Knee Pain - maybe patella femoral syndrome?

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Knee Pain - maybe patella femoral syndrome?

Postby lloydy » Tue Nov 02, 2010 8:32 pm

I've seen the disclaimer above, but seeking other opinions can't be bad, and as I'm having no joy with medical professionals with me knee problem....

I've been suffering from knee pain for a year now. Mine came on shortly after coming back from being knocked off my bike, and damaging in the main my left foot. Returning to cycling, though the pain was in my left knee, outer above the knee cap, and below on the inside towards the end of long and then increasingly shorter rides.

From before doing regular 120k+ rides, daily commuting to work by bike (70k round trip) and loads of hill walking, I was left in the stage where I got pain simply walking. I went to a physio nearly a year ago now, who diagnosed patella femoral syndrome, and I had accupuncture and physio, and was given stregthening exercises - squats, leg raises, scissors etc. which I followed religiously. Three months of this and also stopping cycling altogether, and I was in worse state than before. Practially permanent knee pain, worse from when sitting down I guess (desk job :( )

I tried a chiropactor to see if it might be related to my cycle accident and caused by hips, or ankle - but no joy there. Saw a GP who referred me to a orthopeadic knee specialist who recommended further rest. With no improvement at all, I started to resume light cycling, which was Ok for short distances, certainly no worse than resting.
Going back to the knee specialist after no improvement, I had a MRI scan which has just now come back negative. He said simply that there is nothing structurally wrong and that I should try to resume my full cycling, which is ridiculous as I have knee pain simply from simply walking.

An attempt to slightly increase the amount of cycling produced the inevitable increased knee pain again. So I'm back to square one again, except a few dollars poorer.

I'm lost as what to do next. I've never had any knee pain before, but there's clearly some thing wrong and giving my the knee pain. It's not just cycling, walking's the same. The other noticeable symtom is regular clicking if I bend my knee. There's no change in my bike set up, which I've happily managed along for years (42 now).
I've tried total rest, but that seemed to be worse than doing shorter and easier commute into work.

I'll probably have to bite the bullet and try another physio and hope for the best, but it's so infuriating. If I hadn't managed to keep active through increased sea kayaking this last year, I'd have gone stir crazy.

Anyway be interested if anyone has any similar experiences.
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by BNA » Tue Nov 02, 2010 8:38 pm

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Re: Knee Pain - maybe patella femoral syndrome?

Postby CommuRider » Tue Nov 02, 2010 8:38 pm

lloydy wrote:I'm lost as what to do next. I've never had any knee pain before, but there's clearly some thing wrong and giving my the knee pain. It's not just cycling, walking's the same. The other noticeable symtom is regular clicking if I bend my knee. There's no change in my bike set up, which I've happily managed along for years (42 now).
I've tried total rest, but that seemed to be worse than doing shorter and easier commute into work.


Get a second opinion, and a third opinion, and so forth. Find another knee specialist. And another. Preferably find one that has done further studies in the field eg teach or lecture at a medical school and/or published scientific papers on knee-related stuff because they are usually the problem-solvers and will find your case "interesting" as opposed to the "knee specialist is just my day job" types.

Unless you're a hypochondriac, keep on trying until the specialists find out what the problem is. You've been sitting on the pain for the last year and that's an incredibly long time. Your instinct that there's a problem is usually correct so don't ignore the problem as it won't go away and you'll be in a worse shape further down the track.
Amateur oenologist and green-friendly commuter.
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Re: Knee Pain - maybe patella femoral syndrome?

Postby ft_critical » Tue Nov 02, 2010 9:00 pm

I'll have a punt at it.

You damaged your left foot and lost flexibility. Thus you are not dropping your heel on that side as much. This is the same as having your saddle too high. I am guessing there is a knee wobble in there too in that your knee no longer tracks straight, because of the same issue.

All pure guesses. Try strengthening the ankle and getting the fexibility back.

Don't shoot me for guessing though. please.
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Re: Knee Pain - maybe patella femoral syndrome?

