Runners Knee

By Jonathan Cluett, M.D., About.com Guide

Chondromalacia patella is a common cause of kneecap pain or anterior knee pain. Often called "Runner's Knee," this condition often affects young, otherwise healthy athletes.

Chondromalacia is due to an irritation of the undersurface of the kneecap. The undersurface of the kneecap, or patella, is covered with a layer of smooth cartilage. This cartilage normally glides effortlessly across the knee during bending of the joint. However, in some individuals, the kneecap tends to rub against one side of the knee joint, and the cartilage surface become irritated, and knee pain is the result.

What happens to the cartilage with chondromalacia?
Chondromalacia is due to changes of the deepest layers of cartilage, causing blistering of the surface cartilage. The pattern of cartilage damage seen with chondromalacia is distinct from the degeneration seen in arthritis, and the damage from chondromalacia is thought to be capable of repair, unlike that seen with arthritis.

Who gets chondromalacia?
Chondromalacia is interesting in that it often strikes young, otherwise healthy, athletic individuals. Women are more commonly affected with chondromalacia. Exactly why this is the case is unknown, but it is thought to have to do with anatomical differences between men and women, in which women experience increased lateral forces on the patella.

What is the treatment for chondromalacia?
The treatment of chondromalacia remains controversial, but most individuals can undergo effective treatment by resting the knee and adhering to a proper physical therapy program. Allowing the inflammation of chondromalacia to settle is the first step of treatment. Avoiding painful activities that irritate the knee for several weeks, followed by a gradual return to activity is important. In this time, cross-training activities, such as swimming, can allow an athlete to maintain their fitness while resting the knee. The next step in treatment is a physical therapy program that should emphasize strengthening and flexibility of the quadriceps and hamstring muscle groups. Use of nonsteroidal anti-inflammatory medication is also helpful to minimize the pain associated with chondromalacia. Treatment with surgery is declining in popularity for two reasons: good outcomes without surgery, and the small number of patients who actually benefit from surgical treatment.

Does this sound like your situation?

You're a self-proclaimed athlete--certainly in shape, but not quite a professional runner/cyclist/etc. You decide to train for the local 10-mile race, or perhaps even a marathon, maybe you're a cyclist who is riding more than usual. Your knee starts to give you trouble, so you see your doctor and are diagnosed with chondromalacia.

You're given the treatment for chondromalacia: rest, medications, exercises. You participate, to some degree, with these treatments, but the knee pain persists.

Why is chondromalacia a persistent problem?

I can't tell you how common this story is in an orthopedic surgeon's office. One of the most common problems we see is chondromalacia, and patients often take a long time to recover. Here is why the recovery from chondromalacia can be so difficult:

• You are doing activities your body is not ready for.
  Running 10 miles or a marathon is not a normal activity. You are asking your body to take on a terrific burden by participating in these activities. Often patients complain that "this doesn't seem to happen to others." Absolutely wrong! Nagging injuries in part-time athletes, even in professional athletes, are probably the most common reason for a visit to a sports medicine specialist. On top of asking your body to do some un-natural activities (running 20 miles is NOT natural), many patients spend the rest of their day at a desk. Then they set aside an hour or two to cram all their physical activity into the late afternoon.
  Don't get me wrong...distance running and other activities that cause chondromalacia are great for the body. The benefits to the heart, lungs, etc. far outweigh the knee pain of chondromalacia. But be understanding of the limits of your body. It is not abnormal for your body to develop symptoms of chondromalacia if you are a distance runner!
  
• You don't really participate in the treatment.
  This is certainly not true for everyone, but it is true for the majority of patients. If you want to rid yourself of chondromalacia, you MUST rest. Any activity that causes chondromalacia knee pain, be it a run, walking up steps, or anything else, is causing further irritation to the cartilage under the kneecap. You need to give your body a chance to heal. Many patients are given a knee strengthening program or sent to a physical therapist. The reason for this is not so much to make you stronger (the average patient with chondromalacia is quite strong), but to better balance the muscles around the knee. Without specific exercises to balance these muscles, and a proper stretching routine, the problem of chondromalacia will likely not be solved. Doing the exercises every day is an important part of treatment.
  
• You haven't set aside enough time to recover.
  Many patients have a race in two months, have the onset of chondromalacia, and expect a few days of backing off their training schedule should cure the problem. Sorry. You need several weeks, at a minimum, to allow the irritated cartilage to settle down. You'll then need several more weeks to slowly build up your activities in order to resume your training schedule.