Knee

What It Is

The cartilage underneath your kneecap helps your knee move smoothly. Injury, overuse and various other factors can lead to chondromalacia patella, which means softening and breakdown of the cartilage that lies underneath the kneecap (American Academy of Orthopaedic Surgeons, n.d.a). It is often seen as part of patellofemoral pain (pain at the front of the knee and around the kneecap). The main symptom is pain at the front of the knee when squatting, kneeling, climbing up or down stairs, or sitting for a long time with your knees bent, such as in a seat with poor leg-room (American Academy of Orthopaedic Surgeons, n.d.a).

Chondromalacia Patella Anatomy

Three bones form the knee joint (American Academy of Orthopaedic Surgeons, n.d.b)

Femur – the thighbone, which runs from the hip down to the knee
Tibia – the shinbone, the main bone of the lower leg, which supports the weight of the body below the knee
Patella – the kneecap, which is connected by tendons above and below and sits in front of the joint to provide some protection

The ends of the femur and tibia, and the back of the patella, are covered with articular cartilage, a smooth, slippery layer that helps the bones glide over each other (American Academy of Orthopaedic Surgeons, n.d.b). This is the cartilage affected in chondromalacia. Separately, two C-shaped pieces of tougher, rubbery cartilage called menisci (singular: meniscus), the lateral and the medial meniscus, sit between the thighbone and shinbone and act as shock absorbers (American Academy of Orthopaedic Surgeons, n.d.b).

When the kneecap does not move (track) properly in the groove at the end of the thighbone, it may be pushed to one side, increasing pressure behind the kneecap and irritating the soft tissues. Poor tracking can be linked to the alignment of the legs, and to weak or imbalanced quadriceps (front thigh) and hip muscles (American Academy of Orthopaedic Surgeons, n.d.a).

Cartilage has no nerves, so damage to the cartilage itself cannot directly cause pain. However, it can lead to irritation of the joint lining and pain in the bone underneath (American Academy of Orthopaedic Surgeons, n.d.a).

How Is It Diagnosed?

Usually, your doctor can diagnose front-of-knee pain like this with a physical examination. In most cases they will also send you for an X-ray to rule out damage to the bones. An MRI scan may be used if your symptoms do not improve after a period of physical therapy and home exercise (American Academy of Orthopaedic Surgeons, n.d.a).

Not a diagnosis — for more information, contact me or another trusted healthcare provider.

Treatment

Self-Care & Treatment

How to Treat Chondromalacia Patella

Exercise therapy, especially a combination of hip and knee exercises, is recommended for pain at the front of the knee (Crossley et al., 2016), with a focus on strengthening and stretching your quadriceps and strengthening your hip muscles (American Academy of Orthopaedic Surgeons, n.d.a). I can guide you through a strengthening and stretching programme, along with hands-on work for your thigh, hip and calf. See the My Approach tab for how I work.

1. Rest, Ice and Anti-Inflammatory Medication

Stop or reduce the activities that make your knee hurt until the pain settles, for example by switching to low-impact activities such as cycling on a stationary bike or swimming. Use cold packs for 20 minutes at a time, several times a day, and never put ice directly on the skin (American Academy of Orthopaedic Surgeons, n.d.a).

The American Academy of Orthopaedic Surgeons (n.d.a) says anti-inflammatory medicines such as ibuprofen and naproxen can help reduce swelling and relieve pain. (This medicine information comes from the American Academy of Orthopaedic Surgeons, not from me. Always check with a pharmacist or your family doctor or nurse practitioner before taking any medicine.)

2. Shoe Inserts

Shoe inserts (foot orthoses), either off-the-shelf or custom-made, may help take stress off the lower leg (American Academy of Orthopaedic Surgeons, n.d.a) and can help with pain in the short term (Crossley et al., 2016). I can help you work out whether one might help and how to get it, and point you to a chiropodist or podiatrist if you need a custom orthotic.

3. Taping or Bracing

Some people find that taping or a soft knee brace helps them exercise with less pain. However, the research does not show that taping or bracing realigns the kneecap, and experts have not made a recommendation for or against using them (Crossley et al., 2016). I can help you work out whether taping or a brace might help, and show you how to tape your knee yourself.

Treatments you may want to discuss with your family doctor or nurse practitioner

Options outside my scope

Surgery: surgery for front-of-knee pain is very rarely needed and is only done for severe cases that do not get better with non-surgical treatment (American Academy of Orthopaedic Surgeons, n.d.a).

