Rehabilitation for Chondromalacia Patella
Rehabilitation for Chondromalacia Patella
Generally, conservative rehabilitation is used for chondromalacia patella before looking at other options, such as surgery. Conservative treatment has two main objectives: control of symptoms, and increasing and maintenance of quadriceps strength.
In the article “Chondromalacia Patellae in Athletes-A schematic Protocol of Management”, the treatment protocol was divided into 4 stages: (1) Acute phase, (2) Subacute phase, (3) Chronic phase, and (4) Maintenance phase. During weeks one and two of the acute phase management, the “aim of treatment at this stage is to suppress the pain and minimize the possible swelling. Physical treatment like ice packs and electrotherapy are indicated.”1 Ice can be either an ice bag or an ice cup massage, and the electric stimulation can either be interferencial current or galvanism. All the treatment modalities can be given for one to two weeks until the acute signs and symptoms are subsiding. Exercises during the acute phase management are used “to deter muscle atrophy which would further aggravate the condition.”1 The exercises listed in the article were “isometric quadriceps setting, following the rule of 10 principle”1, “active hip abduction, adduction, and circumduction in supine and side lying positions”1, and “active calf muscle strengthening exercises in standing and wobble board exercises.” 1 Exercises to avoid are strenuous activities, cycling, swimming with breast stroke style, weight bearing knee bending activities such as squatting and climbing up and down stairs should be avoided as well. The athlete is ready for the sub acute management “when there is minimal swelling and the patellar friction test can only reproduce a mild sensation.”1 During the sub acute phase management, electrotherapy is still indicated, but the frequency may be reduced. Ice application may be used after exercises to reduce the soreness. Isometric exercises continue, and straight leg raises are
Generally, conservative rehabilitation is used for chondromalacia patella before looking at other options, such as surgery. Conservative treatment has two main objectives: control of symptoms, and increasing and maintenance of quadriceps strength.
In the article “Chondromalacia Patellae in Athletes-A schematic Protocol of Management”, the treatment protocol was divided into 4 stages: (1) Acute phase, (2) Subacute phase, (3) Chronic phase, and (4) Maintenance phase. During weeks one and two of the acute phase management, the “aim of treatment at this stage is to suppress the pain and minimize the possible swelling. Physical treatment like ice packs and electrotherapy are indicated.”1 Ice can be either an ice bag or an ice cup massage, and the electric stimulation can either be interferencial current or galvanism. All the treatment modalities can be given for one to two weeks until the acute signs and symptoms are subsiding. Exercises during the acute phase management are used “to deter muscle atrophy which would further aggravate the condition.”1 The exercises listed in the article were “isometric quadriceps setting, following the rule of 10 principle”1, “active hip abduction, adduction, and circumduction in supine and side lying positions”1, and “active calf muscle strengthening exercises in standing and wobble board exercises.” 1 Exercises to avoid are strenuous activities, cycling, swimming with breast stroke style, weight bearing knee bending activities such as squatting and climbing up and down stairs should be avoided as well. The athlete is ready for the sub acute management “when there is minimal swelling and the patellar friction test can only reproduce a mild sensation.”1 During the sub acute phase management, electrotherapy is still indicated, but the frequency may be reduced. Ice application may be used after exercises to reduce the soreness. Isometric exercises continue, and straight leg raises are
References: Chondromalacia patellae in athletes- a schematic protocol of management. (1985). The Journal of The Hong Kong Physiotherapy Association, 7, 6-8. Davis, R.V. (1994). Conservative management of chondromalacia patellae. Dynamic Chiropractic, 12(26), 1-3. McConnell, J. (1986). The Management of chondromalacia patellae: a long term solution. The Australian Journal of Physiotherapy, 32(4), 215-223.