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  1. #1
    Senior Member hillcrawler's Avatar
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    Riding through PFPS

    Is there anyone who is able to ride through PFPS? Or ideally get rid of it totally? From my experience, once you have it, it is impossible to get rid of the pain totally but I'd like to hear your advices that would help to keep the pain under control.
    riding with pretty ****ed up knees since 2012
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  2. #2
    Long Distance Cyclist Machka's Avatar
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    Lots of good advice in this thread ...

    Glutes shutting down?

  3. #3
    Senior Member hillcrawler's Avatar
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    Quote Originally Posted by Machka View Post
    Lots of good advice in this thread ...

    Glutes shutting down?
    I am already following your advices. Thanks a lot. Maybe some other people would like to share their experiences.
    riding with pretty ****ed up knees since 2012
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  4. #4
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by hillcrawler View Post
    I am already following your advices. Thanks a lot. Maybe some other people would like to share their experiences.
    Did you read right to the end of that thread?


    You'll also want to read this article: CYCLING PERFORMANCE TIPS -


    And ... what have you done and what are you doing to help your knees? Let's hear what you're currently doing first.

  5. #5
    pan y agua merlinextraligh's Avatar
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    You could fall off a cliff and die.
    You could get lost and die.
    You could hit a tree and die.
    OR YOU COULD STAY HOME AND FALL OFF THE COUCH AND DIE.

  6. #6
    A might bewildered... Dudelsack's Avatar
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    Buy an airline ticket to Colorado Springs, CO. Set up an appointment to see any number of expert sports physicians there.

    I think you've gotten about as much information from this forum as you possibly can get. You need to see an expert.

  7. #7
    Senior Member hillcrawler's Avatar
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    I am already seeing expert #4 next week. Problem is this thing is really complicated and I think cyclists experience might be more helpful than the doctor's suggestions.

    The thing is I have inflammation right now all over my knees and I did nothing but sitting at my office desk whole day. Well I walked maybe a mere mile to get to the car which picks me on the road. And I took short breaks to get up and walk around during the day as Machka suggested but I can't get rid of that damn inflammation! I am taking 800mg ibuprofen daily since a week but it doesn't help. If it helps it is only for few hours. I have already stopped riding since 5 weeks. What else I can do?
    Last edited by hillcrawler; 05-06-14 at 12:07 PM.
    riding with pretty ****ed up knees since 2012
    http://www.strava.com/athletes/924895

  8. #8
    Senior Member hillcrawler's Avatar
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    Quote Originally Posted by merlinextraligh View Post
    The cartilage under your kneecap (patella)...
    I don't think they have a slightest idea on what they are talking about.

    Edit: Sorry. I got it wrong. I thought they were referring to cartilage as patella for some reason. I should keep on reading.
    riding with pretty ****ed up knees since 2012
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  9. #9
    Senior Member hillcrawler's Avatar
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    I was thinking if Gelatin would help with my condition and found this nice bit of information (which can be right or wrong) and it added to my confusion.

    Jelly for Arthritis

    ENEMIES of JOINT REPAIR
    Startlingly, research also shows that Asprin inhibits repair of cartilage and actually accelerates cartilage destruction. Asprin interfers with the ability of the chondroblasts (cartilage building cells) to stimul-ate new cartilage production. NSAIDS (non steroid anti-inflam-atory drugs) also accelerate joint destruction by chondroclasts (cartilage destroying cells). Whereas Vitamin C helps preserve the integrity of cartilage and supports new growth.
    riding with pretty ****ed up knees since 2012
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  10. #10
    Farmer tan f4rrest's Avatar
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    Yeah, I've stopped taking NSAIDS for tolerable aches for that reason. Just in case.

  11. #11
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by hillcrawler View Post
    I am already seeing expert #4 next week. Problem is this thing is really complicated and I think cyclists experience might be more helpful than the doctor's suggestions.

    The thing is I have inflammation right now all over my knees and I did nothing but sitting at my office desk whole day. Well I walked maybe a mere mile to get to the car which picks me on the road. And I took short breaks to get up and walk around during the day as Machka suggested but I can't get rid of that damn inflammation! I am taking 800mg ibuprofen daily since a week but it doesn't help. If it helps it is only for few hours. I have already stopped riding since 5 weeks. What else I can do?
    If you really do have inflammation and if you are taking that much ibuprofen, you really do need to get to the doctor, get a complete physical (bloodwork and all), get your joints checked, and follow what the doctor has to say.

    We can tell you rest, ice, elevation ... and we can suggest you check various other factors (such as your chair at work, the clothing you're wearing when you cycle, etc.) as I did in that other thread, but we can't offer much more than that.


