If you go up and down the stairs, squatting knee pain, or press the knee in front of the "round bone" friction to promote the feeling of joints inside the "rustle", then you have to consider whether the "chondromalacia patella" problem. "The problem is that the patellar bone is not as soft as it used to be.
Chondromalacia patella is a relatively common term. Many people are prone to "look at the meaning", that the entire patella has softened, in fact, patellar cartilage refers to: patellar cartilage softening.
First, the structure of the patella
First of all, let's understand the general structure of the knee joint, the distal femur, the proximal tibia, the patella, is the main bone tissue constituting the knee joint. Among them, the femur and tibia form an articular surface, while the femur and patella form an articular surface (patellofemoral joint). Normally, the patella moves up and down in the groove of the femur (the femoral scooter) during bending movements of the knee.
The so-called cartilage of the patella refers to the side of the patella that contacts the femur, which has a very smooth surface and consists of a layer of cartilage.
If we compare the knee joint cavity to a room, then the cartilage of the patella is similar to the siding of our room. Chondromalacia of the patella is similar to the softening, peeling, and cracking of the siding of a room after it has been soaked with water. The cartilaginous surface of the femur, which corresponds to the patella, also wears down accordingly.
(The white part of the chart is the cartilage of the patella, and the yellow part is the cartilage peeling area)
Second, the reason for the chondromalacia of the patella
1. Congenital factors
Some people, the patella's development of the congenital position of the patella is abnormal, the patella does not have a groove in the femur, and the position of the patella has run out of shape, or the patella is not in the groove. The patella is not in the "groove" of the femur, the position is off, or the size of the patella and the femur "groove" development does not match, there is a kind of "not groove" friction, which causes the patellofemoral cartilage to wear out.
2. Acquired factors
(1) Degeneration of the knee joint or excessive knee flexion
From this picture, we can clearly see that when our knee is straight, the cartilage surface of the patella and the femur are separate, and it is not easy to produce friction. However, when we flex the knee, the pressure on the articular surface of the patella is very high on the articular surface of the femur. This long-term friction can lead to wear and tear of the articular cartilage, causing chondromalacia patella.
So let's think about it, in our daily life, what action to often flex the knee? For example:
Climbing mountains
Climbing stairs
There is a data provided to you: when we are on the steps, when the knee joint is bent when the patella back force is 3.3-4 times the weight! That is to say, if your weight is 100 pounds, then the moment you go up the steps the patella to bear the force is 330-340 pounds! So, climbing stairs and mountaineering is definitely a kind of destruction and torture of the knee joint.
Patients with chondromalacia patella should especially avoid these activities!
(2) old trauma: For example, we have sprained and bruised the knee joint before, resulting in a tear of the ligament (tendon) around the joint. Did not care, and did not go through the formal treatment, patella in the reduction of ligament grip, the position is prone to changes in the joint wear and tear.
(3) Quadriceps muscle strength: the muscles around the knee joint (especially the anterior thigh muscle group, quadriceps) is an important structure to maintain the stability of the knee joint. And patients with chondromalacia patellae have decreased activity because of pain, and the quadriceps muscles will atrophy significantly if they don't get exercise. This makes the stability of the knee joint decreased, so that the position of the patella runs, aggravating chondromalacia patella.
Third, the symptoms of chondromalacia patella
Pain: a little lighter, only going up and down the stairs will be painful, and there may be a sudden weakness in the knee joint. Sometimes it is half squatting when the force hurts, such as from squatting to the process of standing, especially when moving heavy objects. In severe cases, it hurts during daily life activities, and the knee joint is weak when you walk. In addition, if you massage the edge of the patella with your hand, there is often significant pressure pain.
Loud: knee flexion, extension activities, patella often appear below the sound, serious patients, they sit straight leg, put their hands on the patella, press the patella friction, you can hear "rustle" sound, like sand inside the joint.
Swelling: Because of the inflammation inside the joint, the synovial membrane secretes a lot of fluid, so the knee joint is swollen.
Thinning: Chondromalacia of the patella causes the quadriceps muscles to atrophy and become weak, so the thighs become thin in appearance.
