Patellofemoral syndrome - what worked for you?

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snafuspyramid
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Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Sun Apr 05, 2015 4:31 pm

Over the last year, I have been struggling with patellofemoral syndrome (a.k.a. "runner's knee"). Apparently it's a common cycling overuse injury.

I have been making some progress. A foam roller, orthotics, bike fit and stretching have all helped. I am starting a routine to strengthen my VMO, glutes and hamstrings (I already work on my core enough) and hopefully - with a little discipline - this will help to address the issue.

Now I realise that I should really rely on the advice of an experienced professional (and I have consulted a few already). But hey - who needs evidence-based medicine now we have the internet?

Therefore, I'm looking for your anecdotes about PF syndrome. What did you do to recover? What did you find most helpful? What maintenance work do you do?

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Re: Patellofemoral syndrome - what worked for you?

Postby ValleyForge » Sun Apr 05, 2015 7:07 pm

Brace yourself! You will be inundated with all sorts of ideas. Consider VMO strengthening exercises and increasing cadence when riding as the most useful. Just my opinion.
Ha ha ha! Cookies on dowels.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Sun Apr 05, 2015 9:51 pm

How long u been riding? What did u change leading up to.pfps?
age? km/wk?

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Mon Apr 06, 2015 6:50 am

I have been riding on and off for ten years. I am 26. However, before developing PF sydrome I had a large - though steady - increase in km to about 170-200km per week (a lot on my heavy touring bike) plus occasional two-day bike camping trips of around 200km, usually hauling heavy loads up a mountain range. So the thing that changed was intensity and a new touring bike with MTB pedals and wide Q. However, I did used to experience the same issue riding my racing bike. I "fixed" that by giving up cycling and taking up weightlifting for a few years.

The other thing that changed is that I recently became an office drone, together with the resulting posture, hamstring tightness and constant patellar load (not to mention the compulsive need to cycle to retain my sanity).

I have had a pro bike fit. The bike now has pretty significant cleat rotation (I am very duck footed), a shim on the injured leg and my shoes have orthotics fitted. Basically my glutes were extremely weak - expecially on the injured leg - my feet had collapsed arches - to the extent that I have arthritic growths at the arches - and one of my hips was lower than the other. The injured leg was only producing 30% of my power.

It would appear, in summary, that I am now a cycling quasimodo.

I have been largely off the bike for a few months with little improvement. That is not very surprising though, as I have not had time to do the exercises either.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Tue Apr 07, 2015 5:18 pm

go back and see whoever did your bike fit.

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Tue Apr 07, 2015 8:27 pm

I do not think bike fit is the issue any more. I get PF pain regardless of whether I cycle. I will return to the fitter if I don't experience improvement after a few months of exercises.

I am more curious about what others have found helpful, though mindful that they might not apply to me. Good news stories if you like.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Tue Apr 07, 2015 10:02 pm

OK,
where exactly do you get the pain? be specific. PFPS is an imprecise cover all diagnosis.
when do you get it? what do you do to bring it on?
is it always in the same spot?
is it just in one leg?
have you had an mri or ultrasound scan?
Who has told you your gluts were weak and one hip is lower than the other? what qualifications do they have?

Some things to consider:
- poor sleep, diet, and hydration will reduce the ability of your cartilage to recover from efforts, and increase the damage done during efforts.
- if you are still riding now, then your bike fit might not have been extreme enough to unload the irritated cartilage.
- your orthotics may also be inadequate. chronic problems require much more aggressive intervention. orthotics will need to stop your tibia from internally rotating and your mid foot from pronating.
- unloading taping is very effective at easing ongoing irritation of the chronically involved tissue.
- appropriate massage is also underrated. many hard core athletes have a lot of short fibrotic scar tissue in key muscles like Vastus Lateralis, which effect patella tracking. rollers are not specific enough.
- strengthening the hamstrings, quads, adductors, abductors influences patella tracking.
- if you have weak gluts, it is likely due to low back issues, irritated lumbar nerve roots or disc pathology. gluts rarely get weak for any other reason apart from underuse or having too acute a hip angle.
- your cycling technique may be compromised. many guys think their knees should deviate towards the top tube on the downstroke. this is incorrect. your knees should go straight up and down.
- your bars may be too low causing too acute a hip angle. this will mess with muscle recruitment.
- your cranks may be too long. causing too much knee flexion. shimming the painful limb would seem to exacerbate the condition due to increasing knee flexion.
- grinder or spinner?
- there's a possibility you have knocked the crp out of your cartilage with your previous exploits, and no matter what you do, the pain won't stay away with exercise. You could also just have a less than ideal for repetitive use patellofemoral morphology. If the condition persists, a CT scan would be helpful, which means a consult with a sports oriented orthopedic surgeon.
- chondroitin sulphate and glucosamine may be beneficial, after 2 months of daily intake.