    And this might not be cycling-related at all. You say you haven't been cycling for 5 weeks, and yet you're experiencing inflammation? To me, that doesn't sound cycling-related. It could be any number of other things which is why we keep recommending going to the doctor and getting thoroughly checked. Perhaps it is arthritis. Perhaps you've got high or low iron levels. Perhaps it is a more serious disease. When you see your doctor, tell him or her all your symptoms, and all the details about when this started and what has happened since then.

  12. #12
    Long Distance Cyclist Machka's Avatar
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    If you have been diagnosed with patellofemoral pain syndrome (which is a specific syndrome, not just general inflammation), read the article I linked to in Post 4, and also this article.
    The Physician and Sportsmedicine: Knee Pain and Bicycling

    I'll also add that (in addition to the causes those two articles mention) wearing tights or other long pants that are too tight over the knee and constrict the movement of the knee can also cause patellofemoral pain syndrome. This is especially an issue for those who cycle year round, through wintery conditions.

    I was diagnosed with patellofemoral pain syndrome by a sports doctor several years ago. The first suggestion was, of course, rest, ice (properly applied), and elevation. I was off the bicycle for about a week. The second suggestion was to check my fit on the bicycle. That was OK. In my case, the cause was riding a century with several layers of too tight tights. At that time I didn't own tights with articulated knees. I've made the appropriate clothing changes since then. When I got back on the bicycle, I was restricted to short distances and easy spins for a while. Because it was winter, I did that on my trainer. And my sports doctor gave me a set of strengthening exercises to do, and showed me how to do them properly so that I did not make the situation worse. The goal of one of those exercises was to strengthen the vastus medialis.

  13. #13
    Senior Member hillcrawler's Avatar
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    Quote Originally Posted by Machka View Post
    And my sports doctor gave me a set of strengthening exercises to do, and showed me how to do them properly so that I did not make the situation worse. The goal of one of those exercises was to strengthen the vastus medialis.
    Could you please tell me what was that specific exercise?
    riding with pretty ****ed up knees since 2012
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  14. #14
    Senior Member hillcrawler's Avatar
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    Everyone says Ibuprofen is good for joint inflammation but check what this website says about it:

    Naproxen is a drug that works slower than ibuprofen, but in the end will offer longer-term relief compared to the short-term benefit of ibuprofen. Furthermore, it’s much better at targeting muscle tissue inflammations, pain that could be caused by a sprain, arthritis, or strained muscles. Naproxen is therefore best used after a long workout at the gym, a hike, or for sore muscles before bed for best effect. Naproxen goes easiest on your heart, so if you have a history of heart attacks it is better to use than ibuprofen.
    What Is the Difference Between Naproxen vs. Ibuprofen? | Curiosity Aroused
    riding with pretty ****ed up knees since 2012
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  15. #15
    pan y agua merlinextraligh's Avatar
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    Quote Originally Posted by hillcrawler View Post
    I was thinking if Gelatin would help with my condition and found this nice bit of information (which can be right or wrong) and it added to my confusion.

    Jelly for Arthritis
    That whole link looks like a bunch of unattributed horse hockey, including this bit of wisdom:

    "Free radicals destroy cartilage, as does the food additive aspartane. Vitamin C destroys free radicals. Excessive sugar consumption causes the joints to become stiff and brittle by causing cross-linking of collagen.

    Vitamin B6 shrinks the inflamed synovial membrane that lines the surface of the joint, alleviating pain and restoring mobility. Emu oil reduces inflamation and pain, and improves flexibility
    "

    I'd like to see the peer reviewed studies on EMU oil, etc.
    You could fall off a cliff and die.
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    OR YOU COULD STAY HOME AND FALL OFF THE COUCH AND DIE.

  16. #16
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by hillcrawler View Post
    Could you please tell me what was that specific exercise?

    1) Get diagnosed first. If your problem is actually arthritis or something worse, that exercise may be the wrong thing for you.

    2) It's not something I can just tell you. You would have to be shown how to do it properly, or you could really injure yourself.

  17. #17
    Oil it! sfrider's Avatar
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    NSAID is useful where inflammation is self-perpetuating: swelling is pressing and pinching bursas or other tissue, causing inflammation and swelling. Briefly taking an NSAID and rest can be very effective at breaking this cycle before scar tissue has a chance to build up.

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    Vastus medialis exercises: petersen step ups, bulgarian single leg squat, leg extension(low weight) last 30degrees with toes out, which i superset with either of the previous two

    i did that offseason, no more pfs, and my legs look killer.

    But i went to see a doc and he told me to do so.

    also i use a rumble roller and stretch alot

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    Quote Originally Posted by hillcrawler View Post
    Could you please tell me what was that specific exercise?
    Vastus medialis exercises: petersen step ups, bulgarian single leg squat, leg extension(low weight) last 30degrees with toes out, which i superset with either of the previous two


    i did that offseason, no more pfs, and my legs look killer.


