Patellofemoral syndrome - what worked for you?

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mechanics
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Re: Patellofemoral syndrome - what worked for you?

Postby mechanics » Tue May 26, 2015 1:09 pm

Physical therapy uses stationary bike for recovering from injuries. It's safe for those with bad knees, back, or hips.
Best indoor cycling bikes will help you get in great shape by the same means as those bikes you find in the gyms.

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Re: Patellofemoral syndrome - what worked for you?

Postby User Name » Wed Aug 19, 2015 8:57 pm

I've had several minor to moderate knee problems over the years (some persistent, including a nasty bout of chondromalacia about 20 years ago), and the best thing for my knees is straight leg raises with very light weights

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Jumma
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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu Aug 20, 2015 8:25 am

Back on the bike and 3 weeks of successful build so far with little problem. I got a second opinion and was told by physio that my knees are fine and I just need to do more squats and stretching along with hip opening exercises. So doing body weight squats and I do believe most of my problem is from the VMO muscle. Squats help some here. Other issue was probably over use I.e too much too soon. Good so far though.

I'd say +1 for the leg raises as they do work the VMO and quads.

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Re: Patellofemoral syndrome - what worked for you?

Postby User Name » Fri Aug 21, 2015 9:52 pm

The medialis is tricky to target, let alone isolate. I'm considering getting a electro stimulator (tens machine) to target them.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Sun Aug 23, 2015 10:44 pm

The best way to fire up VMO ime is by using a seated leg extension machine.
Unlike during squats, Vastus lateralis, hip abductors, gluts are not recruited as strongly or at all.
Rectus femoris is also put into a shortened position with the hip flexed 90degrees...so VM/VMO play a more prominent role in knee extension.

VMO load can be increased further by externally rotating the hip jt slightly before starting knee extension.
How does this work?
VMO originates partially off the adductor magnus tendon, and these have a synergist association. Loading adductor magnus recruits VMO.
Further, adductor mag in many individuals will fire when the knee's medial collateral ligament is tensioned, which happens when doing knee extensions with the hip externally rotated slightly.

The trick is to focus on inner range knee extensions, as if you are trying to hyperextend the knee.
Pause in hyper-extension, then do a slow eccentric. This canes VMO.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu Aug 27, 2015 3:48 pm

I still find I get a lot of soreness in my left VMO. Very tender to press just left and above left knee. I also feel it there as soon as I load up the legs on the bike. Especially in seated position.
I'll keep up the stretches and strength exercises.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Thu Aug 27, 2015 5:58 pm

Jumma wrote:I still find I get a lot of soreness in my left VMO. Very tender to press just left and above left knee. I also feel it there as soon as I load up the legs on the bike. Especially in seated position.
I'll keep up the stretches and strength exercises.
VMO is just right and above the left knee.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu Aug 27, 2015 7:19 pm

Inside and above knee?

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Thu Aug 27, 2015 7:36 pm

Image

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Jumma
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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu Aug 27, 2015 7:47 pm

Yeah. That's the one. It is really tender near the knee at the VMO.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Thu Aug 27, 2015 10:52 pm

Jumma wrote:Yeah. That's the one. It is really tender near the knee at the VMO.
possibly quadriceps tendonitis

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Thu Dec 10, 2015 8:33 pm

I have noticed that when I do something like squats that I have ended up with a sharp pain in the lateral side of my knee when walking up stairs (90 degree bend to straight) that does improve with some work on the roller over the ITB near the knee. I have also had a similar sharp pain at the medial side of the knee when walking up stairs the same. It is more liked to the VMO and goes away after a light ride. Not sure what it is! But seems a little intermittent.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Sat Dec 12, 2015 3:28 pm

Follow up. A couple of days later and a big ride and all problems gone. Sure I am still a little tender around the VMO but no sharp pains when going up stairs. weird!!