Personally, chronics I see are usually not on a good diet. I've seen enough chronic musculoskeletal pathology resolve when people get health fundamentals like diet, hydration, sleep sorted out. Though often that's harder than changing one's personality!

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snafuspyramid
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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Wed Apr 08, 2015 7:58 am

First of all, thankyou for taking the time to write such a thoughtful response.

The pain is always in one spot on one leg only. It is a generalized discomfort immediately behind my kneecap. It is aggravated by sitting for an extended period, cycling for over an hour, or (particularly) walking on hard surfaces without orthotics. In that case it is sometimes a sharper pain towards the inside of my knee.

I have not had an MRI.

I was informed I have weak glutes by the bike fitter, who is a podiatrist in his main job.

I almost always sit my cadence at around 85 rpm.

I had a similar issue when I first got into road bikes as a teen. My physio informed me that the issue was a tight glute muscle, dry needled the spot and gave me stretches. Regularly performing those stretches did a lot to address the issue for a while, but then I gave up cycling and started weightlifting for a few years. I didn't have any problem after that. But the issue was milder then (on bike only).

I recently took a few months cold turkey from cycling. I noticed only some improvement.

My sleeping patterns are good and my diet is generally ok. But I will start paying closer attention to what I eat if that will assist healing.

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Wed Apr 08, 2015 8:41 am

Upon reflection, the pain is definitely closer to the inside of my knee.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Wed Apr 08, 2015 9:02 am

Could you clarify the sharper pain on the inside of the "knee". Do you mean the inner margin of the patellofemoral joint? or the inner aspect of the knee joint (jt between femur and tibia)? If the latter, you may have medial knee joint cartilage involvement or chronic medial meniscus pathology. Both of these can cause muscle inhibition and influence muscle recruitment for patella tracking.

I get the impression you need to have a good clinician establish the origin of the pain. Behind the knee is very much likely patellofemoral joint cartilage, but it's also possible it is coming from deep within the knee joint itself, especially when considered with it developing into a sharper pain "towards the inside of your knee". It is common when younger that otherwise inconsequential knocks to the knee can compromise the medial meniscus and anterior cruciate ligament, thereby predisposing you to more movement of the femur on the tibia. This can develop over time into recurrent pain that is hard to discern the origin of. But a good clinician can generally isolate the origin via systematic applicationof multiple orthopedic tests.

I don't think the diagnosis of weak gluts is going to get to the bottom of things!

edit: just about to post this and noticed your last post. I still need you to clarify what you mean by the inside of the knee, whether you mean the inner margin of the pfj or medial line of the knee joint. if motivated, find a pic of a knee via google and draw an X on it where you feel the pain.
Better still.....take a selfie with your finger over the sore spot.

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Re: Patellofemoral syndrome - what worked for you?

Postby moosterbounce » Wed Apr 08, 2015 9:20 pm

If it helps, I once worked through "sore knee" type issues with my physio. I had weak glutes - addressed. Tight ITB and TFL - addressed. Patella tracking issues - mainly caused my ITB so addressed. For all of these I used massage, foam roller, kinesiology tape, stretches, strengthening exercises etc. I was a bit of a perfect storm apparently with a lot of different things going on. Anyway, although things were done to fix all the other bits, I was also told I most likely had a meniscus issue as I tested positive to one of the more common tests. MrI confirmed torn medial (inside) meniscus which hadn't caused a problem with riding...until I stopped and the muscle that was holding it together lessened. Oh and I'd partially torn my ACL which had self healed. Surgery was done and it was determined that I'd probably had this for 20 years. As CKinnard said, a simple knock when younger can rear it's ugly head when you get older.

