Question
I read with interest the question Brandon asked 10/14/09 on the subject, unfortunately being in the UK I couldn't look at the link page 167 of your link. I have CP in both knees starting 6 years ago after bad advise from a PT at the gym. I now do pilates, play tennis, walk each day & ski 2 weeks each year. When skiing I take anti informatorys. I'm in pain most days/nights, a recent MRI showed that the CP had worsened particularly in my rt knee. I'm trying to avoid surgery as from my research it doesn't seem helpful & perhaps causes more long term erosion of the hyline cartilage. Any help very gratefully received!! I'd really love to be without pain in my life. To date I have tried physio, osteopathy, myofascial release & accupunture, all without cure. I look forward to hearing from you. Kind regards. Jane

Answer
Dear Jane,

I found your question in the "question pool" on this website. I know that it was not directed at me specifically, but with your permission, I will give you my opinion. Perhaps you will find something in my experiences that will help you.

I have been in practice for more than 20 years, and I have seen many patients with chondromalacia patellae (CP), or patellar tracing dysfunction.

It is very common, and I typically see it more frequently in women than in men.  Some of the reasons why it appears more commonly in women is because of the structure and shape of their bodies, hips, and knees.  Women have more of a tendency towards a valgus deformity (genu valgum) at the knees, which means that the upper legs tend to slope inward from the hip as they approach the knees, followed by a sloping outward of the lower legs away from the knees. It is the opposite of somebody who is bow legged. You can google images for Genu Valgum to see this.  Please remember, there are some cases that are very severe, and some that are very mild.  Even the more mild cases can cause, however, a patellar tracking disorder. This means that the knee cap tracks slightly to the outside of the groove in which it sits, rubbing its underside on the underlying knee joint structures. This causes inflammation and arthritis of the under side of the knee cap, or chondromalacia patellae. A good way to test this on yourself is to stand with your feet together, and then see if your knees are touching. They generally should not touch.

One of the causes of Genu Valgum at the knees is poor longitudinal arches in the feet, or flat feet.  When the arch is collapsed, it allows the ankle and foot to roll to the outside.  If you have a tendency to have flat feet, this could be one of the underlying causes of genu valgum and chondromalacia patella.

At times the knee cap, or patella, will track slightly off center due to some weakness of the quadriceps femoris muscles, in particular the vastus medialis belly of the quadriceps femoris.  This muscle should be strengthened in order to reduce the pressure and rubbing that is occurring on the under side of the patella.

There are some supports and braces on the market that can be helpful.  There is one product called the Cho Pat that is a simple band that attached to the knee and rides just under the lower border of the knee cap. It helps to take some of the pressure off of the knee cap.

So, in a nutshell:

1) evaluate yourself for genu valgum and for flat feet. Remember that you cannot tell if your arches are collapsed when you are at rest. You have to be standing and walking. You might need to have another person watch you walk and stand to see if your arches are flat and if your knees bend inward.

2) If you have flat feet, invest in some good orthotic supports. You will need something that is fairly rigid that helps you to correct the distortions that are in your feet.  If you get orthotics, wear them regularly and consistently, and give yourself some time to adapt to the new foot and knee postures.

3) Use this simple exercise to help to strengthen the vastus medialis muscle of the quadriceps femoris muscle group. While in a seated position, straighten the knee out in front of you (in full extension), and hold that position contracting the muscles in the front of the upper leg. Hold for a count of ten, and then repeat. The key is to hold the muscle tight with the knee in full extension (straight and locked). You should see and feel the muscles of the upper leg contract.

4) Use a Cho Pat to see if you can get some of the pressure off of the knee cap as it attempts to heal. Here is a website with a picture of the cho pat.  http://www.wiggle.co.uk/mueller-cho-pat-knee-strap/

I hope that this gives you some ideas Jane. I know that knee pain can be very discouraging and debilitating. Good Luck!

Keith Biggs, DC
http://www.eastmesachiropractor.com