Patella Femoral Syndrome

petergettins

Hi there,

I've recently got back on the bike after a few years off due to lower back issues. I used to race, but now ride a hybrid for a more upright position. Was all going well till I did a sportive on the weekend & now my old patella femoral syndrome is back in my right knee. Without a doubt it's down to overuse, the ride was 5 1/2 hours and very hilly.

I've got some exercises off the web but they're all geared to the long term strengthening of the various muscles which generally cause it. Does anyone have experience of this & can recommend any specific exercises?

Thanks

Pete

borisface

I too suffer from patella femoral pain syndrome. Like you I used to race but had a dazzling career (ho ho) ended in the early 1990s. I gave up and started back again 5 years ago and after a season of racing it came back. Going to see a sports physio defo helped . Physio has moved on such a lot in the last few years and they don't tend to say well if it hurts stop riding but will give you exercises to help manage it. I doubt very much that it is down to overuse in your case, maybe overuse in the sense that you're unaccustomed to 5 1/2 hr rides. I now live in the Portuguese mountains and regularly do 4 or 5 hours in the mountains without any significant trouble and 4 or 5 rides most weeks. I probably do 12 hrs per week on average. I regularly go touring and stick in weeks of 30 hours plus.

What I have found is to try and manage it before it happens or gets too bad. I wear orthotics in my shoes all the time which helps a great deal. I do stretches but not particularly systematically. I find that if it is starting I stretch for a few days and it goes away. A bike fit explaining your history may help depending on the capability of the fitter. I found that one leg was longer than the other, or it may have been one was shorter and now have cleats that are built up under the short side. Sorting out some pedals with a decent amount of float (I use speedplay) helped for me and ditch the hybrid for drops where you will be able to obtain a much wider range of movement and options to maximise your comfort. I'm not very flexible but now use compact bars which enable me to get down on the drops comfortably.

Unfortunately, what might work for me won't necessarily work for you and it can be costly to sort out a comfortable fit - ie. bikefit, new stems, bars, pedals, shoes etc. But don't lose heart it is still quite possible to ride decently.

petergettins

Many thanks for your reply, there's lots of food for thought there. I had been thinking about getting a bike fitting done both for my road bike(s) & the hybrid so yes I think that'd be a good idea.

If I'm being honest, there was no way I'd done enough long rides before doing the sportive so I know that was a mistake, but I got a bit carried away with it all and yes when I said it was overuse, that's pretty much where I was coming from in that it was that I wasn't used to doing such long rides. What you say about stretching is very true, as many people are I'm quite undisciplined in that area, but I'm making a conscious effort to do it specifically for the muscles which are assocated with PFMS when I saw a physio many years ago when I first got it, he suggested I do that, but as with many things once the pain subsides you tend not to bother.

I think though that the bike fit will indicate the correct positioning and then once I know that I can ensure I stick to it.

The good news though is that overall I'm very pleased to be able to be back cycling again, despite this issue (which I realise is a lot of my own fault) as I missed it. If I can ultimately get back to a road bike that would be great, but if that's not a viable option then at least I can enjoy the more upright hybrid

Thanks once again

Pete

keef66

" I found that one leg was longer than the other, or it may have been one was shorter"

Come on, which is it? We need to know!

tuono24

Patella fermoral syndrome is caused by excessive friction of the patella in the femoral groove 8)
The "cure" is to improve its tracking, and so, depending on the cause, this is normally achieved either by:

strengthening vastus medialis (oblique) by exercises which concentrate on the last 15/20 degree of leg extension (step ups) combined with "stretching" of the ilio tibial band (rollers are good)
or
just keep cycling
since the patella is inside the tendon, toning the quads "generally" will lift it up so it glides sooner than drags in the groove

Oh .............and keep cadence at least 90

20 years practitioner / tutor in sports massage therapy / author of Register of Regulated Qualifications QCF level 3 and level 4 sports massage quals

borisface

keef66 wrote:

" I found that one leg was longer than the other, or it may have been one was shorter"

Come on, which is it? We need to know!

Apologies, now I think about it one foot was lower than the other.

Glad I could help.

whatleytom

Dragging this topic back up as I've just been told I may have similar.

My history is a little more difficult in that on the knee in question I've had a complete ACL reconstruction, as well as a partial meniscectomy. However, after 5 years riding, and 2 years of competitive racing, no real knee issues until the beginning of this year when I started to get medial knee pain. It appears to come on after the first 20-30 minutes of riding. Its manageable but pretty unpleasant. After getting of the bike the knee doesn't hurt, although is slightly tender to the touch, and ever so very slightly swollen. VMO appears to be sore more than anything else.

Been to see a physio last night who said I may have Patella Femoral Syndrome. He gave me some strengthening exercises to do. One legged squats, clams etc. But basically said I can ride, but have longer than usual recovery, but am unlikely to be able to properly ride absolutely pain free again, which was not what I wanted to hear for obvious reasons.

I've not changed cleat position or fit for a couple of years, and ride with Look Keo grey cleats. What I find slightly odd is that this only really hurts when in the saddle. When climbing out of the saddle, even big 1400w+ sprints are pain free.

Any other ideas on things I can do to help improve.

maryka

whatleytom wrote:

Any other ideas on things I can do to help improve.

Haven't read the whole thread but what worked for me was what was said a few posts above:

strengthening vastus medialis (oblique) by exercises which concentrate on the last 15/20 degree of leg extension (step ups)

I used a knee extension machine in the gym for it though. Literally just a one-legged knee extension using the last 30 of so degrees (so not lowering the leg completely, but only 30 degrees then straightening it again for 1 rep).

I reckon you could get a heavy sandbag and hang it over your shin and do it at home seated in a chair. Can't remember what weight I used but I did 15 reps at a time. Worth looking into if you've tried everything else.

whatleytom

Thanks, for the reply Maryka.

Thinking back to it I'm a little wary of trusting the physio in question, I've seen my far share of physio's a couple of who have misdiagnosed even my complete ACL rupture. All this guy wanted to do was get me in for more sessions, after having told me i'd likely never fully be able to recover.....

In any case, I did a good bit of thinking on this last night, as well as going for a bit of a ride. In pretty much the last couple of years my position on the bike hasn't really changed too much, nor has cleat position etc. Checked out my bike and cleats across two pairs of shoes and everything looked in order. But I realised since the beginning of the year, due to the recent cold snap, i'd been wearing both tights and shorts, so two pads. My theory is that this may have effectively raised my saddle height enough to have began my knee tracking slightly off.

Last night I rode pretty easily/tentatively with just a thin pad and had no real pain. Now, i'm hoping/praying that this is it solved, although it just as easily could have been no pain due to the Physio having worked the area, so the next couple of days will obviously be telling.

Still I'm going to carry on with the exercises anyway, as I think its obviously important I have the right support muscles working.