Anyway, it all resolved after surgery and massage and strengthening and taping. When I ride I still tape occasionally, but that is only because I hate using the foam roller on the ITB!! I'm pretty convinced I walked "funny" due to the meniscus injury, but as it had been there so long, I assumed it was just me. Surgery did change my gait which helped come of my issues too.

Good luck with your quest.

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Thu Apr 09, 2015 7:09 am

I'm not sure what you mean by inner margin of the joint - I'm clearly not much of an anatomist - but I mean that the pain feels like it originates from the underside of my kneecap. And that spot is closer to the medial side. Does that make sense? I will work on getting a picture up.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Thu Apr 09, 2015 9:14 am

snafuspyramid wrote:I'm not sure what you mean by inner margin of the joint - I'm clearly not much of an anatomist - but I mean that the pain feels like it originates from the underside of my kneecap. And that spot is closer to the medial side. Does that make sense? I will work on getting a picture up.
ok, I think I understand what you mean. If the pain still feels very much like it is directly under the knee cap, but sometimes just a little inside of center, then it probably is PFJ cartilage pathology. Most often, the pain is outside center because VMO gets inhibited and vastus lateralis pulls the patella more so to the outside. If your feet pronate that also favors the patella moving laterally.

anyway, a good physio should be able to reproduce the pain by compressing and sliding the patella in different directions, and then tape the knee to unload the sore area.

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Tue Apr 14, 2015 11:40 am

What about exercises or stretching? Would that depend upon which muscles are identified as being weak? This page seems to give a good general program: http://www.ssmc.com.au/education/patell ... cises.html" onclick="window.open(this.href);return false;

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Tue Apr 14, 2015 2:01 pm

Which is not to dismiss taping, of course, but I think I am at the point where I can do most activities sensibly without discomfort - it's more about overcoming weakness and getting back to doing 3-4 hours in the saddle without issue

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Tue Apr 14, 2015 3:10 pm

Those exercises would be appropriate in earlier rehab. If your pain is settled mostly, and it's more a weakness thing, then you need to start grading the resistance upwards. Isometric exercises are appropriate for regaining strength with minimal irritation of underlying cartilage

i.e.
- body weight wall squat . hold for at least a minute, add dumbells or bar.
- isometrically hold a half squat under a smith machine or rack, and do shoulder presses or just statically hold the bar til failure.
- under the same equipment in a lunge position.
- knee extension work station. load the stack and get a mate to help you straighten your knees. then you have to hold your leg straight until failure when your mate takes the load.
- leg press rack, set the stop so your knee is 80degrees from straight, load the racks, push out 1-2 cm to take load on legs, and hold until failure and deep burning.
you can repeat to failure with these exercises up to 9 times. best to do no more than 3 to failure in a set, then move to another exercise for another part of body for 4-5 minutes. You are trying to tear the muscle slightly to release muscle enzymes that are a trigger for local muscle hypertrophy.

Don't do these more than 2-3 times a week.
They will hypertrophy your muscle very well, but won't do much for neuromotor compromise.
That comes later with more ballistic work.

If resistance work starts stirring pain again, go see a reputable sports physio. I haven't got a complete picture from what you have said, obviously.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu May 07, 2015 4:14 pm

I have just started having similar problems.

I am not sure what it is called and it is hard to pinpoint exactly where the soreness is coming from. The portion of my quad muscle just above the knee on the inside, seems to be very tender all the time. There is also a general ache in my knees and it seems to get worse when I am riding and increase the pedal load on my legs, like seated climbing.

I have been seeing a physio and chiropracter for some weeks now and been working on stretching my quads, hips, ITB, TFL and glutes to increase flexibility and loosen things up.

One thing that seems obvious is that I have recently got a new bike and new fit, where I was moved forwards by the fitter (specialized shop fit) because he believed I was riding too far back and was too glute dominant. So he lifted my seat and moved it forwards 20mm. My cleats were also moved back on my shoes and my heels rotated outwards as he said my heels were rotated too far inwards. I always thought that my legs followed a fairly straight pattern of rotation, I dont stick my knees out or anything like that. My stem has also been increased by 20mm too.

