DEAR DR. DONOHUE: In high school I was a cheerleader, played on the girls’ basketball team and was a runner. I graduated five years ago. I remain active, but running is my only exercise.

About six months ago I began to notice a slight pain in my kneecap. I managed to ignore it until two weeks ago, when the knee started throbbing. It feels like someone is stabbing me in the knee. I saw a sports-medicine doctor who said I have chondromalacia patella. He told me to stop running, wear a neoprene knee brace and take Aleve.

I didn’t pay much attention to what else he said. Will you elaborate on this condition? How long should I stay off running? Is there any way for me to maintain my conditioning? — L.O.

ANSWER: “Chondro” is “cartilage,” and “malacia” is “softening.” ”Patella” is the kneecap.

The backside of the kneecap is covered with cartilage sort of like Teflon cookware. The kneecap serves a handy purpose. It gives the thigh quad muscles a mechanical advantage when they contract and straighten the knee. It sits in a groove in the thigh bone and is buried in the tendon of the front thigh muscles. That tendon inserts on the lower leg bone. When the quad muscles contract, they extend (straighten) the lower leg. Constant rubbing of the kneecap in its groove can lead to deterioration of its cartilage covering.

Pain in the center of the knee is a tip that chondromalacia is the cause. Affected people, after sitting for a long time, have trouble straightening the knee.

Overuse is the primary cause of chondromalacia. It’s a common runner’s injury. The usual prescription of overuse injuries is rest, ice (at first) and anti-inflammatory medicines. Of those, rest is the most important. You have to keep the leg rested until all pain is gone. That’s usually a matter of three or four weeks.

Swimming will maintain your conditioning. If swimming hurts the knee, cross it off the list. It shouldn’t.

You also can try a stationary bike. Again, let pain be your guide to its use.

When the pain has gone, strengthening the quad muscles will prevent a recurrence. Sit or lie with your legs straight out in front of you. Contract your thigh muscles as though you were trying to pull your knees to your waist. Hold that position for five seconds. Repeat four times. Do this exercise many times during the day.

DEAR DR. DONOHUE: I got talked into doing some boxing training by a friend. No, I don’t intend to be a boxer, nor do I intend to enter any boxing matches. I am 35 years old. We do some boxing without any head blows. I would like to understand why boxing tires me out so rapidly. I am exhausted after three minutes, and I thought I was in good condition. — M.J.

ANSWER: Boxing is incredibly taxing. For one thing, there is no rest during a three-minute round.

Upper-body movement is much more demanding than lower-body movement. It requires more fuel, and fuel sources are rapidly depleted. That’s one reason why boxing tires you so quickly.

Conductors of music are supposed to be in good condition and live longer because of their constant arm exercise.

DEAR DR. DONOHUE: Someone told me that muscle size doesn’t equal strength. Is that so? It seems to me the bigger the muscles, the stronger you are. — K.R.

ANSWER: Bigger muscles usually are stronger muscles. I can give you an example when that isn’t the case. In the early days of lifting weights, a novice lifter can quickly lift heavier loads without seeing any increase in muscle size. That’s because the brain has learned how to involve more muscles in the lifting movement.

Increase in muscle size comes much more slowly. Exercise breaks down muscles, and those muscles are replaced by an increased incorporation of protein into new muscle fibers. That takes time.

Dr. Donohue regrets that he is unable to answer individual letters, but he will incorporate them in his column whenever possible. Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475. Readers may also order health newsletters from www.rbmamall.com.

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