The doctor says it does not – it just numbs the pain….That is contrary to everything I have heard/read. Thank you so so much
Jeanie,
So sorry to hear this. Can you tell me exactly what rehab/physio exercises you are doing currently and how many times a week. Are you actively stretching the quad and hip flexors? Also, switch to ice cups with bio-freeze or mineral ice in them-you will get much deeper penetration and a better response. I have other posts on the site about the stretching and decreasing inflammation of the knee. Unfortunately Jeannie you will have to be patient with this. What concerns me is the lack of improvement over a 2 month period. I’ll look forward to your response.