So basically I have been moved well forward 20 mm.

I am happy with the seat, bars position on the bike, it is actually very comfortable, however I am not sure about the cleat changes. Reading here I am starting to feel that the rotation changes, and I think he actually moved my cleats outwards a bit also, so my feet have been rotated toes more inwards, gone forwards on the pedals and been moved away from the BB. I think that maybe he has tried to fit my body to the bike rather than fit the bike to me. I am starting to think that maybe the rotation and move outwards is what may be causing my sore knees.

I have been and continue to ride 200-250 km per week and last season I raced, but I am not in the position to race at the moment, as this knee issue has slowed my riding, my passion and my ability to train. I have never had knee pain prior to this new fit.

Has anyone had a similar experience to this with a new bike fit?

I am thinking about rotating my cleats back a bit, so I bring my heels inwards again and move them back so my feet come back in towards the BB.

Thoughts? Ideas? Help?

Thanks

James

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Re: Patellofemoral syndrome - what worked for you?

Postby NeillS » Thu May 07, 2015 8:38 pm

Mate, you need a proper bike fit. PFJ pain on the bike is almost always from dropping the opposite hip - so if it's your left knee that hurts, you're typically dropping the right hip which forces the right knee closer to the top tube, and the left one further away from the top tube - challenging the plane of motion of the left knee. The solution is to find why the rider is dropping their opposite hip, which can be a bunch of different things including seat height, cleat position, improper wedging, improper cleat rotation, too much reach and drop to the bars, a functionally or structurally shorter leg.... the list is endless.

Rule number 1 of bike fitting is that anything which creates a challenge for you in a positional sense will always result in an increased tendency towards assymetry. Bike fitting is all about decompensating the rider as much as possible so that they are not having any difficulty holding the position. I spend my days fixing Retul and BG fit mistakes because you cannot use a computer to tell you why the person is functioning assymetrically - you can only observe that they are doing so in more detail.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Thu May 07, 2015 9:21 pm

Jumma wrote:Thoughts? Ideas? Help?

Thanks

James
If you have soreness just above the knee cap in the soft tissue, esp towards the inside, that's exactly where the quads tendon gets torn most.
It's very difficult to settle down while you are doing lots of k's.
After tearing the tendon there, VMO in particular is inhibited, and patella tracking will be compromised resulting in patellofemoral pain.

You say you are seeing a physio and chiro. What have they called your condition and what advice have they given re riding and your bike fit change?
If they haven't told you to cut your riding volume and intensity, or queried the applicability of your new bike fit, then I query their competence.
Radically changing bike position more often than not causes problems like this, which is why volume is usually cut drastically or the change is introduced slowly.

In my view, you need the following:
- regular aggressive icing in line with the sports medicine icing protocol.
- quads tendon unloading taping (not kinesio taping, at least initially).
- possible McConnell patella taping.
- possible derotating tibia taping.
- gait and cycling analysis for pronating midfoot, and query the need for orthotics.
- sufficient relative rest, which often involves at least a 50% reduction in knee usage.
- review of your nutrition, hydration, and sleep to ensure it's optimal for recovery from cycling and healing.

All other therapies are incidental to the above.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Fri May 08, 2015 8:04 am

Thanks Guys

Yes, I am definitely left leg dominant on the bike according to my vectors, typically I am around 54% LHS and 46% RHS, and it is fairly consistent. I can also force myself to be 50/50 by transferring my weight and holding both hands on the RHS of the bars (when on a trainer) and it will correct and get much closer to 50/50. I can also concentrate and load the RHS leg up more to bring it to 50/50, but it is not natural. The other thing I find consistently is that when riding on the road I always get numbness in my RHS hand only. I have to often shake it and get the blood flowing by sitting up etc. This is especially when pushing harder and having a go. I try to hold my hands so there are no pressure points, have looked at gloves, padding etc, to no avail and funnily enough it is only the RHS hand.

