Massage & Bodywork

JULY | AUGUST 2020

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84 m a s s a g e & b o d y w o r k j u l y / a u g u s t 2 0 2 0 Chondromalacia patellae is one of the primary conditions that can cause anterior knee pain, especially in active individuals. Chondromalacia means "softening" or "degeneration of the cartilage" and can occur in several joints of the body. However, it is most common in the anterior knee region, where the cartilage on the underside of the patella softens and degenerates, resulting in knee pain. This condition is given the unique name of chondromalacia patellae, indicating the bone (patella) and cartilage are most affected. Let's take a look at how this common condition develops and the potential role massage therapy can play in its treatment. ANATOMY AND BIOMECHANICS The patella is unlike most other bones in the body in that it is a sesamoid or "floating" bone. It is imbedded within the quadriceps (patellar) tendon. There is a common belief that the primary purpose of the patella is to protect the knee, but this is not true. Its primary function is to pull the patellar tendon farther away from the center of the knee joint so the quadriceps can generate greater power during knee extension. As a result, there is a high force load constantly pressing the patella against the femoral condyles (Image 1). During flexion and extension movements, the patella glides up and down over the femoral condyles. As the knee moves in flexion, the patella moves inferiorly (toward the foot). During extension, the patella moves superiorly (toward the thigh). The patella has a bony ridge on its underside that runs in a superior to inferior direction (Image 2). As the patella glides up and down during flexion and extension, the patellar ridge needs to stay centered in its "track" between the femoral condyles. When the patella does not track straight, it is called a patellofemoral tracking disorder, and tracking disorders are a precursor to chondromalacia. There are some key structural and mechanical factors that increase the likelihood of a patellar tracking disorder. If you look at the skeletal structure of most people in anatomical position, the femur is not aligned straight up and down. The distal end of the femur deviates toward the midline of the body. This is called a varus alignment of the femur, and some amount is normal for the femur. technique CLINICAL EXPLORATIONS The Grind of Chondromalacia Patellae By Whitney Lowe Patella pulls the quadriceps tendon farther from the center of knee joint. Image from 3D4Medical's Complete Anatomy application. 1 Anterior knee pain is a common problem, frequent in our athletic clients, as well as those in occupations that involve repeated squatting or going up and down stairs. There are numerous causes of anterior knee pain, which makes assessment more challenging. Notably, knee pain can exist in the absence of clearly identifiable tissue damage or structural pathology.

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