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Old 08-24-08, 03:16 PM
  #17  
lbogart
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Hi All!

I'm a bit late to this thread (just joined the forum), but since there're still recent postings, I figured I'd add my voice...

I'm a physical therapist (for what it's worth; and consider this the usual disclaimer that this is not medical or therapeutic advice. If your pain is bad and you suspect something is wrong, by all means see your PCP :0) ) and I see patellofemoral pain syndrome (PFPS) quite frequently. I've not yet looked at the aafp.org article Boutwell included, but here's what the newest research shows: PFPS in closed-kinetic chain activities (such as cycling) is associated with weak hip external abductors and external rotators. If these muscles are weak or excessively fatigued, when we put pressure through our legs into the pedals the femur will internally rotate and the knee will also be driven medially (you've probably seen this in other cycslists: at the highest power generating portion of the pedal stroke, their knees drive in toward the top-tube...) and applies a valgus force to the knee. This valgus force is very stressful for a knee. It's like grossly exaggerating your Q-angle while applying the greatest force through your knee...Ouch!.

How can you tell if this is what's going on with you? Simple, but you'll need a friend you can trust.
1) lay on your side with the symptomatic side up.
2) bend your lower leg (asymptomatic) up so knee and hip are flexed approx. 90 degrees
3) have your friend left your straightened symptomatic leg (let your friend do all the work!) up and back (the position is not unlike the position you'd be in if you'd finished a skating stride on skis or inline skates).
4) using the muscles of you hips, you HOLD the leg in that position
5) here's where the "trust" mentioned earlier comes in: have your friend push down on your leg, trying to return it to its original rest position. Ask your friend not to hammer on you, but to apply the force evenly and steadily.

If your hip muscles are too weak, you'll not be able to maintain the test position. Either your leg will come forward to take advantage of the powerful little tensor fascia latae muscle in the anterior hip, or your leg will be easily pushed down (in hip abductors/external rotators with "normal" strength, your friend should have to work REALLY hard to push your leg down)

Okay, so they're weak! What do I do now?

My favorite exercise for this, and occasionally the only exercise I give my patients, is to take a length of theraband (big rubber band which comes in a variety of resistances), tie it around the thighs just above the knees. Lay on your side with both knees and hip bent, feet together. Keep feet together and lift the top knee away from the lower knee. Go slowly and steadily, and go as wide as you can without excessive accessory contortions. Do 20-50 reps and expect that your butt will be on fire! If you feel any pain (other than lactic acid build-up) stop immediately! Repeat for the other side...

Simple, eh?

Let me know if you need further clarification or if you'd like some further info on this (unfortunately, the journals which include this information require affiliation/membership, so a link won't quite work).

Cheers!
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