Yes, I have had a huge change in bike fit. My cleat adjustment is large, they came backwards on the shoe around 5-10mm, and they were rotated to rotate my heels, particularly my RHS heel outwards. I feel this is maybe what part of the problem is as this is trying to force my leg to track in an unnatural way - for my body. My seat was also moved forwards som 20mm and height adjusted based on % of inseam. Angles at body and knee checked and my stem length increased (reach) by 20mm forwards. My drop height from seat to tops, I cant remember but it is similar to what I have always had.

The thing is that I feel really comfortable on the bike, as in forward/rear position and the reach and drop I feel is perfect.

The bike is a Tarmac and I also notice that if I rotate my heels back in much that they get close to the rear chain stay, which is a concern.

The soreness at the moment is definitely most in the soft tissue at the top medial location of the quad muscle. However there is general "soreness" around the knee, which I cannot pin point. It is not bad, just annoying. It tends to improve once my knees warm up a bit and I spin lightly, but I would say that maybe that has to do with lubrication and blood flow improvement in the joint and tendons.

I have been using self massage with a sports massage oil and applying anti-inflammatory cream to the area. If I apply a heat pack it tends to feel better, soothing.

My phisio has recommended I see my bike fitter again and mention I am having problems with my knees since the fit. I am also seeing an ortho and they are having some orthotics made up for me to correct some over-pronation which makes my arches collapse a bit. This was going to be more for my running shoes, which I add, I have not done for a while, because of this issue also. As I originally though the running may have been the problem but it seems to be the same and be getting worse on the bike when I load the legs up. My physio is also treating my for very tight quads, glutes, hamstrings, ITB and sore TFL, ITB etc. The typical cycling stuff!

I have been checked for leg length and physio has not commented that I have any noticeable issue with discrepancies. The main comment has been to do with really bad tightness in muscles and tendons (quad, hamstrings, TFL, Glutes, ITB, hips in general), tight ankle angle (i.e. not a lot of flex). I have been doing strengthening exercises myself, including glutes, core and stretching quads, rolling, hip stretches (pigeon pose etc.), massage etc.

When I think about it now. I am a bit surprised a bike fitter would make such large changes in one step to a persons fit. The argument for moving me 20 mm forward was that he believed that I was riding very glute dominant. I never felt like I was but never questioned the fitter. He said I would produce more power in a forward position, with a balance between glutes and quads. Anyhow. I am going to talk to the bike fitter and discuss the issues. It was a 2 hour plus fit on a new bike, so there were quite a few adjustments.

In the mean time I have been staying away from the bike, which is very difficult for me to do, and it seems of late that everytime I start to get some volume and my training is getting back on track that something happens to slow it up - bad weather, family commitments, work and this knee problem :(

I have rotated my cleats back the other way, to where they were originally, though I have left them in the more rear wards position, so my foot is more forward than it use to be on my original bike fit. I have not ridden at all for a few days now, it has been windy as hell here, and the trainer is not enticing enough at the moment.

The orthotics are now in the works. I will ask about the taping and get the ice pack out. When I get back on the bike, hopefully this weekend I will try and keep the load off and spin. Mind you I normally ride with a high cadence and it is not unusual for me to naturally sit between the high 90's to 110 rpm on the flats, but lower on the hills.

I just hope this issue can be resolved quickly and easily without any long term issues. I am kind of hoping it is just a matter of adjusting my cleats and seat slightly.

Thanks to all.

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Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Sat May 09, 2015 2:31 pm

It is one month since my original post so I felt I should give an update.

I seem to be making good progress and have been steadily increasing my distances. Most of my rides are now over two hours and I don't have any trouble, provided I warm up, stretch and roll religiously.

Over the last month I have taken up the following routine.

-Foam roller, especially on my ITBs, different aspects of quads, and glutes.
-The following exercises -
-Squeezing a foam roller between my knees while seated (adductors).
-Very shallow one-legged squats with the non-working leg supported against a wall with the foam roller, ensuring that my hips remain level.
-Front leg raises, as shown in the earlier link I posted.
-Isometric quad exercise where you lie on the ground, lay one leg out straight and push it into the floor while monitoring the VMO contraction.
-Glute bridges.
-Religiously stretching quads, glutes, hips, calves and hamstrings.
-Icing and topic anti-inflammatory medication (or tiger balm) if my knee does play up.

