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RoadBikeReview's Member
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last summer i converted from doing 50/50 running to doing all biking. one day i decided to go for a run, and after 800M i couldnt walk, due to knee pain. i freaked, went to the doctor,and was diagnosed with Patellofemoral Pain Syndrome, which is, for those of you who don't know, Runner's Knee. for those of you who know what Runner's Knee is, skip the next paragraph.

runner's knee is a syndrome caused by unequal strength between the inner and outer quadriceps. it commonly afflicts runners, and bikers as well, because both sports work the outer quads almost exclusively, causing them to become much bigger and stronger than the inner quads. the tendons get tighter on the outside than the inside, and as such, the patella (knee cap) slides out of its groove, towards the outside. when weight is put on it or muscles are used, there's pain (hence Patellafemoral *Pain* Syndrome).

Of course, i freaked out, and started doing the doctors exercises, and just stayed off the bike, figuring i'd let my quads get weaker so that the discrepancy wouldnt be so bad, so that i could get rid of patellofemoral.
the other day at spinning class, i looked down at my knees, and had a heart attack. my knee caps were on the edges of either of my legs, looking liek they were ont eh verge of a resurgence of patellofemoral. this scares me because ive been doing my exercises and stuff, the ones i remember, and they dont seem to be working.

as i havent seen any other posts about this, im assuming that you guys have not had to deal with this, which means (i assume) that youve foudn a way to get around it.
can you tell me what you guys do to avoid it? i'd rather not get it again, its not very much fun on the bike or in running shoes...

oh btw i developed the patellofemoral *after* i stopped running, so it was solely due to biking, hence my concern as i enter a 90% bike year.

Thanks!
-estone2
 

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Government Mule
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Don't know if this is relevant, but just going to relate my experience. I was playing tennis pretty avidly and running for conditioning; also doing some bike riding. I broke a big toe and had to stop playing tennis and running for a couple years. Bicycling was the only exercise I could do during that time. The first time I ran a couple miles after that, my knees and legs in general hurt like hades even tho I had been bicycling. Didn't go to the doctor just worked thru it. Got back into tennis and let the bike hang for a couple years. Had to ride it one day for about 12 miles as fast as I could go. Had to take off work the next day because I couldn't walk. Different activities work different muscles, and going too hard at something you aren't conditioned for is going to cause pain. Avoided doctors like the plague because I refused to admit any permanent damage. Let the toe heal without medical attention as well. Finally submitted to the docs for blood pressure and like he says "its that time again"!
 

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Wrong assumption

estone2 said:
(i assume) that youve foudn a way to get around it.
can you tell me what you guys do to avoid it?
I ride a bike almost exclusively for exercise, and so I'm sure that my muscles are way "out of balance" but have never had the problem. I'm thinking that possibly your physiology is such that you are more susceptible to this than the vast majority of the population, or it was brought on by something else. Just guessing here.
 

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When we run and when extending our legs with each stride, the lower legs twists toward the middle, while we have X4 major muscles working together: the quads (total of 3) pull the knee cap outwardly, while the vastus medialis muscle pulls the knee cap towards the middle. So if one muscle group is weaker than the other, you will get uneven stress on the knee cap, it will not slide evenly up and down its groove, and cause pain due to inflammation. So strenghtening your leg muscles is very important to avoid this kind of injury. Also, check your feet and your footwear. If they are mis-aligned, you are set up for uneven stress to the knee cap also. Heel support or orthostics help with this issue. Perhaps your lack of running (after doing mostly cycling) weaken your vastus medialis, specially if your pedaling is the hammering style and not the "circle-spin", with the heel pulling up on the upstroke.Avoid running until the knee does not hurt, then gradually get back to it with the approval and assistance from a qualified healthcare provider.
estone2 said:
last summer i converted from doing 50/50 running to doing all biking. one day i decided to go for a run, and after 800M i couldnt walk, due to knee pain. i freaked, went to the doctor,and was diagnosed with Patellofemoral Pain Syndrome, which is, for those of you who don't know, Runner's Knee. for those of you who know what Runner's Knee is, skip the next paragraph.

runner's knee is a syndrome caused by unequal strength between the inner and outer quadriceps. it commonly afflicts runners, and bikers as well, because both sports work the outer quads almost exclusively, causing them to become much bigger and stronger than the inner quads. the tendons get tighter on the outside than the inside, and as such, the patella (knee cap) slides out of its groove, towards the outside. when weight is put on it or muscles are used, there's pain (hence Patellafemoral *Pain* Syndrome).

Of course, i freaked out, and started doing the doctors exercises, and just stayed off the bike, figuring i'd let my quads get weaker so that the discrepancy wouldnt be so bad, so that i could get rid of patellofemoral.
the other day at spinning class, i looked down at my knees, and had a heart attack. my knee caps were on the edges of either of my legs, looking liek they were ont eh verge of a resurgence of patellofemoral. this scares me because ive been doing my exercises and stuff, the ones i remember, and they dont seem to be working.

as i havent seen any other posts about this, im assuming that you guys have not had to deal with this, which means (i assume) that youve foudn a way to get around it.
can you tell me what you guys do to avoid it? i'd rather not get it again, its not very much fun on the bike or in running shoes...

oh btw i developed the patellofemoral *after* i stopped running, so it was solely due to biking, hence my concern as i enter a 90% bike year.

