austinspinner

I have had mild Patellofemoral Syndrome for a little while now and really need to fix it. Since I am super cash strapped with buying a new bike, house and grad school, Doc visits and PT are kinda out of the question. I was hoping it would just go away, but it's not happening.

I was wondering If anyone who has had this before could reccomend specific exercises that helped them get the kneecap back on track.

I found this for starters.
https://www.physsportsmed.com/issues/.../labotz_pa.htm

Additionally I did have a knee x-ray at my GP which was negative for any cartilage degeneration. I started road biking last year after several years of little to no exercise and did about 1700 miles, which may have been a little fast of a start.

My general bike fit is good but I will be having an advanced fit to make sure the affected leg left is not shorter, longer or has a pronounced foot protenation.

Any input is appreciated.

Jinker

I had a big muscle imbalance which came basically by only getting exercise on the bike for 6 months. My inner quads were much stronger than my outer, pulling my kneecap out of aligmnent.

The exercise my doc recommended was to stand on one leg, toe pointed 5 or 10 degrees inwards, knee bent slightly. Do that for 10 or 20 seconds, switch legs. Repeat. (did that a lot on the bus as I was no longer biking too/from work)

It worked for me. That and toning down on the intense biking for a little while.

One thing is (at least in my case) the pain is because of inflammation/irritation of the cartilage in there. When it becomes inflamed, it swells, and is filled with fluid. It becomes more susceptible to damage, leading to the whole 'crunchy knees' thing (think blisters on the cartilage). Icing, anti-inflammatories and rest are really the only thing you can do about it. Addressing the root cause will work, but you also need to give stuff a chance to heal.

This is all based on my personal experience, Patellofemoral syndrome can cover a huge range of different knee ailments though. I'd recommend trying to figure out a way to see someone who knows what's what one way or another.

Oh, and get your bike fit checked, too.

HAMMER MAN

i have the same problem but mine has become degeranative with osteoartheritis, and they keep recommending a knee replacment and I keep saying no.
one of the biggest factors
in cycling that does help tremendously is lowering your saddle somewhat so you do not get full leg extension and you have somewhat of a more pronounced bend.
Spinning instead of hammering in harder gears, and building up your quad area and the muscles surrounding your patella.
A muscle imbalance is a big factor, try some gym work-outs with weights, and on leg exercises do not go full extension like leg presses only go to a 45 type degree angle and do light reps, as well as leg extensions but do not fully extend your legs, do light reps also.

orcanova

^yup. Leg extensions and leg curls will help balance out the muscles, which is the primary mitigating factor. Mine went away pretty quickly with that. Good luck.

jamiewilson3

My orthopedist also recommends bent knee wall squats. Do squats up against a wall, only going down a few inches and hold for as long as you can. It will really work the quads just above the kneecap, which is what will ultimately control the movement of the knee.

Snuffleupagus

PTs don't generally recommend open chain exercises like leg extensions if you've got knee problems.

Exercises like leg presses are much safer, and can still help balance out your leg muscles. Most of all, if riding makes your knees hurt - STOP - rest/ice/compression/elevation will help. Then get thee to the gym to balance out those quads.

But, you should still try to at least get an inital consult with a physical therapist, as there may be more at work than you suspect, and you could be in for a whole world of hurt.

mimis

take up swimming and forget cycling for a month or so, apply ice as often as you can

cslone

Wall sits really helped with my muscular imabalance.

Ibikeowa

I would take any specific therapy, even from an expert, with a grain of salt. The knee is such a complex system, that I think it will take much more research and computer analyses to figure it out well enough to treat accurately. For supporting evidence, I offer the knees of Jan Ulrich, which surely received the most knowledgable care available, yet even then did not improve much. I have tried various techniques which once in a while seem to help for a bit, but sometimes made it worse. Good Luck!

DocRay

Keep checking with your doctor, there are some amazing new drugs that absolutely stop rheumatoid arthritis in most patients that have just cleared FDA. They are effective for later stage osteoarthritis as well.

slowandsteady

That would be incorrect. TNF-a is implicated in RA and not with OA. These amazing drugs such as Humira, Enbrel, and Remicade(my company's drug) are not approved for OA and the mechanism of action is specific to RA as well as Crohn's disease and some other diseases, but not OA.

