musculoskeletal myths#2 chondromalacia patellae

Musculoskeletal myths #2 chondromalachia patellae
Runners knee, jumpers knee, retro patella bursitis, fat pad syndrome, patella dysfunction syndrome etc etc. Where a complaint of pain associated with the patella , usually central , though possibly towards either upper or lower poles, made worse by descending stairs, squats, running etc. Often associated with swelling around the patella, puffiness which is not within the capsule. pain on forced pressures into extension of the knee. Associated with observations of poor recruitment and possible wastage of the Vastus medialis muscle.
Historically this was viewed as a arthritic disease and given the name of chondromalachia patellae, treatments ranged from injections , various surgical procedures ( including the complete removal of the patella! ) through to nsaid's, rest ,electrotherapies, exercise, taping etc.
This problem is caused by a recruitment problem of the VMO. This is at the effect of altered sensations ( which may include pain ) and inhibitory effects stemming from an inflammatory event of L3 facet joint ipsilateraly. The recruitment pattern may be improved by taping of the patella( ala Mconnell) where the patella is prevented from drifting lateraly by pushing and holding the patella medially while fixing it with tape. This is a temporary measure and needs to be followed up with appropriate mobilisation and the turning off of spinal protective responses at the L3 facet joint. Normal spinal protective responses are the underlying cause of spinal joint ( and nerve) inflammatory events.
L3 facet joint pain is often a feature of a more complex bio-mechanical dysfunctional situation. Often seen where ankle foot pronation leads to Sacro-iliac joint dysfunction , leading to chronic stiffness and inflammatory events of lumbar joints and corresponding nerves.
The cause then for patella/femoral dysfunction will be seen to be the inhibitory effects of altered nerve function at the nerve root at L3, driven by a protective response at that joint , including adjacent joints and soft tissues ( see the physiology of spinal pain , a theoretical model , posted in the general physiotherapy section of this site.). this then leads to a poor recruitment pattern during knee movements , of VMO , leading to lateral drift under load of the patella , leading to inflammatory events and pain.
Treatment step one, reverse the protective responses at L3, include the adjacent joints.2. Consider the implications of a biomechanical effect if seen , eg, pronated ankle/foot/SIJ dysfunction ( usually seen together ), 3.restore full dural length if required to femoral dura. 4. coffee

I enjoyed this! Good sense of .......... a lot of things. Our bodies are but slaves of our nervous systems.

recent research suggests that rather than VMO weakness it is decreased Glute recruitment that is more of an issue. The Glutes control not only the adduction (weakness giving a Trendelenberg) but more importantly in knee pain, femoral external rotation. If some one has pain on squatting and you teach tham to activate their Glutes you can often alleviate some or all of their pain. Gluteal re-education is a key component of treating PFJ pain. Also check the control of the deep hip rotators, they are the "rotator cuff" muscles of the hip and rarely addressed!

[alophysio]

i agree with vanphys but in addition to the above

Hi!
Great piece of info.Can chondromalacia patellae cause refered pain (shooting pain) to hip????
Regards
Sana

possibly the knee can refer up to the hip. It is more likely the other way around.

[sdkashif]

Have a look over that good article for more information

<a href="http://www.ptjournal.org/PTJournal/Feb2006/ad0020600236p.pdf" target="_new">Effects of Repetitive Shortwave Diathermy for Reducing Synovitis in Patients With Knee Osteoarthritis: An Ultrasonographic Study - APTA Physical Therapy Journal</a>

hey guys

Im doing my masters and currently aiming to study the recruitment of VMO during squatting, during squatting with taping, and suqatiing with taping whilst performing an isometric hold (pillow squeeze between knees), using EMG.

Can youplease give me references about the glut med activity and/or L3 facet jt probsas wouldlike to read into that.

Thanks