An outline of a rehab program for chondramalacia patellae with exercises to decrease pain and help correct patella tracking.
The following guidelines are for information purposes only. We recommend seeking professional advice before beginning rehabilitation. Each individuals rehabilitation program should be different, depending on the findings of an assessment. For example if the hamstrings are not tight, there is little point stretching them.
Aims of rehabilitation
The aims of Chondromalacia patella rehabilitation are to decrease pain and inflammation, strengthen weak muscles of the knee and hip, stretch tight muscles and gradually return to full fitness. Patella taping is often a key part of CMP treatment and rehabilitation.
Reducing pain and inflammation
Rest from activities that aggravate the injury. As a general rule, if it hurts or is made worse by an activity then don't do it! Running and jumping activities are usually out along with cycling
Apply cold therapy or ice (Do not apply ice directly to the skin as this may cause ice burns). Ice may be applied for 15 minutes every hour initially reducing to every 2 to 3 hours after a day or so.
Compression, particularly in conjunction with cold therapy can help in reducing swelling. Apply a compression bandage after cold therapy. Tight compression bandages should only be applied for 10 minutes at a time in order to prevent tissue damage from restricting blood flow.
Chondromalacia patella taping
Taping the kneecap can have and instant effect in relieving pain as the kneecap is pulled away from the site causing pain. The purpose of taping is to reduce pain and allow muscle strengthening exercises to be done. If the athlete has pain on normal daily activities then taping should be applied all day until there is no pain on normal activities. If there is pain only on sports specific activities or muscle strengthening exercises then tape only for those exercises. The taping techniques used for patellofemoral pain syndrome are the same as for chondromalacia patella.
See more on patella taping.
The main aim here is to strengthen the Vastus Medialis Oblique muscle on the inside of the knee. This should help pull the kneecap inwards and allow it to track normally in the groove of the knee joint.
Chondromalacia patella exercises should start with learning to contract these muscle whilst sitting with the leg straight. This can be progressed to standing, and them maintaining a strong contraction whilst performing progressively harder exercises.
It is important that the athlete can feel the Vastus Medialis Oblique muscle contracting during strength exercises. Beginners may need to actually feel the muscle with their hand as it contracts. Strengthening exercises for the hip abductor muscles such as Gluteus medius, may also be benficial in cases where there is a large Q angle.
See more on strengthening for chondramalacia patella.
Stretching and sports massage
Exercises to stretch the outside of the knee should be done. Tight lateral structures will not allow the kneecap to track naturally. Stretching the ITB, Quads, Hamstrings and groin is usually advised. Sports Massage can play an important part in this. Deep massage techniques to the thigh, particularly outside of the thigh can assist in releasing the tight lateral structures.
See more on chondramalacia patella stretching exercises.
Return to fitness and prevention
Return to full fitness should be gradual and sports specific training should only begin when there is no pain. Full strengthening exercises should have been done to restore the muscles to full and balanced strength. It may be necessary to tape the knee or wear a support whilst returning to sport but do not get to rely in it long term unless specified by your therapist. Any biomechanical abnormalities (e.g. pronation) should be corrected to prevent the injury returning.