Question
QUESTION: Hey Brendon. I was diagnosed with chondromalacia patella a month ago and the pain is still very bad. It hurts when I bend my knee, when I walk, when I walk up stairs, and sometimes even when im just sitting still. The therapist has be doing strengthening exercises with my quad and hip flexors but they dont seem to be doing much. Do you have any other advice or exercises I should do, or should I just keep doing the same thing? Thanks and God Bless.

ANSWER: Hello Brandon,

   Here is a simple exercise you can try.  Sit down on the floor or couch with the leg straight out in front of you.  Take your thumb and index finger cup the patella (your hand should be in a U shape around it) let the knee relax then push the patella towards your foot, then you want to contract your quads while keeping a firm grip on the patella.  This will cause some intense pain initially.  But try to slide the patella underneath your hand. So you will want to use enough pressure holding the patella but enough pressure to let it slide under the hand when you contract the quads, etc.  You can do this a couple times a day, usually takes about two weeks before you notice great improvement.  This exercise helps decrease the fraying of the cartilage below the patella and help restore proper tracking of the patella.

Let me know how it works for you,

Dr. Brendon O'Brien D.C.

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QUESTION: Im still confused about how I should cup it. What direction should my fingers be pointing. Do you know of any illustrations that show how it should look or could you try to be more elaborate. Thank you. I cant tell you how much I appreciate it.

ANSWER: The thumb and index finger should be pointing and pushing the patella toward the foot (sitting with the leg fully extended).  So basically the patella is inbetween your thumb and index finger, right hand for the right knee... Left hand for the left knee/patella etc.  You should be able to feel the patella slide a inch down towards the foot.  I'll see if I can find a picture for you.


Dr. Brendon O'Brien D.C.

---------- FOLLOW-UP ----------

QUESTION: Yea, if you can find one a picture would be great. Is the patella in that little groove between the thumb and index finger? Also, when should it be painful? When i push down or when i flex my quads and it slides under the hand... When I flex I feel somewhat of a snap/rough movement in that area also, is that good? Sorry for all the questions!

Answer
Yep, in the web between the fingers.  Should be painful when you contract the quads while it is sliding underneath your hand.  There is two facets under the patella, so you may be feeling the patella track over them and the crepitus can be from the frayed cartilage (which is good break up).


got to this website http://books.google.com/books?id=xMUC2t58Y_wC&pg=PR12&lpg=PR12&dq=patella+tracti

Look under the subluxation suppression test, shows a picture of a person tractioning the patella in a similar way.

Have a great day,
Dr. Brendon O'Brien D.C.