I have Patelofemoral Pain Syndrome

[x26]

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.

Pics of Buns or it Didn't Happen??

 

[cbrunny]

Pics of Buns or it Didn't Happen??

I just took this one:

Got my physio plan from the good Dr. Damn. He has me doing a ton of stuff thats far above and beyond what the PT was doing. Been a few days and I'm noticing improvements. And I'm noticing pain in my muscles from the work lol. Sitting on the couch does not give you strong glutes, I've learned. My adductors are sore today - first time for that. Not fun. But it means i'm doing something right. Knee pain is at an all time low since this started too. Progress!

 

[x26]

I just took this one:

Got my physio plan from the good Dr. Damn. He has me doing a ton of stuff thats far above and beyond what the PT was doing. Been a few days and I'm noticing improvements. And I'm noticing pain in my muscles from the work lol. Sitting on the couch does not give you strong glutes, I've learned. My adductors are sore today - first time for that. Not fun. But it means i'm doing something right. Knee pain is at an all time low since this started too. Progress!

 

[cbrunny]

Very much good progress. on my way towards pain free. cycling every other day, swimming every other day, and doc says I can start running again on Monday. back-to-run program, but still, very excited.

 

[sd5500]

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.

As a competing cyclist and ex-PT, make sure you stretch your IT Band. That is commonly overlooked, but a big contributor to PFPS.

 

[cbrunny]

I ran yesterday!

Only 4 x 2/1 for 8 mins of running but still. Some pain, but not much. Felt much better than when I ran last (Dec 22).

The last few days I've had slightly more pain than usual lately. I think that's because i've been more active though and its just inflamed a bit. On Saturday I cleaned out my basement and sunday I was also very active around the house. Also Sunday rode harder than I have since I've been injured, which also inflamed it a bit. Monday morning I got curious and started googling to see if I could at least see where/what hurt. The pain, albeit mostly minor, was literally the exact shape of my VMO muscle. That evening I massaged the shit out of it all the way up my leg, and that's just about as close as I have ever been to instant pain relief. There's still some damage under the patella that needs healing, i can feel it. But the pain in my VMO went away basically immediately. So I spent 10 mins this morning and did the same thing. Gonna try that for a few days. Feels great today though.

Ride & swim tonight, run again tomorrow (6 x 2/1), doc on Thursday. All good news I think.

 

[cbrunny]

Can't help but be frustrated by this injury. I have been two steps forward one step back for over two months now. I am swimming normally, but biking and running are still in "back to bike" and "back to run" plans, and holy hell its frustrating. 5 runs in (every other day), but I've been biking for 30 mins every other day for a few weeks now. Morning pain is unchanged and its friggin demotivating to wake up to aches every day. I think I'm making forward progress over time but the progress is so slow that it's basically impossible to tell. The running feels mostly good once I get warmed up, but I feel tugging on those tight muscles while warming up... not good.

My adductors, which were very weak, are now much stronger - certainly strong enough to keep the patella tracking properly. Dr tested that last time I saw him. But they are so inflexible that I think it's still a problem. Going to start stretching the adductor region - in particular my gracilis - multiple times daily and hope it creates some positive impacts. Still doing the physio exercises too as per Dr. orders.

 

[cbrunny]

Saw Dr. again today. He says I'm making good progress. Have improved flexibility slightly, now into the normal range for most muscles including hams, calves, quads, IT band, abductors. Adductors could use a bit more work but I've been emphasizing them lately with good results. Dr talked to me about this a bit today.

Did a two week back to run plan, and now am moving on to a three week back to run plan. Going to increase slowly my time biking as well over the next three weeks. Hopefully by second week of march I'm able to do 4hrs run/4hrs bike/4hrs swim each week. That should set me up rather well for this season I think. Tentative first event is Jul 9... long way to go.

 

[cbrunny]

Still long way to go. Swimming is fine - I'm pretty well back on track there. Cycling I've extended my workouts to 60 mins but still relatively low intensity - should be about 10% more intense than I'm currently doing but it will come. Going to do three or four more rides at that length & intensity before ramping that up, but expecting a good result there. No indication that I'm moving backwards on either of these disciplines.

