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Old 03-14-16, 06:55 AM   #1
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Anyone had knee trouble related to tracking of kneecap when pedaling? PT to correct?

Have any of you had issues with your kneecaps tracking right when you stroke your pedals and are doing/have done physical therapy to fix? If so - what has been your experience? How much of a difference do you see/feel now vs before? What was the timeline to get things corrected?

I've been doing physical therapy for the past ~6 weeks to try and fix a knee problem related to the above. I tried staying off the biking for a few months to let the knee settle down after the close of last season (hit my 1500 mile goal but the last bit was real rough going). In that time I was really favoring the bad knee and caused my leg to atrophy. So far I have most of my strength back in the leg with the bum knee, so that is one aspect of my progression. However, the knee is still off. I have felt it doing a lot of the exercises so I have had an indication there.

Though, with the past few weeks of therapy we were curious what would happen if I went for a ride. So I did a short 12 miles Saturday as a test. I didn't get to the point where my knee locked up on me. I had good strength in my leg, but I still felt my knee would quit on me if I pushed things. After the ride my knee ached, mostly the day after.

I have a few things to report back on at today's appointment. I have had a lot of hope that the processes I've been going through will help. I have kept in the back of my mind the theory of lifting weights - you won't go from bench pressing 150lbs to 400lbs quick. It takes work and a lot of time to get your body to build up. Similarly, tendons, ligaments, and muscles need to be built up right to get things to track right. I want to get back to where I can do 50-100 mile rides, but at the end of last year I hit about 20 and was done.
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Old 03-14-16, 09:27 AM   #2
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Many here, including me. What's your diagnosis, therapy, exercises, etc?
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Old 03-14-16, 11:18 AM   #3
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I have a knee that, while not too painful, does act up now and then. I find KT tape useful at those times. Full Knee Support | KT TAPE The tape can be left on for several days, 2-4, even through showers. What helps longer term is to step up intensity of knee strengthening exercises.
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Old 03-14-16, 09:02 PM   #4
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The actual diagnosis is patellofemoral arthralgia. The spacing between my bones was OK but the doc said my kneecaps track "high", though they didn't think that was in and of itself a "problem". Exercises include rolling out IT bands, hamstring and quad stretches, lots of varying leg exercises, and a lot of manual therapy with ligaments - both my IT bands and some internal work on my bad knee from the front and back of the knee.

My left leg is the bad one. If I am correct with how things look - my kneecap appears to ride out to the left (my left) with the motion of my leg. I noticed, also, that when standing with my knees locked, if I tighten my quad and pull my kneecap up it moves diagonally up and to the left. I asked about that today and showed my therapist and he seems to think that's just the IT band being real tight.

I had my knee taped up a few weeks ago. I didn't notice a whole lot of improvement there, but then again I never got on the bike to test that.
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Old 03-14-16, 10:07 PM   #5
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The actual diagnosis is patellofemoral arthralgia. The spacing between my bones was OK but the doc said my kneecaps track "high", though they didn't think that was in and of itself a "problem". Exercises include rolling out IT bands, hamstring and quad stretches, lots of varying leg exercises, and a lot of manual therapy with ligaments - both my IT bands and some internal work on my bad knee from the front and back of the knee.

My left leg is the bad one. If I am correct with how things look - my kneecap appears to ride out to the left (my left) with the motion of my leg. I noticed, also, that when standing with my knees locked, if I tighten my quad and pull my kneecap up it moves diagonally up and to the left. I asked about that today and showed my therapist and he seems to think that's just the IT band being real tight.

I had my knee taped up a few weeks ago. I didn't notice a whole lot of improvement there, but then again I never got on the bike to test that.
That's another term for patellofemoral pain syndrome (PFPS), which might be a better search term for you. Some of what you have is ordinary and fairly easily fixable. You may have some abnormality however that renders it less easily fixable, i.e. some abnormal tendon length or attachment, etc.

Here's one of my posts on how to fix:
Stretching and cycling specific exercise for knee health
IME on these forums the IT band has nothing to do with it. So look at the guy on the podium in the above link. See his VMOs? Those are the potato-sized things above and to the inside of his kneecaps. Those are supposed to pull to that side and cause the patella to track straight up, even though it is pulled to the outside by his other quads. When you flex your quads, do you have a nice big VMO? When I flex my quads, the VMO is very noticeable.

My wife had a brief bout with this last fall, but mild. Her knee would hurt after say a 4 hour bike ride. Using the leg extension machine at the gym twice a week fixed her right up. You want to do them only though the last 30 before the leg is completely straight, and with as much weight as you can use to do say 3 sets of 10 reps. You shouldn't be able to do an 11th rep on the last set. Yes, it hurts muscularly but it shouldn't hurt your knee. If it does, reduce the weight until it doesn't hurt your knee, but keep doing the exercise. The knee pain should gradually go away. The other exercises in the above link are good too.

Keep doing all the rest of the stuff they're having you do.
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Old 03-14-16, 10:55 PM   #6
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I have some definition in my VMO muscles, but I don't have a good way to gauge.

