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 as soon as the exercises 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.