Definition: Cracking, thinning, and wearing away of the cartilage on the underside of the knee cap that cushions the knee cap against the leg bones. Without the cartilage cushion the joint is chronically irritated/inflamed causing pain. The condition is also called patellofemoral syndrome and chondromalacia patella.
Symptoms: Pain and inflammation under (deep) and/or around knee cap. Redness and swelling may also be present. As the conditions worsens scar tissue accumulates and there will be grinding or crunching noise with movement of the knee cap. The pain is usually worse when going down stairs or running on hilly terrain or rising up from a prolonged period of sitting.
Causes: The knee cap sits between the joined tendons of the thigh muscles (quadriceps) and the patellar tendon that connects the knee cap to the shin. Muscle imbalances and/or tightness in the quadriceps cause the knee cap to be pulled unequally to one side, usually outward and also cause it to sit higher than normal (patella alta). The knee cap normally fits and glides in a groove created by the leg bones and this motion is called tracking. If the knee cap tracks over the leg bones unequally as the quadriceps muscles are being used (running), the knee cap is pulled slightly out of the trough it causes wear and tear on the cartilage.
Contributing factors include: weak and tight hamstrings, glutes, groin muscles, TFL/ITB, and calf muscles, misalignment of pelvis, hip, knee and ankle joints, flat feet or loss of arch, poor shoes, over training, increasing workout intensity too fast, female gender- wider hips puts more stress on the knee, and a history of leg injury.
Treatment: Rest (1-2 weeks) , ice (10-15 minutes then take the rest of the hour off and repeat 2-4 times), over the counter or natural anti-inflammatory medications (a 5-7 day regimen), shorten stride, get knee adjusted, massage thigh muscles, stretch the quadriceps for at least 30 seconds and repeat 3-4 times per day. The best way to work out the muscle is to roll out the thigh with a kitchen rolling pin or purchase a foam roll. They can be purchased at running stores (or I can order them for you too). They are about 6 inches in diameter and usually 1-3 feet long, consisting of dense foam that will support your weight as you roll your body over it. Strengthen quadriceps by starting with "quad sets" which, are done by contracting the quadriceps with the leg straight in a seated position for 10 seconds in sets of 10, done 20-25 times per day. The move on to general leg and glute strengthening exercises. You can also cross train with activities like swimming or biking as long as the don't irritate the knee. If the injury does not significantly improve within 2 weeks get it checked.
Prevention: Stretch the quadriceps muscles thoroughly and properly, warm up before running with a walk or light jog or 5-10 minutes, increase intensity gradually and reduce if you experience pain, avoid hilly or uneven terrain when beginning a new program, stretch and strengthen leg and glute muscles, build in rest days to your routine, get a pair of proper fitting running shoes, have hips, knees, and ankles assessed for problems, get casted for orthotics, look into bracing options, and/or get kinesiotaped (the stretchy tape you see on athletes on TV).