How I can help (see the My Approach tab)

A hip and knee strengthening and stretching programme

Hands-on work for the thigh, hip and calf

Taping, and advice on braces and shoe inserts

A gradual return to sport and activity

Tips

Front-of-knee pain is common in people who play sports, especially females and young adults, but it can also affect non-athletes (American Academy of Orthopaedic Surgeons, n.d.a).
A sudden increase in how often, how long or how hard you exercise can bring it on, so build up your training gradually (American Academy of Orthopaedic Surgeons, n.d.a).
If any part of the quadriceps weakens for any reason, an imbalance can occur.
Weak muscles around the hip can indirectly affect the kneecap and cause knee pain (American Academy of Orthopaedic Surgeons, n.d.a).
Warm up thoroughly before activity, wear shoes suited to your activity, and keep to a healthy body weight to avoid overstressing your knees (American Academy of Orthopaedic Surgeons, n.d.a).

Treatment

My Approach

Pain at the front of the knee is rarely just a knee problem. Weak hip and thigh muscles, tight muscles around the thigh and calf, and the way your leg and foot line up can all change how the kneecap moves. My aim is to settle the pain, then build strength through your hips and knees so they cope with stairs, squatting, sitting and sport again.

I start by assessing the whole leg: how you stand, walk, squat and step down, how your kneecap moves, and the strength and flexibility of your hips, thighs and calves, and I'll ask about any recent jump in your training.

When It's Sore

Cutting back stairs, deep squats, running and jumping for a while, and swapping in swimming or easy cycling
Pain-free strengthening: tightening the thigh, straightening the knee over a towel roll, squeezing a ball between the knees and side-lying hip work
Taping or a soft knee brace if it helps you exercise with less pain, and I'll show you how to tape it yourself

Hands-On Treatment

Massage for the thigh, hamstrings, calf and around the knee
Gentle mobilisation of the kneecap
Work on the hip and buttock muscles when it's relevant, only with your informed consent and a written consent form
Warm or cool applications in the clinic, and I'll show you how to use ice safely at home

As It Settles

Mini-squats, partial lunges and slow step-downs, keeping your knee lined up over the middle of your foot
Stretches for the quadriceps, hamstrings and calves, with hamstring stretches as part of your warm-up
Heavier hip and leg strength work, including gym-based progressions, and a gradual return to running or sport, changing the range or load rather than pushing through pain

I'll also look at your footwear and how your foot moves, help you work out whether a shoe insert might help, and point you to a chiropodist or podiatrist for a custom orthotic.

If the pain isn't settling despite steady work, or your knee swells, locks or gives way, see your family doctor or nurse practitioner.

What to Expect

Typical Course

Typical course: Usually we start with one or two visits a week, then weekly, then spacing them out as you manage more on your own, with a reassessment at about four to six weeks. Most people notice the knee becoming less sore over about six to twelve weeks of steady exercise, and keeping up a home programme helps it stay that way.

What I Focus On

Whole-Leg Assessment

Hip & Thigh Strength

Thigh & Knee Release

Taping

Gradual Return to Activity

Sources

References

American Academy of Orthopaedic Surgeons (n.d.a) Patellofemoral pain syndrome. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/patellofemoral-pain-syndrome/ (Accessed: 7 October 2026).
Crossley, K.M., van Middelkoop, M., Callaghan, M.J. et al. (2016) '2016 Patellofemoral pain consensus statement from the 4th International Patellofemoral Pain Research Retreat, Manchester. Part 2: recommended physical interventions (exercise, taping, bracing, foot orthoses and combined interventions)', British Journal of Sports Medicine, 50(14), pp. 844–852. doi: 10.1136/bjsports-2016-096268
American Academy of Orthopaedic Surgeons (n.d.b) Common knee injuries. OrthoInfo. Available at: https://orthoinfo.aaos.org/en/diseases--conditions/common-knee-injuries/ (Accessed: 7 October 2026).

Massage therapy · Kitchener–WaterlooChondromalacia Patella

What It Is

Chondromalacia Patella Anatomy

How Is It Diagnosed?

Self-Care & Treatment

How to Treat Chondromalacia Patella

1. Rest, Ice and Anti-Inflammatory Medication

2. Shoe Inserts

3. Taping or Bracing

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

Hands-On Treatment

As It Settles

Typical Course

References

Related Conditions

Book a session

Massage therapy · Kitchener–WaterlooChondromalacia Patella

What It Is

Chondromalacia Patella Anatomy

How Is It Diagnosed?

Self-Care & Treatment

How to Treat Chondromalacia Patella

1. Rest, Ice and Anti-Inflammatory Medication

2. Shoe Inserts

3. Taping or Bracing

Treatments you may want to discuss with your family doctor or nurse practitioner

Tips

My Approach

When It's Sore

Hands-On Treatment

As It Settles

Typical Course

References

Related Conditions

Anterior Cruciate Ligament (ACL) Injuries

Fat Pad Impingement

Iliotibial Band Friction Syndrome

Interphalangeal Joint Sprain

Book a session