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Sun Jan 31, 2016 8:03 am

Another update!
After the soreness in the VMO and tenderness around the Adductors and generally around the inside of the knees (mostly RHS) I decided to forget about physio and go see a real sports medicine doctor. I requested an MRI and results.....
Damage to the cartilage to the inner side of the knee joint - upper condyle and some damaged fibres to the inner side of the lower patellar tendon, some blistering under the patellar cap. This was found on RHS only as it was only side done in MRI. So there we go!
This explains why I am getting soreness after loading up and being held back in my training.
Just thought I would update for others out there. It may be worth an MRI.
I am now off to a specialist in Sydney for likely arthroscopy and some repair and recovery work. Not sure how the damage has happened however I have always done some running in the past on and off. Nothing more than 15km generally and all on pavements. Apparently can be result of compression in the joint. This may be from excessive loading of the knee on the bike I guess also. I.e. Big hill efforts, sprints and the like!?!?
Anyhow- I will update on what results with specialist for those who may have similar issues.

A bit devastating because now I am worried that I won't be able to ride anymore and if I can then it will be on flats only, no racing, no training and no 30 plus average paces!!!! :(
Cheers
James

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Fri Feb 05, 2016 5:04 pm

Update!

So went to see specialist with very good record, qualifications and so on in Sydney and he said I have normal cartilage degeneration, actually, he said my knees were very good considering age and what I do. So he said I don't need any surgery or arthroscopy and suggested some more physio and some patellar taping to the medial side. Something about the taping for the medial retinaculum on the RHS knee, which is the connective tissue to the medial side of the knee.

I am off to the physio next week with a letter from the specialist to get some specific treatment. This time I am seeing a more cycling specific experienced physio so hopefully that along with the direction from specialist will help.

Anyhow, I am relieved there is no surgery required. I guess I need to stretch more and I have not tried taping with any of the physios that I have been to so far, so that is a new suggestion.

I am allowed to ride, so that is good.

Cheers

James

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Re: Patellofemoral syndrome - what worked for you?

Postby princessbumblebee » Sat Feb 06, 2016 9:14 pm

Glad it's working out well for you. I guess the MRI was worth the cost in that case (the main thing putting me off getting one...)

I've used comfrey (Flexagil) for VMO tendinitis and it helped.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Sat Feb 06, 2016 9:56 pm

Yeah. Not sure if it's all solved yet. But hopefully progressing. MRI was free - Medicare for knees!! I'll check out flexagil. I'll also update after Physio.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Mon Feb 08, 2016 7:32 pm

Jumma wrote:Yeah. Not sure if it's all solved yet. But hopefully progressing. MRI was free - Medicare for knees!! I'll check out flexagil. I'll also update after Physio.
based on your symptoms reported above, your sports physician rorted medicare by bulk billing that mri, and considering he is at odds with the orthopedic surgeon re your need for surgery.....hmmm.

As I posted earlier in a reply to you, my thoughts are aligned with the surgeon's.
viewtopic.php?f=49&t=83455#p1252727" onclick="window.open(this.href);return false;
You need to unload the inside part of your knee and VMO, so your capacity to heal does not keep being overwhelmed by your activities.

Obviously, reducing the strain you put through your knee from cycling and running will also help.
As usual, optimal hydration, nutrition, sleep, and stress management are key factors to healing.

Considering you have been suffering for 10 months from this condition, I think it can be said you are not resting it adequately.
Hence it is inappropriate to do specific strengthening exercises for the knee extensors.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Mon Feb 08, 2016 8:59 pm

Physician did not bull bill as far as I understand. The radiologist did. I made no requests either way myself. I just requested that an MRI be done.

I must have missed that earlier post of yours. It makes sense. Thanks.

The physician based his call on the results of the radiologist report. He suggested I may need arthroscopy but it was not definite but leaning towards it.

Surgeon obviously did not see the value or need and made his own call etc.

Anyhow. Hopefully the taping will help coupled with some easier riding and minimal efforts for the next few weeks.

I have been trying to hydrate well and using some electrolytes after and on longer rides. I always eat carbs and protein after rides to rebuild and restore. Including protein powders, fruits, almonds, almond milk etc.

I will update on how it progresses for those that may find value, hope or answers from my findings.

Thanks to all help and responses to date.

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Re: Patellofemoral syndrome - what worked for you?