Running - ran a solid 5K for the first time two days ago. Today I run a solid 6K after work. I think its going well but its so hard to tell. Incremental healing is in very small increments. It is not like cutting a finger and watching the cut heal. My muscles are trying to get back to running elasticity/durability, and even on short duration I'm finding the next day has more pain than expected. Even so, I'm at a low point in the pain since the injury hit. I just feel like it should be gone by now, but because its so freaking slow healing its just taking its time. My knees are probably full of scar tissue. I'm fairly certain that the majority of the pain that I currently feel is the result of back-to-run muscle stuff, and not the PF syndrome. I think that's a good thing.

Reg'd for an event on Sept 17 in Niagara Falls. The July 9 event is still on the table, looking highly probable if I can hit a 25km long run by late april/early may, and I think I'll be ahead of that.

 

[mike8675309]

Healing can be slow. Do you have a sense of if the pain is muscle pain or connective tissue pain? If you feel muscle pain, make sure your diet is including sufficient protein for muscle synthesis as it may be rebuilding. Also make sure you add anti-inflammatory foods into your diet, in particular whole berries (strawberries, blackberries, blueberries). Berries have a tremendous anti-inflammatory response in the human body as well as all sorts of good nutrients. A breakfast smoothie or bowl of oatmeal and berries is a great way to get started the day after a workout.

http://nutritionfacts.org/video/reducing-muscle-soreness-with-berries/
http://nutritionfacts.org/video/enhanced-athletic-recovery-without-undermining-adaptation/

 

[cbrunny]

Healing can be slow. Do you have a sense of if the pain is muscle pain or connective tissue pain? If you feel muscle pain, make sure your diet is including sufficient protein for muscle synthesis as it may be rebuilding. Also make sure you add anti-inflammatory foods into your diet, in particular whole berries (strawberries, blackberries, blueberries). Berries have a tremendous anti-inflammatory response in the human body as well as all sorts of good nutrients. A breakfast smoothie or bowl of oatmeal and berries is a great way to get started the day after a workout.

http://nutritionfacts.org/video/reducing-muscle-soreness-with-berries/
http://nutritionfacts.org/video/enhanced-athletic-recovery-without-undermining-adaptation/

I've been drinking tart cherry juice daily which has been helping the inflammation & aiding sleep. On bad days I take Advil but that's few & far between at this point.

The pain is mostly connective tissue, I think. I do have some muscle pain but that has been steadily decreasing as fitness is rebuilding. I'm not a doctor or an anatomy expert, but i do have a hobby-level interest in this stuff. My googling about and consideration of anatomy suggests the primary issue is in the pes anserine and/or where the VMO attaches around the knee area. The VMO/where it attaches I'm pretty sure I tore up pretty good in November, which is at least in part what caused the issue (according to me, not a doctor; poor bike fit overloading the VMO & introducing high intensity intervals, a lot of them..... and general overuse with the poor fit). It is getting better. Just slow. More than anything, I'm just really surprised how long it is taking to be pain free, even with generally positive results all the way.

 

[cbrunny]

Few weeks since last update. I'll be brief since I'm sure no one is actually reading this. I'm more or less back to full strength. Dr gave me the all clear after his back to run plan to continue ramping things up. Last night ran about 8.5 km straight with no pain. Riding is going very well, surprisingly well, and swimming is good too. It's good to be back!

 

[mike8675309]

Great to hear, now I assume you have things in place to prevent the same issue from creeping back in the future.

 

[cbrunny]

you bet!

 

[highland145]

Few weeks since last update. I'll be brief since I'm sure no one is actually reading this. I'm more or less back to full strength. Dr gave me the all clear after his back to run plan to continue ramping things up. Last night ran about 8.5 km straight with no pain. Riding is going very well, surprisingly well, and swimming is good too. It's good to be back!

Mine started acting up for the last 2 weeks but I stopped doing the PT exercises a while ago. Time to break out my list....

 

[cbrunny]

Mine started acting up for the last 2 weeks but I stopped doing the PT exercises a while ago. Time to break out my list....

hahaha happy to be proven wrong!

I found cycling to be a fantastic benefit getting over the pain. fit properly on the bike I use the muscles properly and that balance is massive. Of course, PT exercises could have also done it. Hard to say really.