Knees Up

Anyone who engages in regular leg training that is two or three times a week, may at some time suffer with the condition – chondromalacia patellae.

In my practice, I often see this injury in bodybuilders who constantly squat heavy poundages. However, the likelihood of injury can be reduced if you are guided by the following suggestions. To begin with we must look at the actual nature and cause of the complaint.

The quadricepts are the frontal thigh muscles consisting of four individual muscles. Three of these insert on to the top of the knee-cap (or patella). From the bottom of the knee-cap runs a small ligament which attaches on to the lower leg.

When the quads are contracted this pulls on the knee-cap, which transmits the pull through this ligament thus raising the lower leg. (See diagram one). The knee-cap is situated on the front of the lower aspect of the thigh bone. It lies in a shallow ‘gutter or groove and glides up and down, when the quads are used. The knee-cap, therefore, runs on a sort of tracking system.

It is important that the knee-cap rides evenly through the groove and for this it relies on an equal pull from each head of the quadriceps. (See diagram two). As there are three heads of the quadriceps attaching to the knee-cap, relative weakness in any one head will cause the knee-cap to be pulled away from that side and this may cause the knee-cap to ride unevenly.

This is one of the factors predisposing the knee-cap to the roughening of its underside or chondromalacia patellae.

Ordinarily, the underside of the knee-cap and surface of the thigh bone are covered in a film of cartilage. It is possible for damage to occur between these two surfaces, even though the cartilage allows for a friction-free glide. The cartilage is continually being rubbed away, but is able to regenerate and reform. If the amount of wear and tear on the cartilage outstrips its capacity for reforming , then it will start to break down and wear. Microscopic cracks will form in the cartilage and if these two bony surfaces come into contact pain will result.

There are some important considerations to bear in mind when training legs. When squatting, the amount of weight transmitted through the knee-cap and knee is seven times the squatter’s weight.

Your average bodybuilder weighing 200 lbs and squatting 250 lbs is through each knee. Multiply, this by the number of repetitions and you start to appreciate the tremendous pressure placed on the knees during the average workout!

One of the most basic methods of preventing this condition is by warming the knees up prior to any heavy squatting.

When the knee is thoroughly warmed up the ‘space’ between the kneecap and frontal surface of the thigh will be filled with blood. This will act as a lubricant between the two surfaces, physically separating them.

Developing the quads symmetrically is also important. As outlined earlier, if one head of the muscle is more developed than the other two heads attached to the knee-cap then this will precipitate the knee-cap riding unevenly and will accelerate wear and tear.

Certain modifications in training can be implemented to offset the development of chondromalacia patellae. The knee-cap is engages on the front of the thigh to the maximum when the knee is fully flexed. That is, when the back of the calf is in contact with the hamstrings.

I consider it advisable not to do full squats with heavy poundages because the combination of the weight and the position of the knee-cap, when in that position makes damage to the knee almost inevitable.

It is much more preferable to squat ‘parallel’, that is until the top of the thigh is parallel to the floor.

Finally, the resting tone of the quads is important in so much that the position of the knee-cap on the front of the thigh, during everyday activities, is dictated by the flexibility in the quad. Passive stretching to the quads i.e. as in the hurdles stretch is always a good idea.

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Liberty Osteopathic Clinics
The Liberty Osteopathic Clinics are based in Forest Gate, East London and in the City of London.
All osteopaths at the Liberty Clinics are registered with the General Osteopathic Council (GOsC).