Chondromalacia describes the cartilage, not the cause of the pain
“Chondromalacia patellae” means softening of the cartilage on the back surface of the kneecap, seen on magnetic resonance imaging or during arthroscopy. It is a description of how the tissue looks, not an explanation of why the knee hurts. Cartilage has no nerve endings, and similar changes are also found in many people who have never complained about their knee. On the other hand, typical pain at the front of the joint often occurs with a completely normal scan. That does not mean the MRI result is meaningless – it simply does not, on its own, determine how to treat.
That is why, for typical pain at the front of the knee, we now prefer the term patellofemoral pain syndrome. It is an overload problem: the joint between the kneecap and the thigh bone responds with pain when load – running, stairs, crouching, jumping – exceeds its current tolerance over a longer period. It often comes with weakness of the hip muscles and the quadriceps.
How we identify the source of the pain
The diagnosis is based on the history and examination, not on the MRI report alone. We ask which activities bring on the pain, what has changed in recent weeks and whether the knee has ever swollen or locked. In the assessment we check glute and quadriceps strength, control of knee alignment in a single-leg squat and when stepping down from a step, as well as the mobility of the hip and foot.
Ruling out other causes is just as important. Pain just below the kneecap, clearly localised to one point and getting worse with jumping, suggests jumper’s knee instead, that is, patellar tendinopathy. Locking of the joint and swelling after a twist point to possible damage inside the joint and need a medical consultation. You will find a broader overview of causes on the knee pain page.
What works in treatment
The best documented approach is exercise to strengthen the hip muscles and the quadriceps, combined with sensible modification of load. This is not about complete rest, but about temporarily limiting what irritates the joint most – deep squats with heavy weights, downhill running or long flights of stairs – while building strength at the same time. We choose the exercises so that the pain during them stays at an acceptable level and does not increase the next day, and over time we increase the range of motion and the weight. Medical training carried out in the gym under supervision works well here.
Patellar taping, shoe insoles or a brace can reduce the symptoms in the short term and make exercising easier, but we treat them as an add-on. The same goes for manual therapy – it helps bring the pain down, but on its own it does not change the joint’s tolerance to load. Arthroscopy is not recommended for patellofemoral pain.
How long it takes and how to get back to activity
With consistent exercise a clear improvement is usually visible after a few weeks, and the treatment programme itself most often lasts 6–12 weeks. Patellofemoral pain does, however, tend to recur, and in some people it lasts longer – especially if, once the symptoms ease, they go straight back to their old loads and drop the exercises. That is why we plan the return in stages: first everyday activities and stairs, then squats with an increasing range, and finally running, jumping or the sport you play.
If pain at the front of your knee has kept coming back for months despite attempts at rest, it is worth having it properly assessed and starting with a plan rather than another break. You can arrange an appointment via the Contact page.