Another exercise I have done is squats and some leg presses, mostly extend with both legs and retract on one leg.
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Old 03-15-16, 07:33 PM   #7
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I have some definition in my VMO muscles, but I don't have a good way to gauge.

Another exercise I have done is squats and some leg presses, mostly extend with both legs and retract on one leg.
Please do not use a leg extension machine. That's the best way to do more damage to your knees. It's well known among fitness professionals that the amount of shear stress is dangerous to the knee.

The squats are good, but avoid the leg press machine too. The type of exercise you really should be working on are closed chain exercises and pay close attention to your technique. This will train your agonists and antagonists to work together in stabilizing your knee which is what you need to move efficiently. Functional closed-chain exercises like split squats, step ups and single leg deadlifts will help you develop greater stability over your knee. Using machines will only reinforce or create new imbalances and develop poor muscle activation patterns.



Also, muscle definition doesn't equate to functional performance. I've trained plenty of people who appear strong, but have no functional strength, power or endurance. Being able to do the exercises recommended above with perfect technique will benefit you more than creating hypertrophy at the quads.

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Old 03-15-16, 09:25 PM   #8
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Please do not use a leg extension machine. That's the best way to do more damage to your knees. It's well known among fitness professionals that the amount of shear stress is dangerous to the knee.

The squats are good, but avoid the leg press machine too. The type of exercise you really should be working on are closed chain exercises and pay close attention to your technique. This will train your agonists and antagonists to work together in stabilizing your knee which is what you need to move efficiently. Functional closed-chain exercises like split squats, step ups and single leg deadlifts will help you develop greater stability over your knee. Using machines will only reinforce or create new imbalances and develop poor muscle activation patterns.



Also, muscle definition doesn't equate to functional performance. I've trained plenty of people who appear strong, but have no functional strength, power or endurance. Being able to do the exercises recommended above with perfect technique will benefit you more than creating hypertrophy at the quads.

Vincent Vergara
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EatSleepTrainSmart.com
EatSleepTrainSmart@gmail.com
You might want to have read the relevant studies before making such assertions:
How can we strengthen the quadriceps femoris in patients with patellofemoral pain syndrome?
Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

From one of the studies evaluated:
Quote:
Overall, the squat generated approximately twice as much hamstring activity as the leg press and knee extensions. Quadriceps muscle activity was greatest in CKCE when the knee was near full flexion and in OKCE when the knee was near full extension. OKCE produced more rectus femoris activity while CKCE produced more vasti muscle activity. Tibiofemoral compressive force was greatest in CKCE near full flexion and in OKCE near full extension. Peak tension in the posterior cruciate ligament was approximately twice as great in CKCE, and increased with knee flexion. Tension in the anterior cruciate ligament was present only in OKCE, and occurred near full extension. Patellofemoral compressive force was greatest in CKCE near full flexion and in the mid-range of the knee extending phase in OKCE.
CK being closed chain and OK being open chain. It is true that going from full 90 to 0 knee flexion on a leg extension machine is not a good idea, but that is not what is being advocated. Never do the former, no matter what other folks at the gym do.

BTW, your attachment didn't open for me.
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Old 03-15-16, 09:40 PM   #9
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I have some definition in my VMO muscles, but I don't have a good way to gauge.

Another exercise I have done is squats and some leg presses, mostly extend with both legs and retract on one leg.
Yes, those are good. I do single leg presses pushing the plate with my toe rather than flat-footed. It's very important to track your knee directly over your foot, IOW angle them both just the same. The lower on the plate you put your foot, the greater the quad activation and the less the hamstring activation. Eccentric exercise works at least as well as concentric. The main thing is that the exercise be pain-free at the knee. My guess is that you can use more weight eccentrically and stay pain-free. In general, eccentric exercise causes more muscle strain than concentric and strain is what you want.
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Old 03-16-16, 06:49 AM   #10
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I have noticed when doing some of the leg extension and squat exercises that there is, at some times, a lot of pressure/strain in my knee. It feels like it is well inside. A few weeks ago on one of the leg extension machines (angled platform, lay on one side, work one leg, flip sides for the other leg) I had some pain in the knee along with the pressure/strain.
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Old 03-16-16, 10:43 AM   #11
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I have noticed when doing some of the leg extension and squat exercises that there is, at some times, a lot of pressure/strain in my knee. It feels like it is well inside. A few weeks ago on one of the leg extension machines (angled platform, lay on one side, work one leg, flip sides for the other leg) I had some pain in the knee along with the pressure/strain.
Pain's not good. On the leg extensions, I'd drop the weight and concentrate on the isometric contraction when the leg is completely straight. Watch or put your hand on the VMO and concentrate on activating it. On the squats again I'd drop the weight. What you want to achieve if possible is muscular exhaustion, i.e. you can't do another rep. The number of reps needed to reach this state is immaterial in terms of increasing muscle activation and growth. When I started using weights in the gym as a supplement to my cycling, I started with 30 reps. I'd do 30 reps on each exercise, no matter what it was. When that felt OK, I added a second circuit of 30. So not 2 sets of 30 at each station, but rather 2 circuits of 30. Then 3 circuits of 30. In all cases, choosing weights which by experience gave me failure like on the 28th rep of the last set while using the same weight for all the sets done for a particular exercise. After about three months of that, I was ready to lower the reps and increase weights. I did that every fall for years. It built killer legs but with a downside of having to spend more time in the gym than fewer reps. Worth it though.

