Dr. Shiel received a Bachelor of Science degree with honors from the University of Notre Dame. There he was involved in research in radiation biology and received the Huisking Scholarship. After graduating from St. Louis University School of Medicine, he completed his Internal Medicine residency and Rheumatology fellowship at the University of California, Irvine. He is board-certified in Internal Medicine and Rheumatology.
The primary goal for treatment and rehabilitation of
chondromalacia patella is to create a straighter pathway for the patella to
follow during quadriceps contraction. Initial pain management
involves avoiding motions which irritate the kneecap. Icing and
anti-inflammatory medications (for examples, ibuprofen
[Advil/Motrin] or
naproxen [Aleve]) can also be helpful.
Selective strengthening of the inner portion of the
quadriceps muscle will help normalize the tracking of the patella.
Cardiovascular conditioning can be maintained by stationary bicycling (low
resistance but high rpms), pool running, or swimming (flutter kick). Reviewing any changes
in training prior to chondromalacia patella pain, as well as examining running
shoes for proper biomechanical fit are critical to avoid
repeating the painful cycle. Generally, full squat exercises with weights are avoided. Occasionally, bracing with
patellar centering devices are required.
Stretching and strengthening the quadriceps and hamstring
muscle groups is critical for an effective and
lasting rehabilitation of chondromalacia patella. "Quad sets" are the
foundation of such a program. Quad sets are done by
contraction the thigh muscles while the legs are straight
and holding the contraction for a count of 10. Sets of 10
contractions are done between 15-20 times per day.
What is the prognosis (outlook) with
chondromalacia patella?
Under optimal circumstances, the patient should have a
rapid recovery and return at full functional level.
Chondromalacia Patella At A Glance
Chondromalacia patella is
the most common cause of chronic knee pain.
Chondromalacia patella has also been called patellofemoral syndrome.
The pain of chondromalacia patella is aggravated by
activity or prolonged sitting with bent knees.
Abnormal "tracking" allows the kneecap (patella) to
grate over the lower end of the thigh bone (femur) causing chronic
inflammation and pain.
Treatment involves improving the alignment of the patella
during contraction of the thigh muscle.
Reference:
Koopman, William, et al., eds. Clinical Primer of Rheumatology. Philadelphia: Lippincott Williams & Wilkins, 2003. Kelley's Textbook of Rheumatology, W B Saunders Co, edited by Shaun Ruddy, et al., 2000.
The knee joint is composed of three compartments and ligaments which stabilize the joint. Causes of knee pain may include injury, degeneration, infrequently infection and rarely bone tumors. Although routine x-rays do not revel meniscus tears, they can be used to exclude other problems of the bones and tissues. The knee joint is the most commonly involved joint in rheumatic disease, as well as immune diseases that affect various tissues of the body.
Bursitis of the knee results when any of the three fluid-filled sacs (bursae) become inflamed due to injury or strain. Symptoms include pain, swelling, warmth, tenderness, and redness. Treatment of knee bursitis depends on whether infection is involved. If the knee bursa is not infected, knee bursitis may be treated with ice compresses, rest, and antiinflammatory and pain medications.
Pain management and treatment can be simple or complex, according to its cause. There are two basic types of pain, nociceptive pain and neuropathic pain. Some causes of neuropathic pain includes: complex regional pain syndrome, interstitial cystitis, and irritable bowel syndrome. There are a variety of methods to treat chronic pain, which are dependant on the type of pain experienced.
Regular physical activity can reduce the risk of disease. Regular exercise can also reduce the symptoms of stress and anxiety. There are fitness programs that fit any age or lifestyle.
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