Chondromalacia Patella (Knee Pain) – Experience from TT players

[chestnut]

Hi all,

A few months ago I was diagnosed with chondromalacia patella (cartilage fissure behind the kneecap). I'm an amateur table tennis player (25 y.o.), training around 5–10 hours per week, including footwork and multiball sessions.

I've already been to physiotherapy, but unfortunately it didn’t resolve the issue. I've also been prescribed a compression sleeve, which helps only to some extent. The pain isn’t too bad during training, but it tends to flare up afterward — especially in the evening or the next day.

I’m trying to figure out how to manage this in the long term. Has anyone here dealt with a similar issue?
How did it go for you — did you take a break, modify your training, or find something that helped?
Also, as I understand, this condition is actually pretty common among professional athletes, so I was wondering if anyone here knows how pro table tennis players deal with it?
Any tips or personal insights would be really appreciated.

Thanks in advance!

 

[PoppaChubby]

Alexis Lebrun uses the strong version of the Orliman's infrapatellar compression pad, the Patel'R. I've used it for a while before loosing enough weight to get rid of it. there's also the light "sport" version, orange color, Orliman spanyard brand still. I think you can find those in Germany.
The Patel'R, über strong support

The light sport version OS6110

It's mainly sold in Spain and France but being in the EU I guess you can purchase them easily, the Patel'R is around 25€, the sport version 20€

Now we all know a famous athlete that cannot deal well yet anymore after 30 with that cartilage issue in the kneee: Joel Embiid. He has undergo surgeries, but he's now missing too much games per season in the NBA.

 

[PoppaChubby]

There are also those famous suplementations meds made from collagen, but I'm highly skeptical about those.

Conclusions​

• Strong evidence of 5–15 g/day dose of COL in improving joint pain and functionality. However, further research is required to understand the exact adaptive mechanisms.
• Changes in body composition and strength with 15 g/day COL and resistance training were not as prominent in young recreationally active participants as they were in elderly sarcopenic men.
• Exercise and vitamin C seemed to aid collagen synthesis. 15 g/day COL was more effective than 5 g/day COL in elevating collagen synthesis, hence 15 g/day may be a more effective dose. COL should be consumed prior (~ 60 min) to exercise to maximise collagen synthesis.
• Muscle recovery had a modest but significant improvement with COL.

in https://pmc.ncbi.nlm.nih.gov/articles/PMC8521576/

 

[Tyce]

Physio therapy centered around building supporting muscle is your first priority.
Discuss with your therapist if a patella band is useful in your specific case, there is always a possibility you're doing more harm than good.

If you think about supplements, look at your normal diet first. Perhaps you can improve your intake with actual food which is always preferable to supplements.
When you do choose supplements, do it targeted, take only what you need and look at which variants are well absorbed by the body.
Even better, check for the best time to take your supplements, for example with food or empty stomach, morning or evening can help you get the most out of your supplement.
(this is also why targeted is preferable, taking a multivitamin means you are always taking some of it at the worst moment for good absorption)

I can't say anything useful about collagen supplements. Studies are contradicting as far as I can tell, but I haven't researched the particular topic.

 

[Rao01]

Hi all,

A few months ago I was diagnosed with chondromalacia patella (cartilage fissure behind the kneecap). I'm an amateur table tennis player (25 y.o.), training around 5–10 hours per week, including footwork and multiball sessions.

I've already been to physiotherapy, but unfortunately it didn’t resolve the issue. I've also been prescribed a compression sleeve, which helps only to some extent. The pain isn’t too bad during training, but it tends to flare up afterward — especially in the evening or the next day.

I’m trying to figure out how to manage this in the long term. Has anyone here dealt with a similar issue?
How did it go for you — did you take a break, modify your training, or find something that helped?
Also, as I understand, this condition is actually pretty common among professional athletes, so I was wondering if anyone here knows how pro table tennis players deal with it?
Any tips or personal insights would be really appreciated.

Thanks in advance!

What are the symptoms of this? If any of you can please elaborate, I would like to understand better.

 

[pong99]

Hi all,

A few months ago I was diagnosed with chondromalacia patella (cartilage fissure behind the kneecap). I'm an amateur table tennis player (25 y.o.), training around 5–10 hours per week, including footwork and multiball sessions.

I've already been to physiotherapy, but unfortunately it didn’t resolve the issue. I've also been prescribed a compression sleeve, which helps only to some extent. The pain isn’t too bad during training, but it tends to flare up afterward — especially in the evening or the next day.

