Physical Therapy for Chondromalacia: Helping Our Athletes with Knee Pain

Knee pain is one of the most common reasons why our young athletes seek medical care. With increased participation in sports, and increased intensity of both boys and girls athletics means that incidence of knee pain may likely rise. There are many reasons why anterior knee pain can occur, ranging from severe ligamentous damage to “nonspecific” anterior knee pain caused by overuse or other factors. 

If you are reading this blog right now, perhaps you or your child has recently received a diagnosis of Chondromalacia Patella. DON’T PANIC! Although chondromalacia may sound scary, this is something that can be managed very successfully with physical therapy!

Today, I will briefly take you through this diagnosis and explain what it is, who it affects, and what you can do to treat it so that you can decrease pain and return to your sport confidently!

What is Chondromalacia?

Chondromalacia is an injury or insult to the hyaline cartilage of a joint, which can occur due to overuse, trauma, or idiopathically. Chondromalacia can occur in any joint, however these changes most commonly occur in the knee joint in the extensor mechanism and is diagnosed as Chondromalacia Patella. Other common names include Patellofemoral Pain Syndrome, Idiopathic Anterior Knee pain, etc. 

Young, active adolescent and adult females are most commonly affected by chondromalacia for a variety of reasons, however young males can also experience anterior knee pain. Contributing factors include, but are not limited to:

• Overuse in sport

• Changes in footwear

• Increased hip angle

• Weakness and mobility deficits

• Foot deformities

• Ligamentous laxity

• Knee valgus or varus positioning

This is a very common diagnosis in orthopedic physical therapy and medicine, and therefore there are a number of different management strategies. There is no “one-size fits all” approach to care for knee pain, however the good news is that most athletes have an excellent prognosis and will recover from chondromalacia with the help of quality medical and/or physical therapy care. In some cases, pain may resolve spontaneously as the athlete grows. 

Differential Diagnosis for Anterior Knee Pain

There are many reasons why our athletes experience knee pain. A few specific diagnoses are listed below, but it should be noted that this is not an exhaustive list. I hope this shows how variable and complex knee pain can be and highlights the value of a thorough examination:

As you can see, there are a plethora of reasons that knee pain can occur, and thus there are many ways that knee pain should be managed. It is crucial to have a thorough evaluation of the knee and the entire kinetic chain to improve diagnostic accuracy, regardless of the medical prescription and diagnosis of Chondromalacia Patella. This is important to ensure the most effective and efficient treatment for your knee pain!

Treatment for Chondromalacia

Patients and athletes with anterior knee pain should be treated using a multimodal and multidisciplinary approach. In other words, there is no “one-size fits all” management strategy and each athlete should be provided with the best interventions for him/her to achieve optimal and timely recovery. Athletes will receive some version of the following:

Manual Therapy

After a thorough evaluation of the knee, your physical therapist may recommend and apply various manual therapy techniques to address pain, stiffness, or mobility deficits. Some of these techniques include joint mobilization/manipulation, soft tissue massage, and neurodynamic mobilizations. Below are some examples of manual therapy techniques that may be useful for chondromalacia:

Exercise Therapy

Our goal is to get our athletes with knee pain back on the field pain-free. Using specific exercises we can target deficits in strength, mobility, and control to help our athletes return quickly and better than they were before the injury! Below are some examples of exercises and self mobilizations to assist with addressing common impairments:

Patient Education

At Trifecta, we pride ourselves on providing quality care and education to our patients. Knowledge is power! It is important that the athlete is aware of what they need to do, establish a thorough understanding of the condition, and develop a good Plan of Care to ensure goals are met and the athlete is able to safely return to sport.

In the early phases of Chondromalacia, pain may be elevated and may persist for hours or days depending on the severity of symptoms. It is important to remove aggravating factors early on (to the best of our ability) to allow for healing and improved function. The next phases of recovery involve gradually loading the knee and surrounding structures to help return the athlete to loads that were previously pain-free, and finally we can begin sport-specific rehabilitation once pain levels have subsided and we are working towards return to sport.

Adjunctive Therapy Options

Other therapies and techniques may be beneficial when caring for knee pain in the athlete, and can serve as a very helpful adjunct to exercise and manual therapy, especially in the early phases when pain is high.

Some techniques include kinesiotaping, McConnell Taping, Graston/IASTM, Myofascial release, Cupping therapy, hot/cold packs, and many many more.

The Trifecta Difference

Are you or your son/daughter dealing with persistent knee pain? Are you disappointed with the level of care you have received so far? Do you think you (and your medical team) can do better? 

If you answered yes for any of these questions, we may be able to help! Our experienced team of sports rehabilitation specialists will provide you with a true 1 on 1 experience to help you get better, play better, and stay better. Don’t let your pain define you!

Call us or make an appointment online to see one of our specialized physical therapists today!

By: Dr. Justin Hanus

REFERENCES

Calmbach et al. (2003). Evaluation of Patients Presenting with Knee Pain: Part II. Differential Diagnosis Am Fam Physician. Sep 1;68(5):917-922. 

Habusta et al. (2021) Chondromalacia Patella. StatPearls [Internet] Treasure Island (FL): StatPearls Publishing; 2021 Jan-.

Patel DR, Villalobos A. Evaluation and management of knee pain in young athletes: overuse injuries of the knee. Transl Pediatr. 2017;6(3):190-198. doi:10.21037/tp.2017.04.05