Chondromalacia patellae is degenerative changes or wear and tear of the cartilage under the kneecap. This is often due to repetitive trauma, impact injury, poor mechanics and poor health of the internal system.

It’s difficult trying to figure out what exercises one should do to maintain strength without irritating the joint or tissues further. In my view, the emphasis should be non-weight bearing exercises/activities + massage+ heat+herbal supplements = improve strength/mobility + without irritating tissues + improve circulation for healing + nutrition to injured tissue + restoring balance to the whole system.

Eventually you can progress to weight bearing exercises once the joint can tolerate more loading.

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Transcript:

This is Manu Kalia. I’m going to answer a common question by one of my viewers, chondromalacia patellae. And for those of you who don’t know what that is, chondromalacia patellae is degenerative changes to the cartilage underneath the kneecap, so either due to improper rubbing or excessive wear and tear or an injury. Often it’s difficult to work on strengthening exercises without irritating either the cartilage or the other injuries that have developed like quadriceps tendon issues like quadriceps tendinosis or a bursitis.

In my view, in order to work on maintaining the strength of all those structures without aggravating either the cartilage or the quadriceps tendon, all these tissues, an exercise or a mobility routine has to be designed which will focus initially at least on more non-weight bearing activities as well as doing more hands-on techniques like massage, acupressure massage, and cross-friction massage for the quadriceps tendinosis.   As well as more use of heat and other things like herbal supplements to improve the circulation of that tissue so all these tissues heal and to prevent ongoing irritation of that tissue.

So what I mean by non-weight bearing exercises is that you want to focus more in the acute stage or when things are really irritated. I mean, it could be a chronic injury, but it’s so irritated when you get back to trying activities like, for example, could be walking, running, jogging or weight bearing exercises like squats or lunges, any of those types of things, it aggravates the tissue and more. So you have to focus more on non-weight bearing things like exercise in laying-down positions, so for example, straight leg lift. So a simple exercise like a straight leg lift is not doing the repetitive bending and extending at that knee, which might be less irritating for structures under the kneecap or for that quadriceps tendon issue that’s going on too.  Yet it allows me to still work on maintaining the strength of the quadriceps muscle.  So, as well as doing other things laying down, for example, hip abduction movements to strengthen the glutes.

You might be able to get away with some bridging activities, too, as well as doing a lot of mobility exercises to work on maintaining the mobility of that joint as well as the local soft tissue, the muscles, the quadriceps, the tendons. But focus on non-weight bearing stuff first, which allows you to maintain the strength and mobility without irritating the joint.

So the first rule always is avoid activities or things that continue to exacerbate or irritate your symptoms. So, for example, if I had rotator cuff problems and when I do overhead things, if I grab a hammer and I go overhead and I’m doing overhead movements, it irritates that rotator cuff, possibly compresses it, pinches it. But I persist, it hurts, I bring it back down, and then I go back and try it again. If I keep doing that movement, it’s going to keep irritating that tissue.

So, rule number one, avoid that specific activity. So in your routine, avoid the weight bearing things. No squatting; I think activities like walking in water, for example. Possibly, you can get away with doing a little bit of stationary bike, but sometimes that’s irritating for this also. But focus on the strengthening there, work on massage, use of heat or doing Epsom salts. So all of the things and various herbal supplements, things can be taken to improve the health of the internal system as well as provide nutrition for the joints to help the tissue heal. So that would be a much better strategy to get through this.

And once the tolerance is there, can do the loading, and the tissue’s not as irritated, then you transition to the weight bearing tasks. And if it’s severely irritated, sometimes you might have to wear a knee brace. You might have to do some Ace bandage to support the joint. You might have to use a cane or crutches or a walker. It all depends on how severely irritated the tissue is and how much it wants unloading.

This training protocol can help people too who have chondromalacia patellae and are trying to figure out how they can design an exercise program without continuing to irritate the tissues under the kneecap.

For a step by step treatment protocol for chondromalacia patellae follow the Build Better Knees Program.