Are you an active person who experiences anterior knee pain when running,
playing sports such as soccer and basketball, or lifting weights to strengthen
your legs as part of your exercise routine? Then you may have a condition
known as chondromalacia of the patella, which is softening of the cartilage
that covers the underside of your knee cap, causing pain during activities
that place stress on the knees. The cartilage acts as a natural shock absorber
for the knee during the above activities that can become irritated due to
various abnormal stresses at the knee joint. Chondromalacia is more
common among women than men, however many athletes regardless of
gender and athletic ability experience knee pain as a result of this condition.
Normal joint mechanics of the knee consist of bending and straightening of
the knee joint (where the thigh bone known as the femur and the shin bone
known as the tibia articulate), as well as movement of the knee cap over that
joint. When the knee bends, the knee cap glides downward and when the
knee straightens, the knee cap will glide back up. This movement is known
as tracking of the patella. Irritation and breaking down of the cartilage
occurs as a result of misalignment of the patella over the knee joint, which
affects the normal joint mechanics, leading to altered tracking of the knee
cap.
Altered tracking can occur due to positioning of the thigh bone in relation to
the shin bone as a result of weakness in the hip abductors, which cause the
femur to internally rotate resulting in a lateral positioning of the patella and
increased stress to the medial portion of the joint. Also people who are
considered to have “flat feet” when standing in a weight-bearing position,
may be a candidate for future knee problems if not corrected due to
abnormal stresses at the knee joint. Altered tracking may also occur due to
tightness in the lateral structures of the knee, including the ITB band which
crosses over the patella causing a lateral pull on the knee cap which can lead
to degeneration of the cartilage if not corrected. Another cause of altered
patella tracking may be due to weakness in the VMO, which is the medial
quadriceps muscle, so when your quadriceps muscle is firing the other
quadriceps muscles are pulling the patella in a more lateral direction. Altered
tracking usually is a result of a combination of the above conditions.
Most of the above predisposing factors can be corrected through physical
therapy treatments to prevent further breakdown of the cartilage underneath
the patella due to misalignment and/or altered tracking of the knee cap, as
well as to eliminate knee pain associated with this condition. When
evaluating knee problems, the physical therapist not only should look at the
knee joint, but at the hip and ankle joints because what happens at these
joints can cause abnormal stresses to the knee. Treatment can be as simple
as the physical therapist suggesting proper foot wear based on any altered
posturing of the lower extremity as observed during weight-bearing
activities that may contribute to chondromalacia of the patella. Based on
flexibility and strength assessments, as well as observing joint mechanics,
the physical therapist will design a program to address those factors that may
be contributing to your knee pain. Physical therapy can consist of stretching
of the tight structures and strengthening of the weak musculature, in
conjunction with modalities for inflammation such as electrical stimulation
and ultrasound.
If you or someone you know is complaining of anterior knee pain when just
sitting in a chair or while performing exercise and/or athletic activities, you
may be a candidate for physical therapy. Discuss with your doctor to
determine if physical therapy may be an option and if so have him write a
prescription for an evaluation and treatment of knee pain. Your doctor may
refer you to a physical therapy clinic or you can check with your insurance
company for physical therapy facilities covered under your plan.
By Krystina Cierkowski, PT
Clinical Director of Twin Boro Physical Therapy
Located in the South Brunswick YMCA
