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Frustrated by Patellofemoral Syndrome

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Frustrated by Patellofemoral Syndrome

Old 03-04-07, 08:47 AM
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oboeguy
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Frustrated by Patellofemoral Syndrome

Linkie for those unfamiliar with it. In effect, the left knee cap is moving in the wrong direction because of a muscle imbalance, causing pain in the knee. I've basically been off the bike for a month aside from a brief trainer ride here and there. As I'd felt fine during a 45 minute trainer session, on PT's orders, I went for a short ride yesterday to see where I stand. After about 45 minutes (coincidence?), "the old familiar sting" came back. I'm so bummed. Anybody here used taping to deal with PFS? The sports med doc suggested it could help but the PT isn't a believer.

On a more positive note, I've taken advantage of the free gym membership at my workplace and discovered the elliptical machine, use of which is heartily endorsed by the PT and sports doc. Finally a reason to be indoors for aerobic exercise! though I'd prefer (like 1000%) to ride unless it was cold and rainy outside, I really like the elliptical, what can I say? It's certainly helping me stay fit.
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Old 03-04-07, 09:28 AM
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My ortho-doc send me to a PT for PFPS. The PT guy found that I had a leg length discrepancy
of ~.5 inch. Skipping thru a bunch of junk,,, he discovered that one upper glute (my name) wasn't
firing enough. The muscular issue came from a neurological cause. After exercises for that glute
at the first PT session and I went home without pain!! I went to PT for 7 or 8 sessions and did the
specific exercises for a few months. Now, when I do squats, I do some with my heels elevated
~2 inches with a similar effect. When I slack-off the PFPS returns. I wonder if you should change
your PT?? No reason to think your cause will be the same as mine but it may be easy to cure.
Oh yeah, I also wear an .25 inch heel pad in one shoe now.
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Old 03-04-07, 09:40 AM
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Thanks for the reply. You know, the doc noticed a definite leg length difference too, in the left leg, which would be consistent with the left knee problem (in the sense that maybe the saddles on my bikes have been too low for the longer leg). I'm not quite ready to change PT as I've only been three times so far. Anyway the muscle imbalance for me appears to be a weakened "VMO" muscle. I've stuck to the exercises but I'm disappointed to have so little improvement.
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Old 03-04-07, 10:30 AM
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Hey, i'm suffering from pfs too. However, mine's being bothering me since september......yuck. Granted I was really busy with school/family stuff so I didn't treat it right away.

I've been on anti inflam's for about a month and found that helped to settle it down. The PT and doc gave me several exercises to do which didn't seem to help (did for about 3 months).

Recently I tried on advice from another cyclist to try getting one of those large pool noodles, putting it on the floor and rolling my IT band over it while lying sideways. It hurt alot, but it was that good kinda hurt
You can also use a tennis ball, frozen juice can or anything cylindrical and firm.

good luck
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Old 03-04-07, 10:38 AM
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The PT does a brutal (again in a good way) massage to get to the IT band. I honestly think it helps. I'll ask him about using the pool noodle -- there are some at the gym -- to simulate the massage on a more regular basis. Wow, so since September? Depressing!

So neither of you has tried taping?
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Old 03-04-07, 10:46 AM
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Originally Posted by oboeguy
Wow, so since September? Depressing!

So neither of you has tried taping?
Yeah, depressing is a good word for it. I went for a week vacation where there was no snow and went for a couple of rides (hurt, but was worth it) and got my ass kicked by some of my friends.......I hate loosing my fitness....

No, I haven't tried taping. I'll give that a shot next though if the noodle doesn't work out (been using it for two days and already feels much better). Let us know how it goes!
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Old 03-04-07, 11:24 AM
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Yeah ask the PT / doc about taping. I'm going to ask the PT again and remind him that the doc said to give it a try.
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Old 03-04-07, 11:25 AM
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re: the 'noodle' (foam roller), they are great. You need a decently large diameter one. I find the best effect is when you do it just before a ride (or other exercise), to loosen things up. I bought one for use at home and try to use it at least once/day, sometimes more if things are acting up. For any kind of chronic knee condition you really have to keep on top of things or it'll come right back. Also re-learning various motions, when/how to fire various muscle parts to avoid injury is very important.

