Treating chronic knee pain

Chondromalacia patella is the most common cause of chronic knee pain. It has many aliases, and is also known as ‘Runner’s knee’, ‘Secretary’s knee’ and ‘Housemaid’s knee’.


The symptoms of chondromalacia patella are generally a vague discomfort of the inner knee area. To add to the confusion for the sufferer, this condition can be aggravated by both activity and rest. There will often be pain while running, or climbing/descending stairs. However, prolonged time spent sitting with the knees in a moderately bent position will also cause pain when attempting to rise.

Some people also complain of a vague sense of ‘fullness’ in the knee area. Occasionally, if chronic symptoms are ignored, the associated loss of thigh (quadriceps) muscle strength may cause the leg to ‘give out.’ It is also possible for mild swelling of the knee area to occur.


The kneecap is normally pulled over the knee joint in a straight line by the quadriceps muscle. The undersurface of the kneecap is covered with a layer of smooth cartilage. This cartilage glides effortlessly across the knee during bending of the joint.

Chondromalacia patella is a situation where the kneecap is now pulled off to the outer side of the knee. This slightly off-kilter path causes the underside of the kneecap to grate along the femur causing chronic inflammation and pain.

There is a greater likelihood of this condition in females because their legs are not as straight as men. We can also expect this more frequently in ‘knock-kneed’ individuals or those whose kneecap is misshapen.

Abnormal movement of kneecap also develops in association with excessive pronation (arch collapse) of the feet. When the foot and ankle experience excessive pronation, it causes increased rotation of the leg at the knee joint. This rotation causes twisting at the knee and causes side movement of the kneecap.


The ultimate goal for treatment chondromalacia patella is to create a straighter pathway for the kneecap to follow over the knee joint during quadriceps contraction. Initial pain management involves avoiding motions which irritate the kneecap. Inflammation of the knee-cap cartilage is reduced through icing and anti-inflammatory medications.

Selective strengthening of the inner portion of the quadriceps muscle will help normalize the tracking of the patella. Occasionally, bracing with patellar centering devices are required. Stretching and strengthening the quadriceps and hamstring muscle groups is helpful for an effective and lasting rehabilitation of chondromalacia patella.

The most effective way to improve the movement of the patella due to excessive pronation is with shoe orthotics. The orthotics provides support for the arches, which reduces excessive pronation, and limits medial rotation.

Sometimes chondromalacia is not cured by conservative therapy, and it may be determined that surgery is needed for treatment. Surgery would only be considered as a last resort after aggressive conservative treatment measures had failed.

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