Dr. Rajeev Mahajan

Chondromalacia patella (patellofemoral syndrome)

Chondromalacia patella facts
 chondromalacia patella is the most common cause of chronic knee pain.
 chondromalacia patella has also been called patellofemoral syndrome.
 the pain of chondromalacia patella is aggravated by activity or prolonged sitting with bent knees.
 abnormal 'tracking' allows the kneecap (patella) to grate over the lower end of the thighbone (femur), causing chronic inflammation and pain.
 treatment involves improving the alignment of the patella during contraction of the thigh muscle.

What is the chondromalacia patella?

Chondromalacia patella is abnormal softening of the cartilage of the underside the kneecap (patella). It is a cause of pain in the front of the knee (anterior knee pain). Chondromalacia patella is one of the most common causes of chronic knee pain. Chondromalacia patella results from degeneration of cartilage due to poor alignment of the kneecap (patella) as it slides over the lower end of the thighbone (femur). This process is sometimes referred to as a patellofemoral syndrome.

What causes chondromalacia patella?
The patella (kneecap) is normally pulled over the end of the femur in a straight line by the quadriceps (thigh) muscle. Patients with chondromalacia patella frequently have abnormal patellar' tracking' toward the lateral (outer) side of the femur. This slightly off-kilter pathway allows the undersurface of the patella to grate along the femur, causing chronic inflammation and pain. Certain individuals are predisposed to develop chondromalacia patella: females, knock-kneed or flat-footed runners, or those with an unusually shaped patella undersurface.

What are the symptoms and signs of chondromalacia patella?
The symptoms of chondromalacia patella are generally a vague discomfort of the inner front of the knee, aggravated by activity (running, jumping, climbing or descending stairs) or by prolonged sitting with knees in a moderately bent position (the so-called' theater sign' of pain upon arising from a desk or theater seat). Some patients may also have a vague sense of 'tightness' or 'fullness' in the knee area. Occasionally, if chronic symptoms are ignored, the associated loss of quadriceps (thigh) muscle strength may cause the leg to 'give out' besides an obvious reduction in quadriceps muscle mass, mild swelling of the knee area may occur.

How is chondromalacia patella diagnosed?
Chondromalacia patella is suspected in a person with anterior knee pain, especially in teenage females or young adults. With manual compression of the kneecap, while the quadriceps muscle is tightened, there can be pain. This is referred to as the positive 'shrug' sign. Generally, there is no associated swelling (knee joint effusion).

X-rays or MRIs may be done to confirm the inflammation on the posterior part of the patella.

Joints are intersections between bones; they provide support to your body during movement. There are a host of conditions which might lead to joint pain; they are bursitis, osteoarthritis, rheumatoid arthritis and gout. The most common joint pain disorders are knee pain, hip pain and shoulder pain. 

Ayurveda associates joint pain with loss of bone density in the joints. This problem is characterized by a feeling of discomfort and cracking sounds. If the condition is not treated, it might lead to immobilization of the joint. The condition of the bones tends to deteriorate as they do not receive enough nutrition. 

The other cause that leads to joint pain is toxin accumulation in the joints. As the toxin accumulates, it leads to heavy and stiff joints. If preventive measures are not taken on time, continuous accumulation of toxins may lead to swollen joints. 

The various Ayurvedic remedies for joint pain are:

1. Diet: Focus on eating foods especially that are salty, sour and sweet in taste. Add healthy foods such as rye and quinoa along with ghee as they pacify the "vata" in your body. Focus on natural foods such as vegetables and fruits to your diet.
2. Herbs: Certain herbs such as turmeric help to treat joint pain. It contains curcumin that has anti-inflammatory properties which help in reducing the pain. You may also consume fenugreek seeds for its antioxidant content and anti-inflammatory properties. 
3. Lifestyle Changes: Make sure you exercise on a daily basis, do basic bodyweight exercises such as push-ups and squats to improve your strength. You may also start with yoga workouts to build flexibility and mobility in your body.
4. Smoking and Alcohol: Limit smoking and alcohol consumption to keep your body healthy, and free from free radical damage. Alcohol may also cause you to put on weight, thus leading to obesity. Smoking may cause various problems in the lungs that may lead to breathing disorders. If you wish to discuss about any specific problem, you can consult an Ayurveda.