Chondromalacia Patella: Symptoms, Causes and Exercises

01Definition

What chondromalacia patella means

The kneecap (patella) protects the knee joint and helps the knee bend and straighten. Its underside glides in a groove at the end of the thigh bone (femur). Mayo Clinic defines chondromalacia patellae as damage to the cartilage under the kneecap.

The term describes a change in the cartilage, not a diagnosis of all front-of-knee pain. For a wider view of cartilage problems in the knee, see our guide to knee cartilage damage.

02Terms

How it relates to patellofemoral pain

Mayo Clinic explains that patellofemoral pain syndrome is pain in the soft tissues and bone around the kneecap, and that chondromalacia patellae can sometimes also cause patellofemoral pain. In other words, cartilage damage is one possible cause of this type of pain.

Other sources use the terms more loosely. Mersey Care (NHS) notes that patellofemoral pain syndrome is sometimes called runner’s knee, anterior knee pain or chondromalacia patellae, and Cambridge University Hospitals titles its leaflet patello femoral syndrome, anterior knee pain or chondromalacia patella. This is why you may see the names used interchangeably. Our guide to runner’s knee covers the wider syndrome.

03Symptoms

Symptoms: stairs, squatting, sitting

Mersey Care and Mayo Clinic describe symptoms that often start gradually and can affect one or both knees:

• a dull ache, or sometimes sharp pain, at the front of the knee, around or behind the kneecap
• pain going up or down stairs
• pain with running, jumping, squatting or kneeling
• pain after sitting for a long time with the knees bent
• pain that worsens during or after increased activity
• a popping, clicking, grinding or crackling feeling in the knee

Mersey Care adds that some people feel the knee is giving way, but this is not the true instability seen in cartilage or ligament injuries. It also explains that clicking or grinding noises do not damage the knee, and that keeping moving helps. See also knee popping.

04Causes

Causes and risk factors

Cambridge University Hospitals explains that the kneecap should stay centred and move up and down in its groove. If it is off-centre, it is pulled to one side and stresses one part of its underside; the cartilage there may become inflamed. Contributing factors include tight muscles or ligaments pulling the kneecap sideways, weak muscles not holding it in place, and foot position such as flat feet.

Mayo Clinic adds overuse in running and jumping sports, sudden increases in activity, weakness around the hip and knee, injury to the kneecap, including cartilage damage when it slips out of place, and knee surgery. Risk is higher in teenagers and young adults and in females. Mersey Care also mentions being overweight.

05Diagnosis

Diagnosis and the role of imaging

Mersey Care explains that diagnosis of patellofemoral pain is usually made from your history and a simple examination, without the need for further investigations. A health professional asks when the pain appears and examines how the knee and kneecap move.

Whether imaging is needed depends on the individual case and is decided by the professional who examines you. Mayo Clinic notes that in older people, arthritis is more often the cause of knee problems, which can change the assessment.

06Expectations

Why pain and cartilage changes do not always match

Because chondromalacia is a cartilage change and patellofemoral pain is a symptom, the two do not always go together. Mayo Clinic describes pain coming from the soft tissues and bone around the kneecap, with cartilage damage as only one possible cause.

The sources reviewed focus on reducing pain and improving function with exercise and activity changes. They do not describe exercise as a way to repair cartilage, so it is better to measure progress by what you can do, such as stairs, squatting or sitting, than by expecting a change in the cartilage itself.

07Treatment

Exercise-based treatment

Mersey Care explains that exercise is key to managing patellofemoral pain. Basic exercises lying or sitting can build strength without discomfort at first, then exercises standing as pain allows. It may take up to 12 weeks of exercise rehabilitation for a significant improvement, with gradual progress along the way.

The Cambridge University Hospitals physiotherapy leaflet includes step-ups, single-leg dips, lunges with the kneecap kept over the second toe, a wall-supported squat hold for tracking control, inner thigh muscle activation, and stretches of the thigh, hip flexor and outer thigh. It stresses that your physiotherapist decides which exercises suit you. Mayo Clinic recommends strengthening the outer hip and core muscles to stop the knee caving inward.

08Daily life

Load management in daily life and sport

Mayo Clinic suggests avoiding deep squats during weight training, increasing workouts gradually, warming up for about five minutes, stretching gently, wearing shoes designed for the activity and losing excess weight if you are overweight, which reduces stress on the kneecap on stairs.

Mayo Clinic also notes that simple measures such as rest and ice often help. Mersey Care says painkillers or anti-inflammatory gels may help you keep exercising; discuss them with your pharmacist or GP. Our guide on ice or heat for knee pain covers home measures.

09Sources

Where the sources differ

Mayo Clinic (September 2026) separates the two terms: patellofemoral pain is the symptom, and chondromalacia patellae, cartilage damage, is one possible cause. Mersey Care and Cambridge University Hospitals (July 2024) use chondromalacia patella as another name for patellofemoral syndrome. Mersey Care advises seeking further help after four to six weeks without improvement, while Mayo Clinic suggests calling a professional if the pain does not improve within a few days.

None of the sources discusses surgery; any procedure would be a decision for a specialist after assessment. For adults, our physiotherapy practice in Bilbao can assess the knee and design an individual exercise plan (consultations are in Spanish).

10Summary

In summary

Chondromalacia patella is damage to the cartilage under the kneecap and one possible cause of patellofemoral pain. It typically causes pain at the front of the knee with stairs, squatting, kneeling or long sitting. Exercise to strengthen and stretch the hip and knee muscles, with gradual load, is the core of treatment.

A practical goal sheet helps: aim for pain-free stairs, being able to sit through a film, squatting to a comfortable depth and returning to sport gradually. Record these every few weeks. These are goals for pain and function; they do not show that the cartilage has been repaired, and the sources reviewed do not promise that.