High reps don't increase tendon strength as much as using heavy weights does, but it's a safer entry technique as it allows tendon strength to be built up more slowly with less chance of injury.

On all the bent knee exercises, don't allow the knee to flex beyond an included 120 angle during this rehab. That's 60 from straight. Use a mirror if you can. Focus on contracting the VMO. On leg extensions, a maximum 30 angle is better. That's to reduce inward pressure on the patella. On the closed chain exercises, that'll mean you'll be using a quite a bit of weight. Even though my knees are fine now, I don't break 90 on any bent knee exercise: that's about the knee flexion at the top of the pedal stroke and I'm training to ride, not to be a weight lifter or bodybuilder.

Also don't sell the isometric straight leg lifts short. They work, too. That's the reasoning behind the straight leg high kicks I mentioned in that other thread. They're isometric to knee flexion, but with some added mental kick to aid contraction. Interestingly, isometric contractions are more mental than anything: studies have shown that adding weight to the foot during isometric straight leg lifts does not increase the activation.
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Old 03-20-16, 11:28 PM   #12
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Good info here. I am having a hard time activating my vmo's. Its not something I can do a simple movement with and definitively get it to do something. Its a tricky one. I'll try to work on some more techniques.

I did a ride this afternoon - 21.5 miles this time. I made it through the ride without any "pain". I notice more pressure/tension in my left knee than my right, though. About mile 15 I thought I was really in for it but slowed down a bit and made it the rest of the ride OK.

Things are getting better, but I'm really kicking myself with these short rides. I should be out doing 40-50 miles on a weekend day right now, then 70-80 as the season progresses.
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Old 03-21-16, 12:03 AM   #13
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Good info here. I am having a hard time activating my vmo's. Its not something I can do a simple movement with and definitively get it to do something. Its a tricky one. I'll try to work on some more techniques.

I did a ride this afternoon - 21.5 miles this time. I made it through the ride without any "pain". I notice more pressure/tension in my left knee than my right, though. About mile 15 I thought I was really in for it but slowed down a bit and made it the rest of the ride OK.

Things are getting better, but I'm really kicking myself with these short rides. I should be out doing 40-50 miles on a weekend day right now, then 70-80 as the season progresses.
It took a while to get them into this state.It'll take a while to get them out of it. This kind of thing can take a year of hard work to see real improvement. Are you trying to pedal toes out?
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Old 03-21-16, 06:45 AM   #14
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Id say I pedal more with my toes forward. I never have thought about moving my toe angle.

Another note - I have platform pedals. I was talking to my neighbor last night, he rides with clip-in's. By having a solid connection to the pedals that means I could pull up on the crank as well as push. Right now I am just pushing. I like having the freedom of using regular shoes and being able to move my feet as I go on my rides. It may be more advantageous to get a set of clip pedals/shoes so I can work different muscles though... Thoughts?
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Old 03-21-16, 12:09 PM   #15
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Id say I pedal more with my toes forward. I never have thought about moving my toe angle.

Another note - I have platform pedals. I was talking to my neighbor last night, he rides with clip-in's. By having a solid connection to the pedals that means I could pull up on the crank as well as push. Right now I am just pushing. I like having the freedom of using regular shoes and being able to move my feet as I go on my rides. It may be more advantageous to get a set of clip pedals/shoes so I can work different muscles though... Thoughts?
OMG, platforms. That's the source of the problem right there. All you can do is push down and that-over exercises the muscles which are pulling the kneecap to the side.

#1 Change the platforms out for SPD pedals and get some stiff soled MTB shoes so you can still walk around like you're accustomed.
#2 Go back at read about open stance cycling protocol, talked about in the post I linked to in post 5, which you obviously didn't bother reading.

Many people can ride platforms just fine, but I doubt that you are one of them. There's a reason that almost all cyclists (as opposed to people on bicycles) use clipless and stiff-soled shoes.
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Old 05-03-16, 09:36 PM   #16
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I got some SPD shoes and pedals. I have done one regular ride with them so far, sunday, and noticed that I got a lot more power. The pedaling is awkward, but I will get used to it. I can work a lot more muscles.

When I was pedaling I felt tension in my knee pretty much the whole time. Though, what was a bit alarming was after I got home and got off the bike. What I felt going up the stairs here was about the same as I felt last December, just in my bum knee. I had a good workout at the therapy session I had Thursday so my legs were worked up from that still, then the ride was on top of it. The muscle soreness was to be expected and thats all I felt in my good leg.

My therapist didn't seem to be concerned with it when I brought it up today. Its a big change that I am not used to, for sure. To have such a big difference from one leg to the other just seems really strange/weird to me...

Any thoughts?
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