I’m trying to figure out how to manage this in the long term. Has anyone here dealt with a similar issue?
How did it go for you — did you take a break, modify your training, or find something that helped?
Also, as I understand, this condition is actually pretty common among professional athletes, so I was wondering if anyone here knows how pro table tennis players deal with it?
Any tips or personal insights would be really appreciated.

Thanks in advance!

You were prescribed physical therapy by a medical doctor? Was the doctor an orthopedist/sports medicine specialist?

Were your feet and ankle evaluated dynamically to see how they affect the alignment of the knee? Did your physio include any foot/ankle evaluation? For example, if you stand too much on the inside or outside of your foot, then this can cause knee misalignment. The solution here could also be a custom orthotic to align your feet, which puts less pressure on the knee.

I stopped using a patella band after getting a custom orthotic. When I mean custom, I mean one made by a professional orthotist who did a mold, not one of the ones you get at the drug store. YMMV

Deeper professional insight is required for your particular issues

 

[PoppaChubby]

Oh I forgot something really interesting I'm currently using because of a shoulder capsulitis ! the TENS system: Transcutaneous Electrical Nerve Stimulation.

That might be really usefull before and after pratice time. It helped me recovering faster from that shoulder capsulitis and I've stopped using pain meds or any anti-inflammatory meds. My doctor never told me to use it, it's when having 2 session/week with a physiotherapist that I discovered the best moments were those TENS time (15 to 20 mn) combined with a hot gel pouch on the shoulder (just put it in the microwave for 5 mn)

Transcutaneous electrical nerve stimulation - Wikipedia

en.wikipedia.org

 

[The0rigina1]

Sounds like what is happening is you don't have enough muscle strength to support the heavy movements in table tennis, so your joints and cartilage are taking the fall? I personally think you could really use the break and build up some much-needed important leg muscles such as quads, hamstrings, calves and so on.

 

[chestnut]

Oh I forgot something really interesting I'm currently using because of a shoulder capsulitis ! the TENS system: Transcutaneous Electrical Nerve Stimulation.

That might be really usefull before and after pratice time. It helped me recovering faster from that shoulder capsulitis and I've stopped using pain meds or any anti-inflammatory meds. My doctor never told me to use it, it's when having 2 session/week with a physiotherapist that I discovered the best moments were those TENS time (15 to 20 mn) combined with a hot gel pouch on the shoulder (just put it in the microwave for 5 mn)

Transcutaneous electrical nerve stimulation - Wikipedia

en.wikipedia.org

Hey @PoppaChubby, just wanted to thank you for all your comments, I will definetely look into all tools you've mentioned. In the other comment, you've mentioned using patellar band yourself. Was Patellafemoral Pain Syndrome/Chondromalacia Patella your diagnosis, if you alright with sharing? And, after physio and all the tools, are you able to train pain free now?

 

[chestnut]

What are the symptoms of this? If any of you can please elaborate, I would like to understand better.

Yeah, so I was diagnosed with chondromalacia patella, which means there's cartilage damage behind the kneecap, and it falls under the broader term patellofemoral pain syndrome.

In my case, the main trigger for pain has been table tennis training, especially after intense sessions. What really hurts is high intensity over long period of time (basically any multiball), and some footwork-heavy strokes, especially FH loop against backspin. But it can also show up after things like squatting, climbing stairs, or sitting for long periods. The pain is usually a dull ache behind or around the kneecap, mostly after activity, not during.

 

[chestnut]

Thanks @Tyce and @The0rigina1 for your comments, building stronger legs is my top priority indeed. Although frankly I wouldn't say I was that weak in that department in the first place. As @pong99 mentioned, I do need a deeper professional insight, as for example I have been diagnosed with flat feet and that might effect knee health. But to be frank, medical infrastructure is not great where I live in Germany, so I get little to none useful input from doctors. My insurance provided me with a 90 day training course though, and it is quite beneficial from what I can say having used it for one week already. It is centered around building strength, coordination and flexibility of my legs, so that is my hope for now.

 

[Jslick89]

I dont know anything about your condition but since you said you're wanting to improve your leg strenght around your knees, you should look into kneesovertoes guy routine. asked chatgpt because i was very curious:


You asked:
can you sure chondromalacia patella (cartilage fissure behind the kneecap) by doing kneesovertoes guy exercises?

ChatGPT said:​

Chondromalacia patella (aka patellofemoral pain syndrome) involves softening, irritation, or damage (like fissures) to the cartilage behind the kneecap. It's often caused by poor patellar tracking, muscle imbalances, or overuse.

