Chondromalacia patella is a term used to describe the degeneration of cartilage on the rear surface of the knee cap (patella). If you have chondromalacia patella, it does not always mean you have to stop running.
An important part of my role as a medical professional is to help my patients, and the running community as a whole better understand conditions such as chondromalacia patella that you may come across.
I particularly enjoy dispelling myths that continue to perpetuate despite modern evidence suggesting the contrary!
Fairly frequently, I’m faced with a runner who has come to see me holding a copy of their MRI scan report asking something like:
I’ve been told I have chondromalacia patella. Does that mean I need to stop running?
Let’s take a closer look at the condition, and I’ll go on to explain my usual answer…
What is Chondromalacia Patella?
To start with, let’s break down the term chondromalacia patella itself.
As with so many medical terms, the way the words are structured tells us a great deal about what’s going on:
- When we see a term including chondro this simply means that cartilage is involved
- The malacia element refers to the softening of biological tissue
- Patella (I’d expect most runners to know this one) means knee cap
So, ultimately we’re dealing with softening of the cartilage tissue of the knee cap!
Chondromalacia patella is a term often used by radiologists to describe the wear-and-tear they see at the patellofemoral joint of a human knee that’s seen a lot of activity over the years, relative to what they’d expect to see in a textbook “normal” knee.
The best reason that I could give you for not being overly interested in an MRI report that describes a knee with the dreaded chondromalacia patella is this study:
The authors took a sample of 64 participants with patellofemoral pain (runner’s knee) and matched them with 70 participants who had never complained of knee pain before.
Every participant received an MRI scan, and groups were matched for age, sex and activity level.
The headline finding was that levels of chondromalacia patella did not differ in those with or without patellofemoral pain!
As a result, modern thinking suggests that chondromalacia patella is likely to be the result of factors like age and activity level rather than pain.
Similar to how our hair can go grey and our skin can become wrinkly as we age, our cartilage will change too.
This makes perfect sense to me, as the patellofemoral joint (where the knee cap articulates with the femur) is all about a high surface area, and there is more cartilage on the back of your knee cap than any other joint in the body.
This high surface area means that (for most people) the rear surface of the knee cap is very well structured to deal with the loads related to running, and we can afford to lose some cartilage as we age without it causing any problems.
This is not to say that your cartilage doesn’t matter, far from it.
If the report from an MRI scan shows things like bone marrow oedema (a bone bruise) or a focal osteochondral defect (a large dent in the cartilage), then my advice will certainly differ.
But if ALL the MRI report says is that chondromalacia patella is present, more often than not I will be reassured as in reality, it means we are dealing with an otherwise healthy knee!
Running with Chondromalacia Patella
Hopefully, it’s beginning to become clear that simply being labelled as having chondromalacia patella doesn’t mean you should expect to suffer from knee pain, nor does it mean that you necessarily have to stop running.
Of course, each case has to be considered differently. However, in general, I see consistently good results from taking an approach which focuses on load management, and exercise-based rehab to compliment a patient’s running.
I’ve previously written about load management and exercise-based rehab for patellofemoral pain. These principals apply equally for chondromalacia patella as they do for runner’s knee, so be sure to check those links out!
The bottom line is that it’s never ideal to run in pain. However, pain does vary. If you’re experiencing pain behind your knee cap that registers up-to 3 on a pain scale of 0-10 (zero being pain-free and 10 being the worst pain you can imagine) then I would be okay with you continuing to run as long as:
- The pain doesn’t continue to get worse
- Your symptoms subside quickly with rest from running
- Proactive steps are being taken to manage the injury (i.e. you are working on various runner’s knee exercises)
If your pain starts to get more intense or begins to take longer to settle post-run. You must get it checked out.
Remember, one of your biggest tools when it comes to managing chondromalacia patella, and runner’s knee is training load management. Avoiding training errors, such as big spikes in training volume, and not planning for adequate recovery between workouts, will make all the difference between you being able to run with chondromalacia patella, or having to stop.
To recap, chondromalacia patella is NOT a diagnosis. It’s nothing more than a term used to describe the changes seen on the back of the knee cap on an MRI scan, most often as a result of age and activity level.
It may not be in any way related to your knee pain and it almost certainly does not mean that you need to stop running.
As always, we would advise that you seek the advice of a qualified medical professional, for a personalised treatment plan, but hope that this short piece has made you feel better if your knee has been condemned off the back of your MRI scan.
Happy running!Posted on May 1st, 2019