Dr. Howard Liss treats disorders that cause pain and disability by providing consultative services and soft tissue and joint injections when needed. When medically appropriate, he makes specific referrals for diagnostic testing (lab work, imaging, electrodiagnosis), physical and occupational therapy, interventional procedures (epidurals and facet joint injections), and surgery.
Beneath the kneecap lies a hard, yet smooth layer of cartilage called articular (hyaline) cartilage. It allows smooth movement of the patella (kneecap) over the femur (thigh bone). Chondromalacia patella (CMP) is a condition in which the articular cartilage is damaged.
With symptoms that closely mimic that of patellofemoral pain syndrome, chondromalacia patella causes pain and swelling over and around the patella. Notably, pain becomes worse after sitting for a long period of time or walking downstairs. Consequently, individuals report a grinding or clicking sensation when bending or straightening their knee. This is due to the patella rubbing against the joint behind it. While this causes pain and inflammation, it also causes degeneration.
While CMP can result from a forceful impact or acute event resulting in a sports injury, it is mostly the result of overuse with repeated rubbing of the cartilage against bone. Interestingly, the position of the patella is largely to blame for CMP, as it can become misaligned. To better understand, consider the muscles on the inside and outside of the thigh (inner and outer quad muscles). Both muscles pull on the patella to some extent. Yet, when one muscle is stronger or tighter than the other, the patella can be pulled too much to one side. In a large majority of cases, the outer quad muscle is stronger than the weaker, inner quad muscle. Depending on the imbalance and tightness of these muscles, the patella can be pulled out of place, resulting in dislocation. Even so, there are other structural problems that contribute to CMP, such as patella alta (high position of the patella) and patella baja (low position of the patella).
Treatment and Rehabilitation of Chondromalacia Patella
In the wake of a knee injury, including chondromalacia patella, it is best to rest and apply ice, especially in the first 2 days. When considering a doctor, it’s best to consult one with expertise across many fields, such as a physiatrist.
Physiatrists are adept at identifying and developing treatment and rehabilitation that considers multiple body systems—not one symptom or problem area. This is vital to a patient’s long-term pain relief and functioning.
Through rest, cold therapy, compression wraps and anti-inflammatory medication, initial treatment is centered on pain management and stabilization. With a consideration of biomechanics, specific patella taping techniques are applied to control the position of the knee and to correct patella movement or “tracking.” When pain and inflammation are at bay, rehabilitation for chondromalacia patella begins with strengthening the vastus medialis oblique muscle. It is the muscle located on the inside of the kneecap. Learning to contract this muscle in the sitting position is the first objective. As therapy continues, patients progress to more difficult exercises as a strong contraction is maintained comfortably.
Along with muscle contraction exercises, stretching is vital, especially for the iliotibial band (ITB), quadriceps and groin. Massage is also a beneficial part of rehabilitation, as it releases tight muscle structures that pull on the patella. The aim of strength training and stretching is to help muscles obtain full strength with balance and control. Not only does this help patients return to regular activities or sports, it plays a major role in injury prevention.
At the Howard Liss, M.D. Rehabilitation Institute in Tenafly, patients can rely on Dr. Liss to put together the right treatment, therapy and rehabilitation plan to ensure the most optimal outcome. Dr. Liss works closely with other specialists required to rehabilitate patients suffering from chronic pain or serious injuries, and Dr. Liss will refer patients as needed to ensure appropriate treatment. With extensive education and exposure to a variety of conditions that affect the cervical and lumbar spine, bones, nerves, joints, ligaments, tendons, muscles, brain, and spinal cord, Dr. Liss is uniquely positioned to help patients manage their pain and maximize their functioning.
For pain relief and functional rehabilitation for your knee injury, contact the Howard Liss, M.D. Rehabilitation Institute in Tenafly today.