Can Knees Over Toes Guy (KOTG) exercises cure it?​

No, they don’t "cure" it directly, especially if there are already cartilage fissures. Cartilage doesn’t heal easily because it lacks blood supply. However:

What KOTG-style training can do:​

1. Improve joint mechanics
   – Strengthens VMO (vastus medialis oblique), hamstrings, glutes, and calves, all of which help the kneecap track better.
2. Increase range of motion and resilience
   – Gradually loading the joint through deeper knee flexion (if done properly) may help reduce pain over time and prevent further degradation.
3. Reduce pain and inflammation
   – By fixing muscle imbalances, offloading stressed tissue, and improving blood flow, you might feel significantly better—even with existing cartilage damage.

Common KOTG exercises that may help:​

• Reverse sled drags – Great for building pain-free quad strength.
• Tibialis raises – Strengthens the front of the shin for knee stabilization.
• ATG split squats – Improves mobility and VMO strength (should be progressed slowly).
• Patrick step-ups (like a shallow step-down) – Mimics patellar tracking under load in a controlled way.

But you must be careful:​

If you're currently symptomatic (painful, swollen, or unstable knee):

• Avoid deep knee flexion until symptoms improve.
• Start with low-impact, high-rep, low-resistance work (like sled drags or isometrics).
• Progress very slowly and with expert guidance (ideally a physio or trainer familiar with KOTG/ATG methods).

---

Summary:​

You likely can’t fully "heal" cartilage fissures just through exercise. But KOTG methods can help:

• Manage symptoms
• Prevent further damage
• Possibly delay or avoid surgery

 

[pong99]

Thanks @Tyce and @The0rigina1 for your comments, building stronger legs is my top priority indeed. Although frankly I wouldn't say I was that weak in that department in the first place. As @pong99 mentioned, I do need a deeper professional insight, as for example I have been diagnosed with flat feet and that might effect knee health. But to be frank, medical infrastructure is not great where I live in Germany, so I get little to none useful input from doctors. My insurance provided me with a 90 day training course though, and it is quite beneficial from what I can say having used it for one week already. It is centered around building strength, coordination and flexibility of my legs, so that is my hope for now.

I am not a doctor, be skeptical when you are getting advise from random internet people. So take this for what it is worth.

If the root cause is flat feet, then all the other things suggested may help at the margin, but you need to address this. Flat feet allows your lower leg to rotate inwards, which means your knee rotates inwards causing it to rub on the nerve, which is chrondro. You want to prevent the knee inward rotation. Another thing is was your IT band evaluated? Was it too tight? If too tight, then exercises to loosen it will allow the knee to rotate back towards where its supposed to be.

Years ago, I went to a sports medicine practice that treats pro athletes. After a comprehensive exam by an MD, he told me I had flat feet and sent me down the hall to the orthotics guy. I got custom made hard shell orthotics. I no longer wear a patella knee strap. YMMV

If you don't have access to this kind of care, I would look at alternatives. Can you see a podiatrist? They should be able to get you some kind of orthotic. There are also exercises to address flat feet.

In the US, there's a company named Dr Scholls. There are drug stores where they have a machine where you take off your shoes and stand on pressure pads. The machine will sense you have flat feet via the pressure pads and recommend off the shelf orthotics that you can buy right there. I have never used these, but it's worth a shot because they aren't too expensive.

 

[Tyce]

My unprofessional opinion, orthotics for flat feet is only fixing the symptoms. I've read about plenty of flat feet cases that got tons better by building foot strength, rather than making things weaker using orthotics.

 

[The0rigina1]

My unprofessional opinion, orthotics for flat feet is only fixing the symptoms. I've read about plenty of flat feet cases that got tons better by building foot strength, rather than making things weaker using orthotics.

Yea I do that. Daily arch strengthening exercises and wearing minimalist shoes helped a bit. I've been wearing Vivobarefoot for 2 years but what really helped my arch was the exercise. No longer sore after 2 hours of playing, great stuff.

 

[The0rigina1]

I am not a doctor, be skeptical when you are getting advise from random internet people. So take this for what it is worth.

If the root cause is flat feet, then all the other things suggested may help at the margin, but you need to address this. Flat feet allows your lower leg to rotate inwards, which means your knee rotates inwards causing it to rub on the nerve, which is chrondro. You want to prevent the knee inward rotation. Another thing is was your IT band evaluated? Was it too tight? If too tight, then exercises to loosen it will allow the knee to rotate back towards where its supposed to be.