I should add to this that I had a good bike fit done and quite intrusive orthotics made up. I wear them constantly (or a pair of over-the-counter orthotics from Athlete's foot, which work alright). Wearing runners as much as possible is really helpful too.

I'm not out of the woods yet and I still get a flare-up now and then - usually because I have spent too long sitting at a desk (the 'theatre-goer's sign") or because I have attempted an exercise that puts too much strain on the joint too soon (like wall-sits or step-downs). But I can certainly ride further and with better comfort than has been possible for a long time.

Oddly, there doesn't seem to be any particular connection between my cycling and my knee pain anymore. My knees were cranky on Wednesday, but I did some stretching and warming up and then rode for three hours - they felt much better after that and are still fine now (several rides later). Equally, I took almost six months with very little cycling in the hope that my knees would heal themselves - this didn't help at all (probably largely because I found it very difficult to motivate myself to do all the tedious physiotherapy exercises if I didn't have a big ride to look forward to).

I think it has been helpful that I've been doing all of my riding on my Surly LHT. Unlike my Orbea, the Surly isn't going anywhere fast no matter what I do, so it almost forces me to settle back and spin an easy gear (and be more attentive to my own comfort).

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Re: Patellofemoral syndrome - what worked for you?

Postby NeillS » Sat May 09, 2015 6:30 pm

Jumma wrote:Thanks Guys

Yes, I am definitely left leg dominant on the bike according to my vectors, typically I am around 54% LHS and 46% RHS, and it is fairly consistent. I can also force myself to be 50/50 by transferring my weight and holding both hands on the RHS of the bars (when on a trainer) and it will correct and get much closer to 50/50. I can also concentrate and load the RHS leg up more to bring it to 50/50, but it is not natural. The other thing I find consistently is that when riding on the road I always get numbness in my RHS hand only. I have to often shake it and get the blood flowing by sitting up etc. This is especially when pushing harder and having a go. I try to hold my hands so there are no pressure points, have looked at gloves, padding etc, to no avail and funnily enough it is only the RHS hand.

Yes, I have had a huge change in bike fit. My cleat adjustment is large, they came backwards on the shoe around 5-10mm, and they were rotated to rotate my heels, particularly my RHS heel outwards. I feel this is maybe what part of the problem is as this is trying to force my leg to track in an unnatural way - for my body. My seat was also moved forwards som 20mm and height adjusted based on % of inseam. Angles at body and knee checked and my stem length increased (reach) by 20mm forwards. My drop height from seat to tops, I cant remember but it is similar to what I have always had.

The thing is that I feel really comfortable on the bike, as in forward/rear position and the reach and drop I feel is perfect.

The bike is a Tarmac and I also notice that if I rotate my heels back in much that they get close to the rear chain stay, which is a concern.

The soreness at the moment is definitely most in the soft tissue at the top medial location of the quad muscle. However there is general "soreness" around the knee, which I cannot pin point. It is not bad, just annoying. It tends to improve once my knees warm up a bit and I spin lightly, but I would say that maybe that has to do with lubrication and blood flow improvement in the joint and tendons.

I have been using self massage with a sports massage oil and applying anti-inflammatory cream to the area. If I apply a heat pack it tends to feel better, soothing.

My phisio has recommended I see my bike fitter again and mention I am having problems with my knees since the fit. I am also seeing an ortho and they are having some orthotics made up for me to correct some over-pronation which makes my arches collapse a bit. This was going to be more for my running shoes, which I add, I have not done for a while, because of this issue also. As I originally though the running may have been the problem but it seems to be the same and be getting worse on the bike when I load the legs up. My physio is also treating my for very tight quads, glutes, hamstrings, ITB and sore TFL, ITB etc. The typical cycling stuff!

I have been checked for leg length and physio has not commented that I have any noticeable issue with discrepancies. The main comment has been to do with really bad tightness in muscles and tendons (quad, hamstrings, TFL, Glutes, ITB, hips in general), tight ankle angle (i.e. not a lot of flex). I have been doing strengthening exercises myself, including glutes, core and stretching quads, rolling, hip stretches (pigeon pose etc.), massage etc.