My PT tried taping once and it made things worse so I don't do that. Best thing for me has been prevention (correct motions, etc.), and extra rest when flare-ups occur. I was off my bike from October-January, don't really want to do that again.
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Old 03-04-07, 06:52 PM
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I'm having a similar issue, and posted it here: http://www.bikeforums.net/showthread.php?t=264458. There are some exercises posted in that thread. I recently started using a patellar strap, and that seems to help a bit, as does therapy. I think it has something to do with cleat positioning, and thus your q-angle, as well, but can't seem to get a clear answer on this.
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Old 03-05-07, 12:38 PM
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[QUOTE=oboeguy]The PT does a brutal (again in a good way) massage to get to the IT band. I honestly think it helps. I'll ask him about using the pool noodle -- there are some at the gym -- to simulate the massage on a more regular basis. QUOTE]

Those deep tissue massages made me cry. They were tough!
In my case I don't think they helped.
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Old 03-05-07, 12:40 PM
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Hmmm, Machka's comment in the other thread is interesting. I seem to be fine on the trainer, but outdoors with tights... no good.
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Old 03-05-07, 12:45 PM
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Originally Posted by oboeguy
Hmmm, Machka's comment in the other thread is interesting. I seem to be fine on the trainer, but outdoors with tights... no good.

It was too cold this weekend to go with just shorts, but too warm for my tights so I did a rather dorky thing and cut the ends off of my long wool socks and used them to cover my lower leg while I had shorts for the upper leg. I was plenty warm, but not overheated. It kept my knees uncovered as well. I imagine you could do something less dorky than this by just getting leg warmers and pulling them down far enough to keep your knee uncovered.
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Old 03-05-07, 01:15 PM
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I didn't have patellofemoral pain when I was riding my mountain bike. There are many differences between then and now, including age, conditioning, distance, speed, etc. But maybe the wider Q-factor on the mountain bike was what prevented patellofemoral pain. I'm going to see if sliding my cleats laterally (inward on the shoe) helps at all. Too bad my Speedplay Frogs don't have a Q-factor adjustment.

EDIT: Unfortunately the plate in the shoes allows for almost no lateral adjustment. I guess I'll have to try pedals with longer spindles than the Frogs.

EDIT: Just picked up some pedal washers. I'll see if the slightly increased Q-factor makes any difference.

Last edited by serpico7; 03-05-07 at 03:08 PM.
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Old 03-05-07, 02:23 PM
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Originally Posted by oboeguy
Linkie for those unfamiliar with it. In effect, the left knee cap is moving in the wrong direction because of a muscle imbalance, causing pain in the knee. I've basically been off the bike for a month aside from a brief trainer ride here and there. As I'd felt fine during a 45 minute trainer session, on PT's orders, I went for a short ride yesterday to see where I stand. After about 45 minutes (coincidence?), "the old familiar sting" came back. I'm so bummed. Anybody here used taping to deal with PFS? The sports med doc suggested it could help but the PT isn't a believer.

On a more positive note, I've taken advantage of the free gym membership at my workplace and discovered the elliptical machine, use of which is heartily endorsed by the PT and sports doc. Finally a reason to be indoors for aerobic exercise! though I'd prefer (like 1000%) to ride unless it was cold and rainy outside, I really like the elliptical, what can I say? It's certainly helping me stay fit.
1. Yoga
2.Treat Your Own Knees by Jim Johnson

I had similar problems until I began doing Bikram Yoga and also the exercises in the book (there is one exercise that I do every time after a ride.
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Old 03-05-07, 02:40 PM
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Originally Posted by oboeguy
Wow, so since September? Depressing!
I've been dealing with my knee since March of last year...I think I've finally got it dialed down to the IT band, it's the only thing thing that makes any sense to me. I had ridden a mountain bike for over 5 years, using Time mountain pedals, with no problems. Got a road bike and used the Time mountain pedals on that for one year with no problems. Bought road shoes and Look Keo pedals and all hell broke loose. After the first major ride the left knee started to bother me. I was able to ride still, since the pain was never to the point I had to stop. It's been more of a discomfort for me and a nagging pain on and off the bike. I've seen a doctor, had PT, Active Release and had two pro fittings. I'm using the stick to loosen the IT band and stretching twice a day, plus trying to do exercises to balance the leg muscles better. Part of my problem is no one has been able to pinpoint the exact problem so it's been a whole case of trial and error. My wife got me a new bike for my 40th so I decided to blow the bank and by some new Sworks road shoes and some Time RXS pedals. The Time pedals have lateral float that I sense my body might need (since the Time mountain pedals never bothered me). The Sworks shoes are nice because they are roomy enough for my orthotics to fit in them. I'm going to book one more fitting session and get this bike set up and see ho things go. Right now on the old set-up and bike I'm able to go on the trainer for 45-60 minutes wthout too much pain. It's the day after that's my problem. The outside of the knee has a burning sensation in it that comes and goes. After the fitting the next thing is to book an appointment with a Sportsmed centre, here in Burlington Ontario, that I hope can give me final answer...

Bloody knees...What a pain...Pun intended!

Rich
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