Does Your Kneecap hurt when you run?

Chondromalacia patellae: Analysis of this knee underrated condition 

How many times you felt your kneecap bothering you when you run? Maybe is just a discomfort, not even pain, but it just feels different than the other side. Maybe it also makes more sounds when you are squatting or getting up from the couch.

But maybe, after a few months your knee hurts more than it ever did when you were active. You are doing less and somehow, it’s getting worse? Something must be off with this approach. You finally go and see a physiotherapist and they explain that you have “Chondromalacia Patellae” which means that the cartilage in the back of your kneecap is having some wear and tear. This blog will dive into what Chondromalacia Patellae (CMP) is, what it is not, and how you can overcome it.

Chondromalacia of the patellae is a description of pain in the front of the knee which translates to “softening of the cartilage.” We are talking about a “thinning” of the cartilage but not cartilage that has been completely worn away exposing bone. This refers to the smooth hyaline cartilage on the back of your kneecap which protects the underlying bone. When that cartilage has completely worn away, and there is nothing separating the bones from each other, the condition is called osteoarthritis. Cartilage is a-neural, meaning it does not have nerve endings and thus cannot be a true source of pain. Thus, the logic as a pain generator rests on two theories:

1. Thinning cartilage decreases the cushion between the bones thus potentially generating pain at the bone

2. That chondromalacia patellae represents excessive wearing away of that area due to overuse or abnormal biomechanics (typically described as patella maltracking)

   
   

The typical age range for diagnoses of this condition is 15-35 years old. This diagnosis is usually given based on a clinical exam.  While X-rays will show osteoarthritis, they are unable to detect the subtle changes in cartilage volume described in stage 1 and 2. For this reason, clinical exam is typically the driver of this diagnosis.

The most common test used to diagnosis is called the “Clarke’s Test” in which the examiner presses down on the patella while asking the patient to contract their quad with reports of pain considered as a positive finding.

The Patellofemoral Pain clinical guidelines recommend strengthening the quadriceps and lateral hip muscles as a Level A (their highest) treatment approach. They advise both closed-chain and open-chain knee strengthening exercises. At Nailsea Physio, our team has a thorough understanding of lower limb biomechanics and is fully qualified to offer personalised advice tailored to your specific needs.

By Andrea Cutrupi