Years ago, I went to a sports medicine practice that treats pro athletes. After a comprehensive exam by an MD, he told me I had flat feet and sent me down the hall to the orthotics guy. I got custom made hard shell orthotics. I no longer wear a patella knee strap. YMMV

If you don't have access to this kind of care, I would look at alternatives. Can you see a podiatrist? They should be able to get you some kind of orthotic. There are also exercises to address flat feet.

In the US, there's a company named Dr Scholls. There are drug stores where they have a machine where you take off your shoes and stand on pressure pads. The machine will sense you have flat feet via the pressure pads and recommend off the shelf orthotics that you can buy right there. I have never used these, but it's worth a shot because they aren't too expensive.

It's not rocket science mate, if your bones and joints are taking the fall, it's 99% weak muscles, and most of the time it's the small, stabilizing ones.

 

[Tyce]

It's not rocket science mate, if your bones and joints are taking the fall, it's 99% weak muscles, and most of the time it's the small, stabilizing ones.

Has to be said, increasing foot strength isn't a fix for everyone. Sometimes there's more to it than just weak feet.

 

[pong99]

It's not rocket science mate, if your bones and joints are taking the fall, it's 99% weak muscles, and most of the time it's the small, stabilizing ones.

It's called medical science. My experience is based on having similar issues to the OP and seeing a specialist MD in sports medicine that treats NBA/MLB players and being prescribed physical therapy and orthotics. It worked.

"It's 99% weak muscles" is why I stated that OP should not listen to randos online, including me, and seek better medical advise from qualified professionals.

WCQ and Lebrun wear a patella strap. They have obviously seen top notch doctors and haven't fixed their issues with muscle strengthening.

 

[PoppaChubby]

It's called medical science. My experience is based on having similar issues to the OP and seeing a specialist MD in sports medicine that treats NBA/MLB players and being prescribed physical therapy and orthotics. It worked.

"It's 99% weak muscles" is why I stated that OP should not listen to randos online, including me, and seek better medical advise from qualified professionals.

WCQ and Lebrun wear a patella strap. They have obviously seen top notch doctors and haven't fixed their issues with muscle strengthening.

It's a medical problem you get at 11/12, when the growing process starts, puberty and its issues. Alexis Lebrun couldn't make a full season before he was 16, he's been dealing with back and knee problems all his puberty, genetics... you can't fight against that with simple things like "hey muscle reinforcement and done !". And even after that, he's been out of the WTT for 6 months in 2022/2023 for the same problem. That's why he wears specific Yonex shoes that looks like tennis shoes, the shop in Rouen that buy them for him, Multiset, is always trying to find more supportive badminton shoes for him, means wider, bigger shoes with more cushion. The Lebrun's staff is indeed having sometimes difficulties to get him the right shoes.

 

[PoppaChubby]

Hey @PoppaChubby, just wanted to thank you for all your comments, I will definetely look into all tools you've mentioned. In the other comment, you've mentioned using patellar band yourself. Was Patellafemoral Pain Syndrome/Chondromalacia Patella your diagnosis, if you alright with sharing? And, after physio and all the tools, are you able to train pain free now?

I'm a music teacher and I'm able to play bass and guitar again thanks to the TENS, not upright bass still... but the bass was a problem as I couldn't extend my elbow enough to get to the very first frets near the nut, or even couldn't turn the tuning keys above. Longer scale instruments is a problem with a shoulder capsulitis.

My knee problem was "nearly" the same: i've played volleyball intensively in my youth and was already having some problems. With VB you work really hard on thighs muscle reinforcement, as a setter I had to jump many times for blocks, and after that being a libero/setter was even more difficult. Of course loosing weight helps, but when it's a growth problem like it seems to be for you (you're "only" 25), there's not much to do, indeed. The patellar straps helps, really. Now with volley ball I couldn't wear a patellar strap, it was too much with the knee pads. So I was wearing undersized knee pads, very tight ones, with some Elastoplast (it's a brand) strap at the same knee position between the tibia and the patella.

EDIT: I'm 52 by the way and now I remember I was a bit of a sportaholic in my youth: at the same time I've played tennis, football, volley-ball, table tennis, for 3 years straight, then "only" volley-ball and table tennis, because of music haha. My wednesdays were full booked ! 14h to 15h30 football, 16h-17h30 VB and then at 18h table tennis 🤡
😵☠️