Issue link: https://www.massageandbodyworkdigital.com/i/1256819
CLINICAL E XPLORATIONS Patellofemoral pain syndrome (PFPS) is a condition that is closely associated with chondromalacia and can have a similar pain presentation. PFPS results from overuse and knee alignment challenges just like chondromalacia, but it is sometimes difficult to identify what is actually causing the pain. In some cases, the pain may be coming from irritated tissues like the patellar retinaculum, which may be exposed to an altered biomechanical load. With PFPS, there is usually increased tenderness in some of the quadriceps retinaculum, superior to the patella. There could also be some low-level inflammatory activity around the anterior knee region that could be producing PFPS pain without the cartilage damage characteristic of chondromalacia. Other conditions, such as prepatellar bursitis or meniscal damage, may also share some characteristic symptoms with chondromalacia. The accuracy of assessment with the client in this case is important. TREATMENT It is not always clear whether the degenerated cartilage can fully repair, so treatment goals include symptom management and stopping the offending activities. Chondromalacia is most often treated with conservative approaches such as activity modification and appropriately graded exercise. There appear to be some benefits to strengthening exercises that target the VMO, as it is the primary biomechanical opposition to the lateral patellar tracking that is at the root of the problem. In many cases, it would be ideal to change lower extremity postural challenges, such as genu valgum, but it is quite difficult. Massage therapy can play an important role in the management of chondromalacia. While massage cannot directly repair the cartilage degeneration, it is helpful to reduce and balance the forces that created the problem in the first place. When aiming to achieve muscular balance in the extensor mechanism of the knee, it is not enough to just strengthen the VMO. It is also important to reduce hypertonicity in the vastus lateralis and the lateral patellar retinaculum that are pulling the patella in a lateral direction. Massage techniques that focus on the quadriceps and distal retinacular tissues appear the most effective for addressing chondromalacia. The goal of our massage treatment is more about helping restore ideal biomechanical balance. Techniques such as active engagement stripping methods and pin and stretch techniques (Image 4 and "Retinaculum Treatment" video) for the patellar retinaculum are valuable to help restore ideal knee biomechanics and appropriately manage symptoms. In addition to working specifically on the distal retinacular tissues, it is valuable to perform some thorough work on the entire quadriceps group. These are some of the largest muscles in the body, so the tensile forces they transmit to the patellar tendon fibers are significant. Deep longitudinal stripping and active engagement methods are some of the best ways to address those regions as well. RESTORING AN OPTIMAL ENVIRONMENT Chondromalacia pain can be quite debilitating. If the cartilage degeneration is left unchecked, it not only causes an increase of the client's current pain, but it can also lead to more serious arthritic changes in the knee in the future. If chondromalacia is identified as a likely cause of client knee pain, a conservative treatment approach with massage as a primary focus is a great treatment strategy. Keep in mind that when treating chondromalacia we are not "fixing damaged tissue." Instead, we are helping restore an optimal environment to help the client's body heal, allowing them to get back to activity as soon as possible. Whitney Lowe is the developer and instructor of one of the profession's most popular orthopedic massage training programs. His text and programs have been used by professionals and schools for almost 30 years. Learn more at www.academyofclinicalmassage.com. ABMP members can take advantage of in-depth training with an exclusive discount on Whitney Lowe's 130-hour Orthopedic Massage online program. Normally $750, ABMP members pay only $650. Use this code when purchasing: ABMP PRO. Listen to Whitney and Til Luchau's podcast The Thinking Practitioner on Apple, Google Play, or Spotify. N e w ! A B M P P o c k e t P a t h o l o g y a t w w w. a b m p . c o m / a b m p - p o c k e t - p a t h o l o g y - a p p . 87 Active engagement lengthening techniques on quadriceps and patellar retinaculum. Image from 3D4Medical's Complete Anatomy application. 4