The are very few options for OA. You can look into Orthovisc(my company's drug) which is a substance that is injected directly into the intra-articular space of the knee and provides cushioning. I don't think anyone else has a similar drug, but you can just ask your doctor.

slowandsteady

It isn't so much that the knee is complicated but rather it is not vascularized. It is extremely difficult to deliver a drug to the intra-articular space without injecting it directly, which is impractical for any drug that would need daily, weekly or even monthly delivery.

This severely limits our ability to make a drug to treat OA. Not to mention, we are still learning about the mechanism of action of the disease and there are poor in vivo models of OA which means testing the efficacy of a drug and predicting its success in humans is darn near impossible.

Ibikeowa

I was thinking more of physical rather than drug therapies. For example, I think it would be difficult to conclude that some specific weak muscle or specific bike dimension is causing a knee cap to rub something it shouldn't. My knees often get worse after very mild strengthening exercises, but "slowandsteady" increases in biking are usually tolerated.

slowandsteady

Actually, it is easy to conclude that a specific weak muscle is causing knee instability. This has been proven time and again. We even develop in vivo models of OA by causing knee instability with weakened ligaments or muscles. And bike fit which can affect inflammation in the knee could cause even slight changes in how the knee articulates. This instability can lead to OA in chronic or severe cases or at a minimum would cause some pain.

What specific exercises are you doing that aggravate your knees? Even a mild exercise isn't so mild if the technique is off or it is inappropriate.

donrhummy

Don't do anything (including riding) until you get a professional bike fit. Tell them everything. If you keep pushing it, you can really injure yourself. ligaments and tendons do not heal/recover very well.

HAMMER MAN

that is correct. Presently I use Anakinra/kineret, but it is not for RA, but for another problem

HAMMER MAN

[QUOTE=Snuffleupagus]PTs don't generally recommend open chain exercises like leg extensions if you've got knee problems.


actually it depends on the extension there should be zero problems doing leg extensions as long as he does not lock his knees out when performing the reps.

squats work also, but you should not go all the way down, go down just far enough like you are going to sit down in a chair

bccycleguy

I used to have Patellofemoral Syndrome and for a couple of years it looked like I was going to have to stop doing a lot of my favorite activities, riding, hiking, etc. I saw several doctors, specialists, physios, etc. even had a special analysis done on my gait and pedaling, etc.

All of them said pretty much the same thing but offered few solutions, i.e. we'll operate when it gets worse, stop backpacking, don't cycle until it gets better, etc...

Then I met a phys who explained that there a several tiny muscles around the knee that maintain proper alignment and when you feel a jab of pain those muscles involuntarily relax and the problem gets worse.

Over time, I built up those muscles by lifting weights with my leg, usually with kind-of a sideways orientation. It took only a few months to solve the problem and I haven't had any pain for several years.

It worked for me.

austinspinner

Thanks for the input everyone!

I will lay off the riding and go see a sports medicine guy, then just do the PT myself with the advice gleaned from the Physician and everyone here.

I just needed to break the cycle of denial and get serious about fixing this problem.

I'll post back whenever impovement occurs.

Thanks again.

JonnyV

Really sucks doesn't it? The explanation of it doesn't sound all that bad, when you tell someone, "The IT band got a little too strong, so it pulled the kneecap out of alignment a little bit." But it hurts like hell. I developed it while running and cycling didn't hurt it at all. My physical therapist recommended it as an option to running all the time. But whoever (sorry, don't feel like scrowling up) mentioned the leg curls and leg extensions is right. Throw in a leg press and lots of stretching, you should up and running in no time. Good luck!

serpico7

Can you describe the exercises? TIA.

vantassell

My doc/PT recommended for me to do abduction exercises (i think that's what it was called). Anyway, it's the machine where you sit down spread eagle and then pull your knees together against resistance. It really helped when i did it, but i ended up deciding to take it easy on my knees rather than to keep running and hurt them more. Cycling doesn't really bother mine at all as long as i stretch a lot before rides and keep a high cadence (90+)