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For conservative treatment of patients suffering from chondromalacia of the patella, an important part of improving the dysfunction is to focus on:
- reducing pain
- obtaining the best joint mobility
- improving muscle flexibility
- improving muscle balance affecting the proper function of the joints of the lower extremities and pelvis.
The range of methods used for conservative treatment of patients suffering from symptoms of chondromalacia of the patella depends on the stage of the disease. Surgical treatment is usually recommended for advanced lesions if conservative treatment is unsuccessful.
Techniques used for conservative treatment.
Mobilization of the patella - a technique to increase its mobility.
Before mobilizing the kneecap, it is important to assume a comfortable position in a straight sit with back support to stabilize the pelvis. Place the entire hand on the patella carefully trying to feel its shape. The base of the hand should be over the base of the patella (that is, the part closer to us). During mobilization, the quadriceps muscle of the thigh should be relaxed. We start by smoothly moving the patella downward, to the outside and to the inside to examine in which direction we feel more resistance from the tissue. This movement should not cause us pain. Try to perform the movement slowly, in as much range as possible.
Performing the movement in the direction of the resistance felt, hold for 3-5 seconds at the end of the range, then repeat about 20 times.
Improve muscle flexibility
Stretching the quadriceps muscle of the thigh while lying on your stomach on a recliner/bed. In a lying position with one leg resting on the ground in slight flexion, using a strap perform a heel-to-toe pull toward the buttock. Carry out the movement until the first sensation of stretch.
Hold the position 30 seconds repeat 4 times on each side.
Stretching the quadriceps muscle of the thigh while lying on your side
In the side-lying position, we bend the lower limb resting on the ground to better stabilize the pelvis, then with the palm of the hand, we make a heel-to-buttock attraction of the lower limb until the stretch is first felt. We try to direct the knee backward to keep it in extension of the trunk-pelvis line.
Hold the position 30 seconds repeat 4 times on each side.
Stretching the iliac-tibial band while lying on your side
Performing the position described above, we use a modification of the exercise, in which we direct the knee downward. The position should not cause pain to the patient. We carry out the movement until the first sensation of stretching (photo above).
We hold the position 30 seconds repeat 4 times on each side.
Stretching the iliac tibial band in a sitting position
In a sitting position, we bend the knee of the leg we plan to stretch and put the foot to the outside of the knee of the straight leg, rotate the torso towards the leg being stretched. With the elbow of the opposite hand, we make an adduction movement of the stretched limb until the first pulling sensation.
Hold the position 30 seconds repeat 4 times on each side.
Making the iliac-tibial band more flexible by using rolling
In a side-lying position, rest the outside of the thigh on a roller (or on a bottle full of water) and perform a slow massage of the area starting below the buttocks toward the knee ending just above it.
Perform from 30 - 60 seconds, 1-2 times per side.
Strengthening the muscles that improve the stability of the pelvis and lower limbs
In a supine position, flex the lower limbs. We perform tension on the gluteal muscles after which we lift the pelvis upward. We avoid performing lumbar spine overstretching or thoracic thrusting. The movement is mainly to occur at the hip joints.
Perform 20 repetitions in 3 series.
In a lying position on the side, bend the legs at the knee joints, the lower limbs try to keep straight at the hip joints, feet joined. We make the movement of lifting the knee of the upper leg towards the ceiling without tearing the feet away from each other. Pay attention that the movement of lifting the knee does not provoke rotation in the lumbar spine.
Perform 20 times in 3 series.
In a standing position on a step, stepladder or thicker book, perform a pelvic lift on the side opposite the weighted leg, then return to the initial position. Take care not to lower the foot below the level of the weighted leg's foot.
Perform 20 times in 3 series.
In the single-leg standing position, try to maintain balance with the pelvis level. The difficulty of this exercise can be a suggestion to maintain the position while bouncing the ball off the ground.
Proper stabilization work within the pelvis and lower extremities (photos above)
Correct body position - lower limb held in alignment, pelvis aligned horizontally.
Abnormal body position - lower limb aligned in a valgus position with the pelvis dropping on the opposite side (indicating gluteal muscle insufficiency).
Correct foot position - foot aligned with full contact of all toes
Abnormally aligned foot - ankle escaping to the medial side, toe escaping towards the rest of the toes (a condition that disrupts the normal stabilization of the lower limb, leading to a state of muscle dysbalance).
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