    But i went to see a doc and he told me to do so.


    also i use a rumble roller and stretch alot

  20. #20
    Senior Member topflightpro's Avatar
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    I partially tore my patella in August 2012. I spent nearly all of the fall/winter of 2012 and much of 2013 in PT dealing with it. I'm now back to training and racing. I experience pain in my knee occasionally, but it no longer swells up after hard rides.

    PM me if you want to chat more.

  21. #21
    Senior Member hillcrawler's Avatar
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    Ok. Today I have had too much pain whole day while sitting at the office and when I got back to home I tried quadriceps activation test and saw that the quads on my right leg simply don't fire while the other leg muscles firing properly (I have always more pain on my right knee). I think it happens because of pain or ongoing inflammation. I will try that test again when I have less pain. I think this is the source of all my knee issues. Now it is down to how to correct that...
    riding with pretty ****ed up knees since 2012
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  22. #22
    Senior Member hillcrawler's Avatar
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    Update with my situation. I have seen two different ortho this week. First one on Monday and the other yesterday. Last year's MRI renewed. They both said my condition was simply PFPS. Second doctor called it as chondromalacia patellae but I learnt that they are the same issue. I can also clearly see my patella is tilted laterally on the MRI which causes a friction with the femur. Second doctor advised me to do pedaling motion while I was lying on my back. I didn't ask why but I think he is aiming to make my joints move while taking the pressure off, like swimming. I have also started physical therapy. They are doing ultrasound massage and TENS therapy on the damaged tissues and tendons. Has anyone heard of TENS therapy? Electrical nerve stimulation. On my own research I found out that semi-squats are most helpful exercise for this condition. None of the doctors advised me to do that but I think they didn't follow the latest articles for this issue.
    riding with pretty ****ed up knees since 2012
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  23. #23
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by hillcrawler View Post
    Update with my situation. I have seen two different ortho this week. First one on Monday and the other yesterday. Last year's MRI renewed. They both said my condition was simply PFPS. Second doctor called it as chondromalacia patellae but I learnt that they are the same issue. I can also clearly see my patella is tilted laterally on the MRI which causes a friction with the femur. Second doctor advised me to do pedaling motion while I was lying on my back. I didn't ask why but I think he is aiming to make my joints move while taking the pressure off, like swimming. I have also started physical therapy. They are doing ultrasound massage and TENS therapy on the damaged tissues and tendons. Has anyone heard of TENS therapy? Electrical nerve stimulation. On my own research I found out that semi-squats are most helpful exercise for this condition. None of the doctors advised me to do that but I think they didn't follow the latest articles for this issue.
    Follow your Doctor's orders. Do not do additional exercises unless they are approved by your doctor and/or physical therapist.

    And ... ask! Ask your doctor and/or physical therapist why you should do a particular exercise. Ask how it helps. Ask about other exercises you've discovered. Show them what you're doing, or what you want to do, so that they can see and make corrections as necessary. Talk to them about your concerns, questions, etc. That's what's they are there for.

    Yes, I've heard of TENS therapy. It might work for you.

  24. #24
    Senior Member hillcrawler's Avatar
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    Quote Originally Posted by Machka View Post
    Follow your Doctor's orders. Do not do additional exercises unless they are approved by your doctor and/or physical therapist.

    And ... ask! Ask your doctor and/or physical therapist why you should do a particular exercise. Ask how it helps. Ask about other exercises you've discovered. Show them what you're doing, or what you want to do, so that they can see and make corrections as necessary. Talk to them about your concerns, questions, etc. That's what's they are there for.

    Yes, I've heard of TENS therapy. It might work for you.
    But there is already a conflict between the two doctors. First one prescribed quadriceps intensive exercises while the other one suggested only pedaling move as I described and told me to ease off quadriceps exercises for the first 3 weeks. What would you think in this situation? I know that I have to work out the VMO's to get the kneecap realigned but I don't know which exercise would be the most effective.
    riding with pretty ****ed up knees since 2012
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  25. #25
    Long Distance Cyclist Machka's Avatar
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    Quote Originally Posted by hillcrawler View Post
    But there is already a conflict between the two doctors. First one prescribed quadriceps intensive exercises while the other one suggested only pedaling move as I described and told me to ease off quadriceps exercises for the first 3 weeks. What would you think in this situation? I know that I have to work out the VMO's to get the kneecap realigned but I don't know which exercise would be the most effective.
    Start with the less intense exercises ... build up to the more intense. But don't add in something you've read on the internet. And talk to them ... ask them what they think. They are the doctors.

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