Treating Chondromalacia: Exercises to Relieve Knee Pain – Verywell Health

Kristen Gasnick, PT, DPT, is a medical writer and a physical therapist at Holy Name Medical Center in New Jersey.
Mohamad Hassan, PT, DPT, is a physical therapist at Premier Physical Therapy in Chicago.
Chondromalacia patella occurs when the cartilage at the back of the kneecap begins to soften and break down. This breakdown causes the kneecap to grind against the leg bones that join to form the knee joint, resulting in pain that worsens with activity.
Chondromalacia patella is often referred to as runner’s knee since the condition is common among runners and other active individuals who endure repetitive stress to the knee joint. Injury to the knee, overuse of the knee joint, and muscle imbalances or malalignment of the knee commonly lead to the development of chondromalacia patella.
Treatment for chondromalacia patella includes strengthening the supporting muscles around the knee and hip joints without increasing pressure on the kneecap. Open chain exercises that allow the leg to move freely are often used in the beginning of rehabilitation rather than closed chain exercises, which involve keeping the feet planted on the ground. This minimizes weight-bearing through the knees in order to decrease irritation at the kneecap.
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Verywell / Ben Goldstein
Straight leg raises help strengthen the hip flexor and quadriceps muscles to lift the leg while stabilizing the knee. The quadriceps muscles are a group of four different muscles that extend the leg at the knee joint and help stabilize the kneecap.
To perform this exercise:
To increase the intensity, add ankle weights around your ankles to increase activation of your quadriceps muscles.
Verywell / Ben Goldstein

Side lying leg raises help to strengthen your gluteus medius while stabilizing the knee. The gluteus medius is a muscle on the sides of the hips that moves the leg away from the body and stabilizes the hip and knee joints. If the gluteus medius is weak, the femur, the upper leg bone that forms the hip joint and upper half of the knee joint, can become misaligned, placing increased pressure on the knee joint.
To perform this exercise:
To increase the intensity, add ankle weights around your ankles to increase activation of your quadriceps and gluteus medius muscles.
Exercises that compress the kneecap against the femur with a high degree of force, such as squats and lunges that involve deep knee bending, and high-impact activities like running and jumping should be avoided until pain decreases and strength of the muscles surrounding the hip and knee joints improves in order to stabilize the knee with activity.
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Clamshells help strengthen the gluteus medius and deep external rotators of the hip joint. When these muscles are weak, the femur can become misaligned, putting increased stress on the knee joint. 
To perform this exercise:
To increase the intensity, add a resistance band around your thighs above your knees to increase activation of your glute muscles.
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Hip extension leg raises help strengthen the glutes and quadriceps muscles to extend the hip joint while stabilizing the knee. The quadriceps help to stabilize the kneecap while the glutes provide overall strength and stability to the entire leg. If the glutes muscles are weak, the knee joint becomes subjected to increased stress and repetitive forces.
To perform this exercise:
To increase the intensity, add ankle weights around your ankles to increase activation of your quadriceps and glutes muscles.
Anussara Phromkrasear / Getty Images
While open chain exercises that allow the leg to move freely are often used in the beginning of rehabilitation, progression to closed chain exercises that involve keeping the feet planted on the ground can safely be performed when irritation behind the kneecap has decreased and activation of your quadriceps and glutes muscles has improved.
Semi squats performed halfway through the range of motion to a 45-degree bend in the knees can help strengthen the quad muscles to stabilize the knee and support the leg during weight-bearing without placing too much stress on the kneecap. 
To perform this exercise:
To increase the intensity, increase the range of motion to a full squat as long as you do not feel pain in your kneecaps. Add a resistance band around your thighs above your knees to help maintain good alignment of your hips and knees and increase glutes activation. 
Chondromalacia patella commonly develops from stress to the knee joint through repetitive and high-impact activities. This occurs because the muscles surrounding the knees and hips are not strong enough to support the demands of the activity. Strengthening the muscles that stabilize the knee and hip can help support proper alignment of the joints and muscle activation patterns to prevent increased strain at the knee and kneecap. That can help you return to moving and exercising without pain.
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American Academy of Orthopedic Surgeons. OrthoInfo. Patellofemoral Pain Syndrome. Updated October 2020.

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