One particularly annoying and disabling syndrome that plagues runners, walkers and stair climbers alike is chondromalacia patella or patellofemoral pain. It is usually described as a dull ache in the front of the knee, where the knee cap (also known as the patella) sits. It is often felt while walking up or down stairs, squatting or kneeling. Interestingly, it can tend to disappear while doing the running, walking or biking that brought it about in the first place.
In order to understand its cause, we need an anatomy lesson on the knee cap. The knee cap, or patella, is a round, flat bone that is suspended between two tendons, one above and one below the knee joint. When your knees bend or extend, the patella is pulled up or down over the knee and glides in a groove on a smooth, firm and flexible cartilage. With overuse, age, and repetitive movements, such as long distance running, biking, walking and stair climbing, the cartilage starts to have bouts of inflammation, followed by healing and then scarring. This cycle causes the cartilage to become rougher and less elastic. The patella then has more friction to deal with and, you guessed it, you feel pain. Some even report hearing and feeling a grinding noise coming from the affected knee(s). In the medical world that is known as crepitus.
The immediate treatment of this malady is to stop engaging in the activity that brought it on. For instance, if you’ve been running 3 or more miles every other day, take a break for at least a couple of weeks. Try to elevate and apply ice to the affected knee when possible. Acetaminophen (Tylenol, others) as well as non-steroidal anti-inflammatory medications (NSAIDs) such as ibuprofen (Advil, Motrin, others) or naproxen (Aleve) can be helpful. In more severe cases a visit to an orthopedic surgeon may be necessary. In rare instances, arthroscopic knee surgery may be required.
One particularly important cornerstone in the treatment and prevention of chondromalacia patella is physical therapy- the goal of which is to strengthen the muscles of the hips, thighs and legs, specifically, the quadriceps, hamstrings and hip abductors. Those muscles help to stabilize the knee joint and keep proper alignment of the patella. The proper alignment assures that the patella slides in its appropriate groove and meets minimal friction and resistance. A licensed physical therapist can be invaluable and will help you create an exercise regimen to strengthen leg muscles. However, you will probably need a referral from your primary care provider to meet with a physical therapist. Fortunately, you don’t have to give up aerobic exercise entirely when dealing with this. Exercises that involve less impact on the knees can be great alternatives, such as swimming, cycling, or using an elliptical machine.
Another important point is that you should not try to make this diagnosis by yourself. If you are experiencing significant knee pain, see your primary care provider as soon as possible. Other, more serious causes of knee pain will need to be ruled out such as arthritis, gout, or a sprain. Once a diagnosis is made, you and your doctor can come up with a plan that is best suited for your situation.
Jeffrey Heit is an internist in Burlington, Massachusetts and is affiliated with Philadelphia Veterans Affairs Medical Center. He wrote for HealthCentral as a health professional for Obesity.