Postby scotto » Wed Nov 03, 2010 7:26 am

lloydy, it sounds like patello-femoral pain, possibly not managed too well by how you describe it.

as a physio, i would be checking your foot posture in standing and on the bike(though this is less significant as cycling involves way more forefoot than whole foot) as an over pronated foot or one with a flattened arch can have a big impact on your knee. we'd check out PFjt tracking and muscle activation. a quick check on lower back and the rest of the knee to rule out anything else.
then onto taping the patella to 'correct' its tracking and eliminate pain on squating. simple exercises to increase inner quads (VMO) strength without loading the patella too much (single leg 1/4 squats perhaps).
the big issue with this type of problem is that if you have any pain or swelling, the brain 'turns down' the input to certain muscles, a bit like a dimmer switch on your lights. pushing hard with exercises into pain, often means the muscle imbalance simply gets worse.
if the exercises arent pain free, you shouldn't do them. thats my number one rule.

now, more from a cyclist POV i'd chuck your bike on a trainer and quickly check cleat position, frame and seat height. too low or too small a frame can increase PFJ pressures. orthotics specific for your cycling shoes, or cleat wedges maybe necessary.

maybe try another physio. its a very simple problem to manage that isnt managed too well unfortunately.

additional: oddly enough, i just had to stop typing as it was time to work, and sure enough, the first appointment is a 41 yr old guy with left PFjt problems. saw him initially on monday, taping, simple exercise, lots of education. much better. maybe thats why i'm not a rich physio !
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Re: Knee Pain - maybe patella femoral syndrome?

Postby elantra » Wed Nov 03, 2010 2:57 pm

if the exercises arent pain free, you shouldn't do them. thats my number one rule.

Yes to that for sure.

Which knee is it ? or is it both.

Patello-femoral pain, AKA chondromalacia patellae, is a poorly understood medical condition which can be a considerable PITA.

Typically the symptoms can be reproduced by sitting for a long time with knee bent at approx 90 degrees, such as at the movies.

If it is patello-femoral pain, i advise try to continue bike riding but only small to moderate distances and only low to moderate intensity.
Get out of the saddle on hills.
As per previous advice, get your foot position reviewed, and if any doubt try for a while using shoes that do not clip-in.

I had fairly classic and quite severe patello-femoral pain ages ago, eventually it got better and i am free of it now.
But you cannot be entirely sure that this is the correct diagnosis, so consider repeat MRI scan.
Hope that helps,
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Re: Knee Pain - maybe patella femoral syndrome?

Postby jpgibson » Wed Nov 03, 2010 4:37 pm

I've had a similar problem. I went to a Physio and started exercises for vastus medialis (VMO) to try to correct patellar tracking. The thing that worked was gettin my bike fitted and being instructed to pull on the pedals and not push. This has worked. The other thing to note is , like me, you're not 25 and injuries will occur an take a lot longer to heal. I also had shoe thingies inserted an I think it's made a difference. Good luck. Be reassured by the negative MRI.
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Re: Knee Pain - maybe patella femoral syndrome?

Postby ireland57 » Wed Nov 03, 2010 9:20 pm

I'm in the midst of repairing a similar problem, not from a crash (not recently anyway) but years of work and abuse.

Things that did/do damage to it :- work on building site (lifting. climbing ladders, scaffold/steps), dear friend doctor jamming knee joint shut (after I told him not to; couldn't walk properly for 3 wks after), rowing machine (1 session ignoring pain took months for knee to recover from), hill walking (high steps, closing knee joint too far), tight back, hamstring, glute, itb, quad muscles. Also pushing firm gearing into wind on flat ground causes pain fairly quickly. I can't do it for long or seated climbing; I have to spin mostly.

Things that are helping it :- shorter cranks on bike (roadie only so far; will be swapping mtn bike asap), proper stretching and strengthening program (devised from podiatrist and physio), bike fit (mtn bike good; still adjusting roadie), spinning instead of pushing big gears. At night if they hurt (mostly one knee is problem) I use a compression bandage and much pain is gone by morning.
I found icing can cause almost a "lockup"; sometimes it works, sometimes it doesn't.