Postby rodneycc » Mon Feb 08, 2016 10:02 pm

Got a quick question. How far away is that medial ligament and this inside quad ligament as is suggested here. I have a small niggle in a similar sounding spot which is a bit of a weakness. More of a niggle than bad enough to see the doc and I've pretty much put it down to a slight medial strain a while back and got a bit of arthritis in it.
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Patellofemoral syndrome - what worked for you?

Postby Jumma » Tue Feb 09, 2016 10:15 am

The medial referred to here is the attachment of the VMO into the ligament structure that connects the VMO into the knee structure. Not sure on exact name of the top of my head. There is also the medial cruciate which is more to the medial side of the knee. It is like a stabilising ligament. I understand the only muscle to connect to the knee and the hip via ligaments is the middle quadricep (vastus medialus)?

From what I understand now, my issue is imbalance between legs (left is larger and stronger than right) an overuse injury has occured on my RHS around the site of the VMO as it would seem. Part of the whole issue is soreness coming from the medial side of the patellar, perhaps coming out of alignment and rubbing or contacting with the medial side of the knee (trochlear groove).

I also have had soreness on the LHS leg at the location of the VMO and adductor muscles similar to the RHS but not as bad and not lingering as much.

I am hoping some reduced loading (less volume and lower load) coupled with some taping will help to solve the issue. I have had this issue on and off for a while, starting with a bike change, positional change and still maintaining high volume (for me) 250-300 km per week with probably too many hard efforts and big climbs. I need to learn to go slower, which I have been doing recently. It is very hard to do and I would have to say going slower (25-26 kph averages) is harder to do than going fast (30 plus averages for me). At the moment recovery is more important I guess.

I probably need to do some RHS leg specific exercises, to try and balance the strengths between the two sides once things are getting better to help stop it happening again.

My VMO is well developed and strong I am told, it is firing well, but I do have a very poor dorsiflexion angle in my ankles, so I am also working on this at the moment to try and improve this angle.

Anyhow - physio tomorrow, taping and hopefully some more answers and a plan and solution.

Hope this helps you a bit to isolate your issue.

James

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Tue Feb 09, 2016 6:24 pm

Jumma wrote:Physician did not bull bill as far as I understand. The radiologist did. I made no requests either way myself. I just requested that an MRI be done.

I must have missed that earlier post of yours. It makes sense. Thanks.

The physician based his call on the results of the radiologist report. He suggested I may need arthroscopy but it was not definite but leaning towards it.

Surgeon obviously did not see the value or need and made his own call etc.

Anyhow. Hopefully the taping will help coupled with some easier riding and minimal efforts for the next few weeks.

I have been trying to hydrate well and using some electrolytes after and on longer rides. I always eat carbs and protein after rides to rebuild and restore. Including protein powders, fruits, almonds, almond milk etc.

I will update on how it progresses for those that may find value, hope or answers from my findings.

Thanks to all help and responses to date.
Re the mri bill, yes the radiologist generates it, but whether it is bulk billable is based on the wording of the sports doctor's request.
Regarding your diet, I'd suggest you get familiar with the AUstralian Dietary Guidelines, especially in relation to intake of vegetables/salad and fruit. This stuff is underconsumed by 98% of Australians, and yet ime and that of other sports health pros i know, it makes the biggest difference to recovery from chronic overuse conditions.
You might also get your physio to inspect your foot arches, as a collapsing arch will contribute to knee pain and VMO strain.
Regarding your limited ankle dorsiflexion, that might be due to previous ankle damage and can be really difficult to correct due to bony adaptation. Reduced ankle DF will lead to greater knee flexion which may be contributing to VMO strain. But your bike fitter should have picked all that up.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Tue Feb 09, 2016 7:08 pm

Ok.

I eat tonnes of vegetables, fruit and salad. I love spinach, broccoli, Brussel sprouts and all Vegetables. I eat at least 4-5 pieces of fruit per day, including seasonal fruits at the moment peaches, mangoes, apples, plums. I love dried prunes, and eat almonds every day. I drink 4-5 600 ml bottles of filtered water a day at work. I don't drink much in the way of alcohol or sugar drinks. Maybe one or Two cans of Coke per week and that's it. I agree and do understand the effect of poor diet and antioxidants etc. so I take that on board.

