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Chondromalacia patella aka The Anterior knee pain

This week I am writing all about Anterior knee pain and how to manage it non-pharmacologically.

What is it?

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It is overuse and degenerative injury of the cartilage behind the kneecap or the patella. Cartilage is a soft tissue that acts as a shock absorber and makes the patellar movements smooth and efficient. When the knee is overloaded it puts a lot of stress on this small area and causes the cartilage to break down. As with any injury, inflammation follows with pain and loss of function.

Our bodies respond to our habitual postures… here are few and their effects on our knees

Image courtesy Dawn.com  Aug 12 2021

Flatback

Forward head, flattening of the low back makes the hamstrings overactive and inhibits the gluts activity. This does not allow the knees to straighten fully and over a period of time puts excessive loads on the front of the knee aka the Patellofemoral Joint and causes degeneration.

Swayback

Weak core and makes the pelvis moves forwards. Now the knee is locked in an abnormal straightened out position aka HyperextensionThis causes overactivity of the quadriceps which pushes the knee caps into the knee joint causing the patellar cartilage to wear out.

How does it feel?

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Persistent pain in the front and inner side of the knee.

Burning and grinding sensation behind the knee caps

Locking during static postures like long sitting or standing

Reduced knee bending while walking on the affected side.

Three steps for recovery

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Improve torso stability and alignment so that the lower back and hips are free enough to support the knees

The increased hip extension helps to engage the big gluteal muscles and offload the knees 

Improve core muscle control to improve the position of the pelvis and free up the knees for walking painfree.

Movements which help

Standing core tuck in with toes extension

Stand with feet shoulder-width distance against the wall such that the psis touch the wall. Your weight must be on the heels. Now breathe out and pull the navel to the spine keeping the low back in neutral. Count to 4 . Simultaneously lift only the toes keeping the balls of the toes on the ground up. Hold for 4 counts and relax counting to 8.

Single leg standing and hip hiking in the unsupported side

Stand with feet shoulder-width distance and the outer border as parallel to each other as possible. Bend one knee to 90 degrees. Breathe out, engage the core counting to 4 and hike the hip on the unsupported side without leaning over with the torso. Hold for 4 counts Relax counting to 8.

Standing and heel strike

Stand as above. Engage the core counting to 4. Place a cushion in front of you. Take a step forward such that the heel is placed on the cushion. Try to contact your gluteus maximus without altering your position. Keep the knee cap facing forwards. Hold the contraction for 4 counts and release counting to 8.

Lying single leg lift

Lie on the back. Place a small towel under the left hip. Now place your fingers on the front of the hips on both sides and check that they must be in the same line. Bend one knee to 90 degrees and place the foot flat on the bed. Straighten the left knee such that the toes point towards the ceiling. Engage the core counting to 4 and simultaneously lift the left heel up by 3 to 5cms. Hold for 4 counts and relax counting to 8.

Each movement can be repeated 3 to 5 times each hour. One movement per hour.

Pain is the biggest driver to determine how we move, how much we move, and how we feel about ourselves.. I am signing off by wishing all of us pain-free bodies and movement rich lives.

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