I have Patelofemoral Pain Syndrome

[cbrunny]

https://en.wikipedia.org/wiki/Patellofemoral_pain_syndrome

Diagnosed by my PT. Getting it treated. Apparently the treatment is strengthening of the glutes, so I'm workin on gettin buns o steel. Apparently my quads are too strong relative to my glutes which means when I put power through my knees (cycling) the femur isn't kept in place properly, rubs against the soft tissues behind the patella, and over the course of many revs, becomes inflamed and damaged.

Hoping it goes away soon. Need to keep working out. I've gained weight! I lack willpower. Need to work on my diet some more. Also fitness. There's that.

I don't think mine is that bad though. Been in pain for 5-6wks now, but really agressively treating it on my own for about half that time, then decided I need PT help to treat it more. Hoping to be back running & cycling before the new year. I have a gait analysis and a bike analysis (fit by a PT) scheduled for later this month.

Pretty sure it was caused by a poor bike set up. I got new pedals which surprisingly screwed up my entire bike fit, and in fixing this on my own I set it up with my seat too far forward, which transfers almost the entire load onto the quads, and in particular the VMO. So my glutes weren't able to function properly. This likely started the damage, then switching onto the treadmill (used to running outside) broke the rest. Either that or I'm just trash. haha

Tip: if your knees hurt, stop what you're doing.

 

[highland145]

Did PT last year for the knee. Several things wrong for me but, apparently, the glute not activating is not uncommon. And when it "gets away with" not working, it doesn't magically start back up because other muscles took over.

 

[vi edit]

Stretch your calves and hamstrings well. That's what ultimately got me past mine.

 

[mike8675309]

A common enough problem that there are physical therapists who have shown various exercises for activating glutes available online.
https://youtu.be/pRKvszxpSSs

 

[cbrunny]

So the pain is "changing"

I've been doing all the PT stuff very diligently and have continued my daily stretching. I've followed the PT's advice and have not run or cycled (bike being the thing that likely caused it due to poor set up. I think I addressed that in the OP.) but I have swam twice. Each swim was a typical workout, meaning I wasn't going lightly. After both I experienced some knee pain, so I'm now stopping that too. It's now been 4 days since I swam last, 17 since my last run (30 mins; before that was 12 days prior for 10 mins), and 16 days since my last ride. Lots of rest and recovery.

The pain "as it was" is almost completely gone now. I don't feel the pain in behind the kneecap on a day-to-day basis, which is where it was before. I do still feel it when going up stairs but not consistently and only a small amount of pain. But now I feel it on the top of the kneecap. And it is now also sore to the touch. It still hurts to put power through it (stairs). But it definitely now feels more like a tendinitis type pain than the PTFS. I can massage the areas around the patella, the muscles/tendons, and it provides some relief as well. Strange. I'm not sure what might be causing this. Maybe my patella has been tracking wrong for a looong time, and now that it might be tracking better the tendons are now required to stretch in a different, more biomechanically sound way. that's my best guess, cause I sure as hell haven't aggravated it otherwise. This to the touch pain is quite new - ~48 hours.

Obviously i'm not going to change what I'm doing without talking to my PT. Go back tomorrow, will see what she says.

 

[cbrunny]

Pt says it's probably a good thing & to keep doing what I'm doing. I'm also very inflexible.

 

[cbrunny]

been doing as I'm told for the last few weeks. today I ran at the PT office for the first time in a month. Pain free. Now I have a plan to get back to form over the next few weeks. If all goes well I'll be at 5k before end of january, and should be able to ramp upwards from there.

Apparently I have very weak glutes too.

 

[cbrunny]

This sucks. Still in pain a month later. Making progress but damn progress is slow on this one. Seems like even spending 30 minutes doing a thorough stretch can make this inflame. Frustrating.

I've had the PT do a proper bike fit, which should help. I should be able to spin and work my glutes, help build some balance in those muscles. Hopefully. Don't want to make it worse though.

 

[mike8675309]

Seems like even spending 30 minutes doing a thorough stretch can make this inflame. Frustrating.

What exactly are you stretching for 30 minutes that would inflame your patella? Perhaps you are spending too much time stretching.

 

[cbrunny]

What exactly are you stretching for 30 minutes that would inflame your patella? Perhaps you are spending too much time stretching.

I do this:

It's a good stretch session that targets the major muscle groups that I use most. There's a few stretches that I suspect might be making things worse, but it could also be something as simple as rolling around on the floor like that, on my knees, transitioning from one to the next.

 

[mike8675309]

I do this:

It's a good stretch session that targets the major muscle groups that I use most. There's a few stretches that I suspect might be making things worse, but it could also be something as simple as rolling around on the floor like that, on my knees, transitioning from one to the next.

I would avoid any knee stretches, or those involving your hamstrings. I would show this to your physical therapist and get their thoughts on it. Note that static stretching is generally not recommended any longer for us in general workouts. Statically it has been found to have no benefit, and have some negative consequences.