I have orthotics for my running shoes for over pronation. I also wedge my riding shoes to help support my arches. I have the intermediate (blue) arch support in my sworks shoes and medium wedge under arch in my heat Moulded Shimano 320s. This I feel helps with my alignment and reduces inward bend stresses at the medial side of the knees.

Have also been wondering about Q angle too. Have heard some successes from pedal extenders etc.

I have always been a toe walker from childhood not sure how I fix that but I am trying my best to stretch the calves and hamstrings to improve flexibility.

I also try to keep the heels down in pedalling as suggested by fitter and I do have a pretty smooth pedal style I.e. Use all muscle groups through the revolution - push over the top, down power stroke, drag back at bottom and pull up with hamstrings and repeat.

Anyhow. Thanks for your input. Any information helps solve the puzzle.

I am starting to develop a good understanding of my own anatomy at least and how it behaves, weaknesses etc.

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Re: Patellofemoral syndrome - what worked for you?

Postby CKinnard » Wed Feb 10, 2016 7:26 am

ok, your diet sounds pretty good. a minimum 5 cups a day of veges/salad and 2 cups of fruit is the dietary recommendation.

the toe walking thing is interesting. if it is very pronounced, it is possible it is due to a hypoxic central nervous system event i.e. during birth.
I currently have a 10 year old client with the same thing. He also is hyperactive with frequent poor impulse control. This can also be an effect of minimal brain injury during delivery, or as an adverse reaction to vaccinations.

what's this got to do with your quads? toe walking is indicative of excessive lower limb extensor muscle tone. often if the calf muscles are hypertonic, other limb extensors will be too, like the gluts and quads. hypertonic muscle effect may be very subtle, and not noticeable generally. however it can influence the quality of rest and recovery in two ways - the muscles never fully relax, therefore healing is compromised. nerves that control blood flow through the muscle during rest are compromised so that blood flow is not optimal.

a similar effect is possible if you have compromise of nerves in your lumbar spine, such as with a herniated disc or spondylolisthesis.

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Re: Patellofemoral syndrome - what worked for you?

Postby Jumma » Wed Feb 10, 2016 10:32 am

Yeah I have always walked forward stance. Puts a spring in my step and I can sneak around very stealth like :)

I will ask my Physio about this when I see him.

The interesting thing is when I had my bike fit, as mentioned before, I was moved forwards a lot compared to my previous position on the TCR. 20mm in the seat position and my cleats were moved towards my heels, away from my toes by some 5-10mm if I recall correctly.

I have adjusted this back some to more comfortable position, I have also rotated them as per my natural stance a while ago as they were trying to twist my feet, toes in, when I am naturally a little toes out. This can cause problems as my heels can get close to the stays and crank arms due to the standard Q factor on the compact DA cranks. I think I have this all dialled in now. Well it feels ok and doesn't feel like it's causing twist or strain to the knees.

I have also moved the seat back at least 10mm or more, so closer to my original position vi have rotated the 120mm stem over to angle up, improving my reach as I was feeling like I was tending to hold the bars a little back from the hoods. I am actually thinking of getting myself a 90mm -100mm stem and replacing the existing with the angle down, so the drop height is still lower but closer to me in the current position. I run a 90mm stem on my TCR BTW and it is comfortable even with a slightly longer top tube (about 5-10mm).

I have positioned my seat height and have a plumb line between top of TB and meta tarsal, line where cleats are and spindle.

I have a nice angle in leg at full extension and height is good and comfortable. Feels good in a tempo and when spinning at 100-110 rpm for extended periods.

I was thinking that maybe pedal extenders might help get my ankles a little further from the stays and increase my Q distance and help with the soreness in my Adductors which connect into the VMO as I am thinking that maybe I am overusing them to maintain a straight line power chain throwing hips, knees, ankles etc!?!?

I don't have back problems however I am lacking an arse, flat butt, never have had much of one. I do also get sore lower back when standing a lot or walking around for extended periods. I think that's maybe part of tight glutes, hamstrings, calves and so on.

I can touch my toes quite easy and actually almost place my palms on the ground in front of me with straight knees, so not sure if that means my hamstrings are tight. But I am told they are.

Will see what happens with taping next.

Thanks again for your reply.

James

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