My kneecap grinds and hurts underneath when I go down stairs. Is it chondromalacia?

Harmless crackling versus a painful grind

Many knees crackle or pop when they bend, and without pain this is almost always harmless. What raises suspicion of chondromalacia is the combination of a rough, gritty or sandpaper-like grinding felt under the kneecap together with a deep ache behind it, brought on by stairs, squatting, kneeling or getting up from a chair.

People often describe it as feeling sand under the kneecap, or a grating they can feel with a hand on the knee as it bends and straightens.

Why the cartilage becomes sensitive

The cartilage under the kneecap is among the thickest in the body because it carries large forces when the knee bends. It can soften and fray after repeated overload, a direct blow such as falling onto the knee on a hard floor or a football pitch, a kneecap that tracks off-centre, or a previous dislocation. In older adults it may be part of early kneecap arthritis.

What you can do now

• Avoid deep squats, long kneeling and heavy lunges for a few weeks
• Use the handrail on stairs and take them one at a time while sore
• Keep moving with cycling, swimming or walking on flat ground
• Start gentle thigh and hip strengthening in a comfortable, shallow range
• Use ice or simple painkillers for flare-ups if they suit you

When to get it examined

See a knee specialist if the grinding comes with swelling, the knee locks or catches, it follows a fall or twist, or pain persists for more than a few weeks. At Aman Hospital in Doha, Dr. Pablo Gelber feels the kneecap as it moves, checks its tracking and the surrounding muscles, and decides whether an MRI is needed to look at the cartilage directly.