Fourth, the diagnosis of chondromalacia patella
1, self-diagnostic action
(1) patellar compression and grinding test: press the patella with your hand, up and down or left and right sliding, if there is pain, rough friction, friction sound; or push the patella to one side with your hand, and then the fingers of the other hand to press the cartilaginous surface of the edge of the patella, if there is pain, it means that there may be chondromalacia patella.
(2) The patella can be chondromalacia.
(2) single-leg squatting test: if you suspect that you have chondromalacia patella, you can try to stand on one leg, and then slowly squat, if there is pain, leg weakness, squatting down one leg can not stand, it means that you may be suffering from chondromalacia patella.
2, imaging diagnosis
Here we recommend that if you suspect that there is chondromalacia patella, you can take a patella 30 °, 60 °, 90 ° axial film, to see if there is any change in the position of the patella.
Treatment of chondromalacia patella
1, oral medication:
There are two main categories.
A class of non-steroidal anti-inflammatory drugs. Mainly anti-inflammatory and analgesic effects, applicable to the acute stage of patellar chondromalacia.
The second category is chondro-nutritional drugs: mainly aminoglycans chondro-nutritional drugs.
2, physical therapy:
Ultra-short wave: high-frequency electromagnetic field to achieve anti-inflammatory purposes
Low and medium frequency electrotherapy: through the improvement of the permeability of the cell membrane to improve the circulation
Wax therapy: to promote the local heat, blood circulation
Of course, the specific method of treatment, the dosage needs to listen to the professional physiotherapist's arrangements. Home physiotherapy equipment will also have a certain role, but the effect is relatively poor.
3, brace treatment:
There are many knee patella fixed brace can effectively correct the dislocation and subluxation of the patella, correct the patella outward movement, maintain the stability of the patella. Some patients take on after the knee pain will disappear after going up and down the stairs, or quite useful. (And then do an advertisement: this support Delconi clinic has sales Oh!)
4, functional exercise
Just now we said, quadriceps muscle strength and patellar chondromalacia has a very big relationship, so strengthen the quadriceps muscle strength, restore the stability of the knee joint, is the core of the treatment of chondromalacia patella. Today, we recommend two rehabilitation exercises:
Lift the leg exercise
Lie down on your back, straighten your leg with maximum force, and then lift your leg to a height of about 15 centimeters from the heel of the bed. Note that the knee must be straight. After practicing for a period of time, the strength is improved, you can change to sitting position practice. That is, sit on the bed and sit up straight, and then lift the leg straight. Because after sitting up, the hip joint is flexed, the iliopsoas muscle relaxes, does not participate in the contraction, does not help the quadriceps muscle's favor, so it is also more tired, and the muscles of the anterior side of the thighs are better practiced.
Static squatting exercises:
Feet apart and shoulder width, toes and knee joints are forward, the upper body is leaning against the wall, the center of gravity falls on the heel. The knee joint should not exceed the toes in the vertical direction, and the angle of knee flexion should not be greater than 90 degrees. Maintain the sub-posture to exhaustion, rest for 10 seconds and then repeat, 10 consecutive times / group, 2-3 groups / day. Simply put, it is back against the wall to practice "Zamabu"!
Of course, all of these exercises should be gradual, from less to more, from easy to difficult, from the static posture of the static exercises to the movement of power exercises, from simple to complex movements. The above are only the simplest and safest basic exercises. Excessive exercises will not only fail to alleviate the symptoms, but may even aggravate the damage to the cartilage. So without special guidance, it is better not to practice blindly.
In addition, more important is the adjustment of daily life activities, not because of the fear of pain will not move a little, and can not feel as long as the practice is better than not practice, grit your teeth and endure the pain to practice. Because insufficient exercise and excessive exercise will be counterproductive, is going to aggravate the condition!
5, surgical treatment:
If after a period of conservative treatment has no effect, you can consider doing arthroscopic minimally invasive surgical treatment. Arthroscopic surgical treatment is mainly 1, the damage to the shedding of articular cartilage cleaning. 2, restore the balance of the knee joint inner and outer support band, especially the lateral support band release. If the patient's age and condition are suitable, you can also consider doing articular surface microfracture cartilage regeneration treatment.