When I think about it now. I am a bit surprised a bike fitter would make such large changes in one step to a persons fit. The argument for moving me 20 mm forward was that he believed that I was riding very glute dominant. I never felt like I was but never questioned the fitter. He said I would produce more power in a forward position, with a balance between glutes and quads. Anyhow. I am going to talk to the bike fitter and discuss the issues. It was a 2 hour plus fit on a new bike, so there were quite a few adjustments.

In the mean time I have been staying away from the bike, which is very difficult for me to do, and it seems of late that everytime I start to get some volume and my training is getting back on track that something happens to slow it up - bad weather, family commitments, work and this knee problem :(

I have rotated my cleats back the other way, to where they were originally, though I have left them in the more rear wards position, so my foot is more forward than it use to be on my original bike fit. I have not ridden at all for a few days now, it has been windy as hell here, and the trainer is not enticing enough at the moment.

The orthotics are now in the works. I will ask about the taping and get the ice pack out. When I get back on the bike, hopefully this weekend I will try and keep the load off and spin. Mind you I normally ride with a high cadence and it is not unusual for me to naturally sit between the high 90's to 110 rpm on the flats, but lower on the hills.

I just hope this issue can be resolved quickly and easily without any long term issues. I am kind of hoping it is just a matter of adjusting my cleats and seat slightly.

Thanks to all.

Everything you say makes me think you are dropping the right hip to protect that side (90% of riders will protect and favour the right side unconsciously whenever there is a positional challenge), which is forcing the left knee outwards. Loading the right hand excessively also backs this up.

Seriously, I would just get a decent bike fit first. They are hard to come by. Sturgeon's Law; 90% of everything is cr@p. You've managed to find one of those 90%.

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Jumma
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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Sun May 10, 2015 4:05 pm

Ok. Thanks for the replies. I went back to the original fitter.

The fit I got, I am told, is not a full Specialised BG fit or whatever they call it. It was basically 95% of it. I was checked the other day and it was noted that my feet point outwards a bit but not excessively. My cleats were once again adjusted and float checked. I also had some wedges (2 in each shoe) inserted inside of my shoes at the front to help rotate my foot back in plane and help keep the forces through my knee in line.

My seat height and position were also checked and my seat was moved back 5 mm. I was told I could keep it where it was, but I wanted it moved back a little.

I have since been for a 40 km or so ride into a hard wind with some fairly good efforts and did not seem to have any problems with the knee at all.

I have also been using some anti-inflamatories along with some topical cream applied to the sore muscle area at the end of the quad at the medial location, where there seems to be more soreness. Actually I am noticing that the soreness is more in that location and slightly further up the insides of my legs, quads, on my inner thighs. Quite tender there just up from the knees.

Time will tell now with some longer rides 100 km plus. I also have orthotics on the way to help with arch support, for cycling and more running when I get back into that eventually. I over pronate a bit.

As for the imbalance, L to R I will keep an eye on that and if it is causing trouble I will pursue this. I think the biggest issue I am having from this is probably as you said the LHS ITB being sore, higher power on LHS leg and more pressure on the RHS hand on the bars.

I live South of Sydney, About 80 km. Problem is I would not have the faintest idea on where to go for a bike fit and who is good or bad. They are generally pretty expensive from what I understand. I know there is a guy called Steve Hogg in Sydney who is supposed to be good, but I also here he charges big $ for a fit and then does the big on-sell also!!

Cheers

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snafuspyramid
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Joined: Sun Oct 17, 2010 11:03 am

Re: Patellofemoral syndrome - what worked for you?

Postby snafuspyramid » Sun May 10, 2015 7:48 pm

.

NeillS
Posts: 184
Joined: Mon Jan 17, 2011 4:28 pm

Re: Patellofemoral syndrome - what worked for you?

Postby NeillS » Mon May 11, 2015 1:24 pm

Steve will sort it out. And if he doesn't, he will give you your money back - nothing to lose really. He doesn't really up-sell anything, unless you're buying a custom frame.

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