Knee stretches upsetting my MCL or Pes Anserine

Xcessiv

Hello guys,

I recently developed a patellofemoral syndrome probably due to 3 causes:
- saddle too front forward and too low
- too much power too often on the indoor trainer
- overuse (I'm at 4500 km in Zwift since last November)

With my PT and according to the pain points when massaging, we believe that the VMO was the root cause because it was extremely sore. It took a full 2 weeks to get it back to life. I also eased up on training during these 2 weeks. Daily massages and re-positioning of the saddle allowed me to get back to Zwift.

Now the problem...

My PT gave me 6 stretching exercices. Two of them pull on the MCL and Pes Anserine.

Even going extremely gentle, and making sure that all my muscles are warm, after these stretches, I feel pain in the MCL and Pes Anserine area for 1 to 2 days.

On the other hand, I also feel (somewhat... really not sure on this one) that these exercices are beneficial after the 1 to 2 days heal.

Should I keep going? Did you ever experience this?

Thanks!

trekvet

In general terms, and reading between the lines, I suggest it is not what you are doing that is the problem, but rather what you are not doing. If I wanted to improve my knees that cycling and related activities had buggered up, I would stop cycling, stop indoor training, stop Zwift, and instead get out there and walk in the countryside up hill and down. This will have the effect of conditioning the knees and body generally, then you need some core and hip strengthening exercices. Then when the summer arrives you'll be ready to sell all except the bike, to which you fit Speedplay pedals and get out in the sun. Good luck.

pinno

Just a few rhetorical questions that I am going to chuck in the hat.
As cycling is a non-impact sport and encourages the production of Cortisone, has there been a reduction of Cortisone (due to some hormonal reason or other)?
Are you sure it's entirely muscular?
Would some hydrotherapy help? What Trekvet suggests is a brief cessation of what you are doing and some other exercises to correct the problem. Hydrotherapy and swimming is great for both exercising muscles that we don't normally use so much in cycling and being in water takes the weight off your body and of course, in your case - the knees..
That leads me to the last one - Have you done some core stability/lower back strengthening? It's not unrelated. I'm just wondering if there's pain in the knee from the Sciatic nerve.

Xcessiv

Hello guys,

I've reduced zwift to a minimum and have been massaging/stretching. It seems to help, but I'm not 100% there yet.

You're probably right, I should "cross train" more as I'm totally getting out of balance muscle wise.

I'm almost positive it's a muscle issue, as I discover new trigger points every day when massaging lol. I haven't had a single massage, and haven't stretched once in 11 000 km (12 months) of fairly intense riding... Big mistake.