Symptoms
Pain
- Along the medial (inner) aspect of the kneecap or just below the kneecap
- When using stairs or going up/down hills
- Worse after prolonged sitting with the knees bent
- More of a dull ache
- Cracking or grating in the knee
- Eventually, knee may want to “catch” and may feel like it wants to give out
Definitions
- Softening of the cartilage on the patella (kneecap)
- Roughening of the cartilage under the patella caused by the kneecap not trackingproperly (patella doesnot glide smoothly over the femur/thigh bone)
- May also be referred to as Chondromalacia Patella
- One of the most common knee problems in running and other sports (may occur atany age)
Primary Cause
Excessive Pronation
- Pronation is a normal movement of the foot, that allows the arch to flatten to a degree, which helps thebody to absorb shock and adapt to different ground surfaces.
- In analyzing ones gait, first contact is on the heel and outside of the foot, followed by a shift of bodyweight forward, toward the arch and toes.
- If the foot is weak or tired and/or the footwear is not supportive, then the arch can flatten more thannormal, which is excessive pronation.
- Flattening of the arch (excessive pronation) increases stresses on the foot, which can further contributeto ankle, knee, hip and low back problems (a chain reaction).
- This repetitive, excessive pronation, is the main contributor to many lower extremity, overuse injuries.
Contributing Factors
- Mechanical conditions including wide hips (females), knock knees, patella alta (high patella) andsubluxating patella.
- Over pronation of the foot.
- Weakness of the quad, especially the VMO (Vastus Medialis Oblique Muscle) which runs along the inneraspect of the thigh and connects at the knee.
- Overuse, or an increase in hill running or stair use.
- Too large of a Q-angle at the knee (this is the angle of the quad muscle’s effective pull on the kneecap)
Less than 12 degrees is normal and greater than 15 degrees is abnormal.
Treatment - Advice Given Most In Current Literature
The 3 S’s — Stretching, Strengthening and Supporting, along with ICE and REST, have been found tobe the simplest and most effective for these injuries.
- Stretching of the hamstring, quad, calf and IT Band with help to decrease pressure at the kneecap
- Strengthening of the quad, especially the VMO (vastus medialis oblique muscle) will help the kneecap toglide more correctly through the groove at the knee joint.
- Supporting the foot with proper shoes and insoles, can prevent or help to eliminate the vast majority oflower extremity problems due to faulty biomechanics. This may be a Birkenstock sandal, with a broadbase and contoured footbed, that is low to the ground and conforming to the foot. It may be a shoe withan upper that wraps the foot and supports the arch and heel thus limiting excessive pronation. The vastmajority of footwear have more than enough cushion but very little support for the arch and heel. One ofthe easiest and most effective solutions is to add a simple over the counter insole that provides a forgivingsupport for both the arch and heel.
- Avoid downhill running or going up/down stairs.
- Avoid exercises done with the knee bent unless being done as an isometric.
- Physical Therapy including exercise, ultrasound, iontophoresis and patellar mobilization
