The knee is a very fragile joint that is especially susceptible to injury and may never return to normal once it has been damaged. Experiencing pain while sitting is often a tell-tale sign that the knee’s structure has been compromised. Severe degeneration of the cartilage under the kneecap will eventually lead to knee osteoarthritis.
The most common cause of chronic knee pain is caused by a condition known as chondromalacia patellae or chondromalacia. Chondromalacia develops when the hyaline or articular cartilage lying beneath the patella (kneecap) slowly starts to deteriorate which is known as patellofemoral syndrome and is a common problem for both athletes and non-athletes. This condition can occur in the front or inside of the knee and is generally worse with prolonged sitting with the knees bent. This leads to “popping” and “creaking” of the knee accompanied by pain.
Characteristically, chondromalacia sufferers also experience knee tenderness and stiffness along with a grating or grinding sensation when the knee is extended. This action creates excessive friction between the thigh bone and the bent kneecap. Chondromalacia appears to affect girls and women more than boys and men, and presents symptoms when the knee is subjected to excessive and uneven pressure from structural changes occurring during growth spurts.
Causes of Chondromalacia
Chondromalacia may develop due to overuse, trauma, unusual weight being put on the knee joint, dislocation of the kneecap and in adults over age 40. The constant and wear and tear of the knee joint especially when running, squatting, jumping, climbing stairs, kneeling and even sitting cross-legged can exacerbate chondromalacia, such as when assuming half lotus and full lotus positions.
Knee Pain Caused by Assuming the Lotus Position
The lotus pose (Padmasana) is a very physically demanding and dangerous thing to attempt while opening up a higher consciousness during meditation. People with natural agility in their hips can perform this maneuver easily, but the majority of people have difficulty fully rotating their thighbone to complete the pose. This may happen due to tight hamstrings, tight ligaments or bone-to-bone limitations deep in the hip, in certain cases. In order for the meditator to complete the pose, they must elevate their foot higher by bending the knee sideways; however, doing this action can cause extensive structural damage to the knees. When the knees are repeatedly forced downward, the thighbone and shinbone apply great pressure to the knee which can seriously damage the meniscus. Since knees are only designed to flex and extend, injuries caused by improperly forming the lotus position can be very painful, debilitating and slow to heal.
Detection of Chondromalacia
The smooth movement of the patella over the femur or thigh bone in the knee can be disrupted when a sudden single impact (i.e., falling directly onto it, or being hit from the front) or multiple impacts to the knee happens long term causing small tears or roughening of the cartilage. Generally, the patella shifts out of position towards the outside of the knee due to imbalances in surrounding muscles. The quadriceps muscles and other tissues such as the retinaculum are too rigid on the outer part of the knee and the vastus medialis oblique muscle are too weak on the inner part of the knee.
In order to confirm a diagnosis of chondromalacia, a posterior, medial and lateral MRI can be done to reveal to rule out any other reasons an individual may be experiencing chronic knee pain. Chondromalacia patella can be determined by factors such as swelling, limited range of movement, pain intensity, signs of muscle atrophy or tight structures in the knee. The physician may also look at biomechanical factors where the foot turns inward or flattens causing the lower leg to rotate and the knee to twist.
Treatment for an Injured Patella
Chondromalacia is more common in those who have experienced previous traumatic knee injuries such as fractures and dislocations. It can even occur among athletes who are otherwise injury-free. A sports medical professional will give advice on treatment and a rehabilitation program consisting of the following:
Nonsteroidal anti-inflammatory drugs medications such as ibuprofen or naproxen are often prescribed both to alleviate pain and reduce the chronic inflammatory processes that increase the structural damage.
Patella taping techniques are often done by sports physicians to encourage correct tracking of the kneecap and can instantly reduce pain by preventing it from constantly rubbing on the athlete’s injured spot. One such patella taping technique is done to control the position of the patella and is often applied for performing CMP exercises. The other patella taping technique is ideal for returning to sports activities without restricting the athlete’s movement. A patella knee support can help support the patella and relieve pain.
A full knee rehabilitation program with specific exercises aimed at increasing the strength of the muscle (vastus medialis oblique) on the inside of the knee and stretching the lateral quadricep muscle on the outside of the knee is key. In addition, short arc quad exercises should be done with a maximum bending angle of 30 degrees. When the vastus medialis oblique muscle is regularly exercised and strengthened, knee pain may significantly lessen. Sports massage is another measure used to help relax tight lateral structures of the knee.
Roughly 85 percent of patients suffering from chondromalacia improve with conservative treatments to alleviate symptoms, such as rest and applying ice and compression to reduce swelling. Avoiding trauma and abnormal stresses on the knee and keeping the leg muscles strong and flexible may be effective at preventing the development of chondromalacia, in many cases. Exercise rehabilitation, icing, taping and pain relievers are the typical methods used to reduce symptoms once chondromalacia develops. In about 15 percent of chondromalacia cases, the pain is so severe that surgical correction of the knee joint is the only option to gain a measure of relief for the patient. Knee surgery for knee pain can be performed via an arthroscopy or keyhole surgery where the cartilage is removed or shaved off.