Question - Patellar Chondromalacia (exercise program review)

by Bobby
(Port Colborne, Ontario)

I have just been recently diagnosed with patellar chondromalacia. According to my sport doctor, my vastus medialis muscle does not fire properly (the timing is completely off) and my vastus lateralis muscle is compensating for it (and has been for a long time).

My doctor has recommended that I do these 6 hip and knee strengthening exercises and cardio workout.

1. Quad Strength single leg step up
2. Quad set in slight flexion
3. Squatting (placing a ball in between legs and squeezing)
4. Side lying hip adduction
5. Terminal knee extension (laying down on back and straightening knee by tightening muscle of top of thigh and turning toes outward)
6. Leg raises ( lying on stomach and simultaneously raising locked leg and opposite arm 6 inches from floor).
CARDIO: SPIN at a 80 rpm 4 times a week as well as SWIMMING 1-2 times a week.

I have read your interesting article on patellar femoral syndrome and although you have not mentioned hip strengthening exercises to control your femur, I was curious to know whether the above exercises are what you also had in mind.

In addition, would high heeled wedge shoes (3.5 to 4 inches high) place havoc on your knees?

Thank you very much for your time. I look forward to hearing from you!


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Jul 28, 2008
Not too bad...
by: Anonymous

Overall, I think that your program has some good points to it...however, there are a few things I would change.

The single leg step up is a great exercise - make sure that when you do step up, use the step leg to LIFT your body, and try not to push off from the floor with your other leg. Also, try to keep your chest up tall, and don't bend over at the hips.

The quad set in slight flexion is not really effective in my opinion, unless you are having a lot of trouble just activating your quad - and if that is the case, then you probably shouldn't be doing the other quad exercises.

Squatting is a fantastic exercise, and I use it with just about all of my patients, even my shoulder patients. However, the primary goal of hip and core strengthening for patella femoral syndrome (and patellar chondromalacia) is to increase the function of the lateral hip muscles - squeezing the ball is the opposite action compared to what you want to be working. I use squats with Abduction - pushing the knees out rather than in. You can place a theraband or elastic band around your knees and push against this resistance when you squat. This is a great exercise.

In defense of your physician, squeezing the ball during squats is thought to help activate the VMO...the VMO and adductors are innervated by the same nerve, so by squeezing those muscles, you are indirectly activating the VMO. But, as you read, the VMO is usually not the problem, it is the lateral hip muscles.

Same thing goes for the hip adduction. This is a good exercise, but not the focus you need for improved femoral control during activities. I would replace this with hip Abduction - so laying on your side and then lifting the top leg, with the toes pointed slightly down.

Terminal knee extensions are again, like quad sets, a fairly low level activity that doesn't involve the hips - take it or leave it.

Jul 28, 2008
by: Bart - SII

Leg raises are another exercise I use with my patients a lot. But I modify it just a bit. I use an elastic band attached to the top of a door frame (you can tie a knot in the middle and just close the door to secure it) Then, laying on your back with your head toward the door, put one end of the band in each hand, and then pull both arms down to the floor. This engages your core. Once you pull your hands down, lock both legs all the way out (like a quad set) and then lift one leg as high as you can - when you do this, keep the down leg flat on the floor, and the lifting leg completely straight. Stop lifting as soon as you feel your down leg start to lift off the floor at the knee, or rotate, or when your lifting leg feels like the knee needs to bend. Lower your leg back down, let your hands go back up, and then repeat on the other side. 2X10 each leg works well. This is basically a straight leg raise, however it engages the core and hips to keep everything straight and stable.

The spin and swimming for cardio is a great exercise and shouldn't bother your knee.

These are just my opinions with the program. I would highly recommend talking to your physician about all of these exercises before beginning them. As I am not your clinician, I can't really prescribe you a program. So, take this as a hypothetical as what I put my patients through.

Hope this helps - comment back with other questions.

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