Strengthening exercises which may form part of a treatment and rehabilitation program for Chondramalacia patella.
The following is for information purposes only. We recommend seeking professional advice before attempting any rehab exercises. It may be beneficial to tape the knee before beginning exercises to assist with patella tracking.
Aim of strengthening
It is usually the vastus medialis obliques on the inside of the thigh near the knee and the gluteus medius muscle on the outside of the hip that require strengthening. The aim is to encourage the patella to track in the proper position spreading the forces throughout the joint.
Begin the exercises as soon as they can be performed without pain. It may be necessary to use taping while performing exercises so they can be done pain free. The vastus lateralis on the outside of the thigh often requires stretching.
Static quadriceps contraction
This is a good early stage exercise to use whilst standing exercises are painful. A foam roller or rolled up towel is placed under the knee so that it is slightly bent.
Place your hand on the vastus medialis muscle to feel it working. It is essential that the athlete learns to isolate this muscle and feel it being used during strengthening exercises. A muscle stimulator or tens machine can help in the early stages. Contract the muscle, hold for 3 to 5 seconds, relax and repeat 10 times. The foot should lift up off the floor as the knee is pushed down into the towel. This exercises should be performed 3 to 5 times a day if pain allows.
The athlete is in a side-lying position with the knees bent to and feet in line with the spine. The top knee is lifted away from the bottom knee. Make sure the lower back and pelvis are kept still and don't rock backwards. The Gluteus Medius muscle at the back, top of the hip should be felt to be working. Start with 2 sets of 10 repetitions and gradually increase to 3 sets of 15-20.
This exercise can be started as soon as pain will allow. Tape the knee to avoid pain if necessary. With one foot in front of the other and the injured knee in front the front knee is bent enough to feel the vastus medialis working. Aim to keep the knee pointing forwards - don't let it fall inwards. Return to starting position and repeat. Aim for 3 sets of 10 repetitions.
This is a more advanced exercise than the lunge. Again it should be emphesised that it is the vastus medialis on the inside of the knee that is working. The athlete bends the standing knee to lower the other heel towards the floor as far as is comfortable (this does not always need to be all the way down) and returns to the starting position. Repeat 10 times and aim to perform a number of sets throughout the day.
Stretching exercises for chondramalacia patella
The following guidelines are for information purposes only. We recommend seeking professional advice before beginning rehabilitation. With chondramalacia patellae, it is usually the structures and muscles on the outside of the knee such as the IT band and the Vastus Lateralis which are tight. However, each athlete's rehab program may be different depending on their specific causes of injury.
The tight structures of the knee such as the lateral retinaculum need to be stretched and mobilized. This is often done by a therapist. The athlete sits with the knee slightly bent. The kneecap is then glided or pulled towards the inside of the knee the the hands and held for 20 to 30 seconds.
Hold the foot of the leg to be stretched and gently pull up behind. Aim to keep the knees together and pull the leg up straight not twisted. The athlete should feel a stretch at the front of the leg. It should not be painful. Hold stretches for 20-30 seconds. Repeat 3-5 times. Important - if this stretch is painful for the knee then do not do it.
Iliotibial band stretch
Place the leg you want to stretch behind the other one. Raise the same arm upwards and lean over to the opposite side as shown. Hold for 20-30 seconds, repeat 3-5 times and do this at least three times a day.
It is a lot of stretching but it is worth it in the end if you want to be rid of this injury. Never bounce when stretching, always ease into it gently and try to relax. If it is painful you are not doing it properly!
Long adductor groin stretch
To stretch the long groin muscles which cross the knee joint stand with the feet wide apart. Bend the knee that you don't want to stretch and lean away from the one you are stretching.
A more comfortable long adductor stretch is done sitting on the floor with the legs out wide as far as they will go. Gently lean forward to increase the stretch. Hold for 20-30 seconds and repeat 3-5 times, at least 3 times a day.
Short adductor groin stretch
Sit on the floor with he soles of the feet together and as close in to the buttocks as possible. Rest the elbows ont he insides of the knees and gently push down until a stretch is felt in the upper groin. Hold for 20-30 seconds, rest and repeat 3-5 times, at least 3 times a day.