 

[cbrunny]

PT said stretch hammys and calfs thoroughly, and work the glutes. I'm very inflexible, and its been recommended to me that I work to become more flexible more times than I can count.

The knee stretches are the ones that I think really got me again. PT didn't say not to do it, and did tell me to get more flexible. They've been quite thorough on instructions on other things so I assumed the same level of detail here too. Oh well. I'll just avoid the knee stretches and keep working my hams and calves.

 

[cbrunny]

Following PT advice, I did a light 20 minute spin yesterday at roughly 50 to 60 %FTP. After about 12 minutes I was hurting in the knee more than expected, slowed down, and for the last few minutes i just very slowly spun at about 30 to 40 rpm. I thought for sure I'd be hurting like a mofo today, off it with no exercise for another week at least.

The opposite of that happened. After the ride, I iced immediately and took ibuprofen. rested with straight leg for the rest of the evening and went to bed early, feeling like garbage. solid nights sleep. Woke up to no discomfort in the knee (until I went down stairs), and only very mild discomfort right now - and in different places than I was feeling yesterday. Less discomfort and stronger feel through the knee overall. feeling optimistic!

 

[highland145]

Without reading the thread, any other cardio? I have to switch up bike/elliptical to keep the knees/hips/feet/...somewhat happy.

 

[cbrunny]

Without reading the thread, any other cardio? I have to switch up bike/elliptical to keep the knees/hips/feet/...somewhat happy.

well when I'm healthy I am a triathlete. Did a half-ironman last summer.

Lately I'm just getting fat

 

[highland145]

And old....

 

[cbrunny]

And old....

hey! I'm only 30.

 

[highland145]

30...those were the days. The best shape of my life. The day I got married (32) I was 193lbs, <10% body fat. My MTB route 17mph+ average. Now (52), 198lbs, haven't lifted in 3 years because of the bicep tendon I just had fixed. And the same route...15.3 average. I'm probably in better shape than 90% of the people my age which should really suck for them.

 

[cbrunny]

Ok, so i've stopped the knee stretches. Now doing standing stretches for hams and calves 2-3 times a day. Cycling on a proper fitted bike 20-30 mins every other day (I've only completed three rides). During the rides I'm feeling discomfort but only in the muscles around the knee, as if they have to re-lengthen or re-attach properly. Vastus Medialus and tibialis anterior in particular. No grinding in the knee and no pain within the knee. The cycling is helping to re-establish a muscle balance in my hams and glutes. And it is working. Just frigging slow. I've now been "out" since Nov 22, and just now having the soft tissues in position to do some proper rehabing. I have also started some self-massaging of my quads and calves every day. I do not think this is actually doing anything helpful though.

I'm also going to see a second Dr. today about this as I'm starting to get fed up. Want to see if anything I can do will make this go faster, or if perhaps I'm doing things wrong still. Almost two full months out of the game, I could have broken a limb and had it heal by now.

 

[vi edit]

. I have also started some self-massaging of my quads and calves every day. I do not think this is actually doing anything helpful though..

Do you foam roll?

 

[cbrunny]

Do you foam roll?

I did. But after doing it for a while I was convinced that it was actually causing more harm than good. It seemed like days that I would foam roll, the knee pain would be worse the next day. I haven't rolled my quads in two or three weeks now though.

 

[mike8675309]

Massage will help if needed. It will causes the body to move some extra blood into the area thinking it needs some work. If it did need work, that will help. If it didn't need help it won't hurt.

 

[cbrunny]

Went back to my Chiro that specializes in sports and sports injury. He is an elite duathlete on his own, far more successful than I am.

Wow. I should have went there first. He said that what I've done so far to recover is good, and to keep doing it for the most part. But he was able to identify an entire muscle group that was out of balance, by a LOT, and that's probably causing the problem to continue. In reflection, this all makes sense, because in my first several rides of the season at a higher intensity, this is the muscle group that forces me to stop most often. Actually, not even through the start. Through the whole season. And I didn't even think about it, neither did the PTs I've been working with at the other spot. He flushed the fluid from my knee and did some very painful stuff to that muscle group. It's the adductors that are the problem. He said my abductors are strong but the adductors are significantly weaker. from the knee down looks good - so it isn't a form issue - so it is most likely the adductors. Makes so much sense to me now.

And he told me I should start swimming immediately. So I did that yesterday too. Damn I love swimming.Knocked out a short 1500m workout and felt great. First swim since November! I'll be back to my usual 12km/wk in no time there.

Damn I love doctors.

 

[mike8675309]

Hmm, when doing adductor lifts I am about 70lbs below my abductor weights. Both are pretty strong, but the adductors generally have always trailed.

 

[cbrunny]

Hmm, when doing adductor lifts I am about 70lbs below my abductor weights. Both are pretty strong, but the adductors generally have always trailed.

he didn't do any actual quant measurement but in the test he said I was barely putting any force into his hands before I had to stop because it hurt so bad. Repeated the test twice with the same result.