I honestly don't think many understand what the problem is including some of the medical profession. I've been advised to do squats many times. They SMASH my knees. I haven't done them for ages apart from now sneaking up on a split squat as my knees improve. MRI 's and Xrays have shown my knees to be in sound condition.

They are still bothering me but are slowly improving. I HATE stretching but can see it working and do it at least twice, usually three times per week.
I can do things on the bike now that I couldn't do a month ago.

Last night I beat a mate up a 3km hill climb (10%) for the first time, only beating him in the last 200 metres. I've wanted to do that for ages but couldn't think about it until 2 wks ago because my knees hurt so much under certain types of stress.

Also been doing core strength; back getting better too. Long winded but hope it helps.
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Re: Knee Pain - maybe patella femoral syndrome?

Postby scotto » Thu Nov 04, 2010 7:09 am

ireland57 wrote:I found icing can cause almost a "lockup"; sometimes it works, sometimes it doesn't.

to be honest, i find ice sometimes over rated

simply put, ice does two things physiologically. it causes blood vessels to contract - thats how it limits bleeding and the swelling it produces. secondly, it slows down nerve conduction speed - thats how things go numb.
oh, and being colder, soft tissues sometimes tighten up, which seems to be what youre describing. do me a favour and try a heat pack on it one night when its aching a bit. :wink:
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Re: Knee Pain - maybe patella femoral syndrome?

Postby cavebear2 » Thu Nov 04, 2010 4:07 pm

scotto wrote:to be honest, i find ice sometimes over rated

simply put, ice does two things physiologically. it causes blood vessels to contract - thats how it limits bleeding and the swelling it produces. secondly, it slows down nerve conduction speed - thats how things go numb.
oh, and being colder, soft tissues sometimes tighten up, which seems to be what youre describing. do me a favour and try a heat pack on it one night when its aching a bit. :wink:
I have found this with my ITB tendonitis, icing is too extreme and ITB and hamstring become stiff or lock up. On the other hand just running cold tap water over my leg (not very cold in Perth at any time of the year) significantly reduces this stiffening tendancy.
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Re: Knee Pain - maybe patella femoral syndrome?

Postby toolonglegs » Thu Nov 04, 2010 4:46 pm

Maybe OT (probably)...but mixed in with my other issues I have very bad shooting pains and an underlying dull ache starting in the front of my thigh and shooting down around my knee and finishing just underneath my knee cap.Internet anatomy studies :lol: showed me that the only muscle that goes into those areas is the rectus femoris...I have been stretching it for years by just bring my foot up to my bum...but more research showed that hooking my foot over the kitchen sink (I am tall!) and dropping my other leg down while pushing my pelvis forward really stretches this muscle out and has reduced the knee pain a lot....then I have been rolling my thigh out with a rollin pin...OK I am getting really OT :mrgreen: .
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Re: Knee Pain - maybe patella femoral syndrome?

Postby ireland57 » Thu Nov 04, 2010 8:46 pm

I'll try the heat (but 2 physios said use ice; I asked about alternate [ice/heat cycles] or heat; they said no. :? 8)

The stretching (rectus femorus, ITB + others) is working well. I'll cut a foot off the bottom of my sink :oops: and well.....not ready for the rolling pin yet but the ITB roller doesn't hurt so much anymore.

Lloydy, it's well worth a shot at it.
I'm now wondering if my whole life building (and suffering back pain) could have been eased enormously by stretching these same parts.

If only I'd rung a bike rider or two.
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Knee Pain - maybe patella femoral syndrome?

Postby scotto » Thu Nov 04, 2010 9:49 pm

Sounds like you've thought of everything including the kitchen sink. Re: icing, it's vital for 48 hours after an injury. Then it ain't. Rectus femoris, Aka quads, can always do with a stretch, and this can reduce pressure under the knee cap .
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