Chondromalacia Patellae

Chondromalacia patellae or Chondromalacia patella is quite common among healthy people.

 What is this “Patella”, and what is it for?

The kneecap, or patella, is a small bone that articulates with the femur, attached to the tendon of the quadriceps, and the patellar tendon attached to the tibia. Its principal function is to facilitate knee extension, allowing the tendon to exert a bigger leverage to the femur as it increases the action angle. It also covers and protects the anterior articular surface of the joint.

What is "Chondromalacia patellae"?

This patella, covered with a smooth cartilage that works as a shock absorber, glides along the knee when bending it. Some individuals have a problem with this action, as the kneecap rubs against one side of the joint, causing an irritation of the cartilage, damage in it, and a malfunction and pain as an ulterior result.
This pain typically occurs after long time sitting, that’s why is also called “movie sign” or “theatre sign”.

What are the causes?

Some of the causes are overuse, misalignment, bursitis, flat feet, core instability or patella maltracking. In my opinion, all these join into one: Wrong Leg Alignment, often due to a bad feet positioning.



How to treat “Chondromalacia patella”?

There are a few steps that you can do, besides corrective taping (very useful, a physiotherapist can teach you how to do this), but don’t hassle, it takes several weeks to get through the process:

-First step: Reduce/get rid of the pain: Avoid any motion which could irritate the kneecap (running, cycling, etc) and relieve the pain and the inflammation with anti-inflammatory medicines (e.g. Ibuprofen) and ice. It is possible and desirable to practise some physical activity like swimming (flutter kicks) or aquagym, strengthening the muscles under low impact exercises.

-Second step: It would be strengthening all the muscles around the area (Quadriceps, Hamstrings, Glutes, Calves and Kneecap muscles). (We'll look into it in next posts).

*Of course, we need to check the cause of everything, and change it. It could be a wrong alignment of our bicycle (usually because the hips are too low so the knees need to bend further, causing the injury), our way of walking (bad alignment of the foot-knee-hip axis, leading to an imbalance), small chairs, flat feet (we can use shoe insoles), etc.

-Third step: After a while, and once we feel our knees are safer because of the improvement of our strength, we should combine those of strength with stretching exercises. (We'll look into it in next posts).

-Fourth step: Balance and proprioception training. (We'll look into it in next posts).

-Fifth step: Re-education of the altered functional patterns.

LACTIC ACID AND PHYSICAL EXERCISE

WHAT IS THE LACTIC ACID? HOW IS IT FORMED?

Here there is a simple approximation to it:

The muscle glycogen decomposes forming Pyruvic Acid and energy. This energy is called anaerobic as it occurs without oxygen intervention because in the process. At the same time, this Pyruvic Acid decomposes within the muscle cells in much more energy, being this the aerobic type, as it uses oxygen during the process. If these cells are not able to transform the entire Pyruvic Acid’s energy, this is chemically transformed into Lactic Acid.

So far so good, right?

Well, we should explain that some cells are better able to use Pyruvic Acid than others. With training we get more cells able to efficiently use the Pyruvic Acid producing less Lactic Acid.

If we look at it from the aspect of intensity , imagine that increasing the intensity require the use of new fibers , which are not as well accustomed to function as the most basic fibers, so we produce more Lactic Acid.

Furthermore, when performing max. exercises the body generates a large amount of Pyruvic Acid, in order to meet the energy demand, producing in turn a lot of Lactic Acid. The amount of Lactic Acid here helps us to know how fast we are producing energy.

HOW DO WE SEE THIS WHEN MEASURING LACTIC ACID?

Measuring the Lactic Acid during submaximal efforts we can see that its presence indicates that the aerobic energy of some of the muscle fibers involved in the exercise is limited.

However, if the measurement is made for max. efforts, the amount of Lactic Acid produced is indicative of the anaerobic system development .

Well, and WHAT HAPPENS TO THIS LACTIC ACID?

Most of it tends to leave the muscle and go into adjacent muscles, or the bloodstream or intercellular spaces.

When this Lactic Acid passes into other muscles, this is converted into Pyruvic Acid by enzymes, regenerating aerobic energy, normally used in these adjacent muscles that may have intervened less in the exercise and are less fatigued.

So IS LACTIC ACID GOOD OR NOT?

Well, neither one nor the other. What happens is that when Lactic Acid is produced, hydrogen ions are also produced, which increase muscle acidity, causing muscular exhaustion. Meaning it is not bad, but the fact that there is, is a synonym for exhaustion.

SUMMARISING:

We can say that it is a byproduct of anaerobic energy production, and a source of considerable importance in aerobic energy production at the same time, but high levels are a sign of muscle acidification (not by the Lactic Acid, but by the hydrogen ions produced from the breakdown of Pyruvic Acid into Lactic Acid) that will cause muscle exhaustion afterwards.