# Patellofemoral Syndrome and Recovery



## CrankyMonkey (Jul 8, 2007)

A bit of background before my question... (sorry for the long explanation)

Back in September I started having severe pain and issues with my knees. I went to the doctor and he diagnosed my issue as patellofemoral syndrome with a bit of patellar tendonitis and sent me to physical therapy. At PT we mainly focused on stretching my IT bands, stretching my hamstrings and strengthening my quads/hamstrings. They also treated me with ultrasound and ice/stems. And finally the had me do SMR with foam rollers on my quads, IT bands and hamstrings. After 8 sessions I had made quite a bit of progress with everything and they discharged me. I also got a professional bike fit before I started riding regularly again (raise my saddle and adjusted my cleat position so it's more toe in).

I wasn't totally pain free on the bike but I had quite a bit of improvement. After a few rides I was about to stop riding for a while because I still had quite a bit of pain. Then a friend suggested using knee straps which allowed me to ride without as much pain with only some slight discomfort. Over the last couple of months my off the bike pain is almost completely gone and some mild discomfort in my patellar tendon post ride (especially after hard climbing). Even the mild pain (ride and post ride) is starting to tapper off but it's not completely gone. 

I've continued with the SMR and daily stretches but have completely dropped the strength training since I hardly have enough time to fit in my rides (plus I hate going to the gym). I'm worried about relying on the knee straps as a crutch, things have improved quite a bit since I started using them but I'm worried that I will have to use them permanently. Also I'm not sure how the strength training with my quads and hamstrings helps my patellar tendon. 

Should I continue using the knee straps? Is there a way to strengthen my patellar tendon? Will strengthening my quads and hamstrings really help?


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## cyclesport45 (Dec 10, 2007)

Tendonitis.... UGH! I have had several bouts of patellar tendonitis. The problem with it is one never knows one has it until AFTER the damage is done. The first time, years ago, I tried riding through it. Ended up at orthopedic surgeon's, then therapy very similar to what you describe..... then SIX MONTHS off the bike (I had it bad). My last time was about a month ago. I recognized the symptoms, bit the bullet, and shut down for a couple of weeks. Tried riding once, wasn't quite ready, and took another week. Symptoms are gone again. 

I am NOT a doctor, so please take that into account. But, from (painful) experience, and from the mouth of my wonderful orthopedic surgeon, Dr Howard....
1. Tendonitis needs REST. PERIOD. Unlike muscles, they heal SLOWLY. And as you get older.... even SLOWER.
2. Go ahead... try riding through the pain. See you on the bike next year. Maybe.
3. Ice it. Anti-inflammatory. Mine was naproxin.
4. AFTER you're pain-free, proper stretching really helps. I started doing cycling specific yoga, helped immensely. Until I got lazy early this fall and stopped. And...hip flexors got sore, hamstrings tightened.... and the mild tendonitis.
5. REST, DAMMIT!

So, if you still have even mild pain, it's great that you're riding a little, but, it'll take forever to get better. I would get it ALL better first, then start over.


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## CrankyMonkey (Jul 8, 2007)

Yeah... I'm leaning towards taking some more time off the bike. I would like to get to a place where I don't have to wear the knee straps but I also don't want to loose my fitness either. It's hard to stay away from your passion. But the crappy weather helps.


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## Welles (Aug 19, 2008)

I think knee straps just work to support the tendon. If you can continue with exercises that strengthen the tendon without irritating it,then I don't see a problem with using the knee straps for extra support. A lot of athletes tape their knees and ankles for extra support. I think its the same concept behind a lot of new athletic wear, multipanel, tight, to support the muscles. 

Go back to your PT and see what they say.


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## rbart4506 (Aug 4, 2004)

Get back on the weight training, at least that what I think has really helped me...

I've been dealing with similar problems over the last couple years and found that the straps helped me. I was like you and did everything you mentioned and was feeling better, but not great. Then this year I upped the leg work with weights. The goal was to strengthen the legs and guess what happened. The knee issues started to become less of an issue.

It's to the point now that the straps are gone and I just ride. I still get twinges here and there and am bothered some days the day after harder rides. I've always had less then perfect knees and my doctor and PT felt a lot of my problems were related to muscle imbalances.

I think they are right, since I've started focusing on leg strength the knees have improved.


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## CleavesF (Dec 31, 2007)

Knee brace. Considering this is usually chronic there's not much we can do. 

For runs longer than 5 miles I have to wear one, as well as very very long bike rides. Sometimes it comes back bad and I gotta wear it to put the pain away, but I can't do painkillers.


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## twinkles (Apr 23, 2007)

Back in 96 I had a knee making me crazy. I started using a chopat knee strap and the pain went away instantly. I was told by Andy Pruit in Boulder to wear it all I could. I wore it except for sleeping and when it could cut off circulation. I did this for a few years and itt totallly took care of my pain and now I just wear it when riding.

Why don't you wear a strap on one knee all day and wear the other just when biking and see which gets to feeling better faster? A frozen bag of peas on each knee for half an hour a day will help keep inflamation down. I'm not aware of any downsides of wearing the straps so what's the hurry to stop weareing them? I would not stop wearing them until the pain is gone. Good luck and enjoy your sweet tan lines.


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## williethewaiter (Nov 25, 2008)

my 2 cents.

I've struggled with Patellofemoral Syndrome for a while - mainly due to the fact that all the Physios etc had me doing strength exercises based around quads to help sort the muscle imbalance and get the knee tracking correctly.

Had some improvement, but still an issue.

Finally saw a biomechanic specialist, and as it turns out my problem was caused by a weakness in the glutes. Had the strength there of a 12 year old girl! Apparently that muscle is the primary muscle responsible for keeping the leg i.e. knee straight!

easy to diagnose. Get in front of a mirror. put your hands on your hips, lift one leg off the floor and try to do a one legged squat. If your knee goes inwards or outwards or you can't keep your pelvis level as you do it then you're weak in the glutes.

Exercises to fix

- squats using a swiss ball behind your back against a wall, can hold a weight if you want. make sure your thighs go parallel to the ground.
- 1 legged squats concentrating on keeping straight pelvis (after you've built strength up first)
- lay on the ground with your back against a wall, keep your leg straight and lift it up the wall. do a million till it burns! 
- do same thing but with knees bent and just lifting the knees up. 
you can do the two above using a stretchy band for resistance.

hope this helps, man it's made the most massive difference to me.

Also interesting in the above posts no one mentions strengthening the glutes.. would be keen to know how you get on.


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