Thanks!
-estone2
 

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Genetics

While at rest and with a fully extended knee, are your knee caps easily manipulated to the left and right? If so this might explain the excessive travel. I have the same problem and while showing some riding buddies they were amazed at the amount of free travel in the caps. I thought eveyone had the same condition but have found most have pretty tight caps. Find a Dr. who cycles and understands the condition. Other ortho guys just don't get it.
 

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Pfs

If all you have been doing so far is the stretching and exercises that your doctor gave you, then you might have more improvement with an actual course of physical therapy- they have ways to strengthen the vastus medialis without strengthening the other quad muscles. If you get straightened out there, then the exercises they give you may hold you for a while... unfortunately whatever caused the imbalance is still there- more crosstraining would likely be beneficial (Low impact such as eliptical), but you might need to reevaluate your position on the bike. Little things like the slope of the road for runoff can cause PFS in some people because the forces on the 2 knees are different towards and away from the crown of the road- and that can cause people to have PFS in one knee and not the other. Maybe getting the "fit" or positioning of your shoes changed by an expert would help.
 

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RoadBikeReview's Member
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Discussion Starter #7
jmchase76 said:
If all you have been doing so far is the stretching and exercises that your doctor gave you, then you might have more improvement with an actual course of physical therapy- they have ways to strengthen the vastus medialis without strengthening the other quad muscles. If you get straightened out there, then the exercises they give you may hold you for a while... unfortunately whatever caused the imbalance is still there- more crosstraining would likely be beneficial (Low impact such as eliptical), but you might need to reevaluate your position on the bike. Little things like the slope of the road for runoff can cause PFS in some people because the forces on the 2 knees are different towards and away from the crown of the road- and that can cause people to have PFS in one knee and not the other. Maybe getting the "fit" or positioning of your shoes changed by an expert would help.
hmm. since you seem to know your stuff, (no sarcasm, you know the muscle names and i dont, soooo :p ), do you have any idea what would cause PF in both knees? cuz i dont think im bad enough of a cyclist to weave back and forth over the road... though i'm a fred, i dont think i'm to that extent yet... *sticks out knees* ;)
 

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Discussion Starter #8
West End Rail said:
While at rest and with a fully extended knee, are your knee caps easily manipulated to the left and right? If so this might explain the excessive travel. I have the same problem and while showing some riding buddies they were amazed at the amount of free travel in the caps. I thought eveyone had the same condition but have found most have pretty tight caps. Find a Dr. who cycles and understands the condition. Other ortho guys just don't get it.
uh i'm guessing fully extended knee means straight leg, relaxed muscles? (i'm slow :D )
both my right and left knee caps move to the inside the width of my thumb (side/side of the pad), and two times the width of my thumb to the outside. they dont travel back and forth when im riding, they sit very solidly on the outside, and i cant get them to sit in the middle or insides worth my life.

how do you deal? (yeah im still hoping for a miracle exercise :p )
 

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Exercise the VMO

estone2 said:
uh i'm guessing fully extended knee means straight leg, relaxed muscles? (i'm slow :D )
both my right and left knee caps move to the inside the width of my thumb (side/side of the pad), and two times the width of my thumb to the outside. they dont travel back and forth when im riding, they sit very solidly on the outside, and i cant get them to sit in the middle or insides worth my life.

how do you deal? (yeah im still hoping for a miracle exercise :p )
They told me (PT & Ortho Surgeon) to build up the vmo muscle. Thast is the muscle on top of the knee to the inside.

Here is a link to some good exercises:
http://www.rice.edu/~jenky/sports/pfs.html
 

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I had it last summer - totally derailed my chances at the State RR. But, I would definitely go see a Physical Therapist. The Orthopods recommended general quad strengthening exercises, while the PT got me on a home program to strengthen my vastus medialis only - it worked! BTW, I am a physician too.
There were several home exercises to do but the best thing that worked for me were leg extensions on a weight bench using only the last 15-20 degrees of extension of the affected leg. I also got my bike refit at a bike shop specializing in racers (i.e. high mileage types who have no room for error). Hope this helps!
 

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Discussion Starter #11
otoman said:
There were several home exercises to do but the best thing that worked for me were leg extensions on a weight bench using only the last 15-20 degrees of extension of the affected leg. I also got my bike refit at a bike shop specializing in racers (i.e. high mileage types who have no room for error). Hope this helps!
i'm not sure exactly what you mean by 'the last 15-20 degrees of extension', can you send pictures or something similar? (like you said, no room for error, i want the exercises to work). how did they refit it? (ie did they lower your stem, scoot your saddle forward/back, etc?) i'm not gonna try myself (tho i might drop by the LBS), im just curious
-estone2
 

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estone2 said:
i'm not sure exactly what you mean by 'the last 15-20 degrees of extension', can you send pictures or something similar? (like you said, no room for error, i want the exercises to work). how did they refit it? (ie did they lower your stem, scoot your saddle forward/back, etc?) i'm not gonna try myself (tho i might drop by the LBS), im just curious
-estone2
Definitely have an LBS help you. You can't do a refit alone and expect good results.

Sit on a chair, feet on the floor. Your lower leg should be at about 90 degrees relative to your upper leg. Now lift your feet straight up without moving your thigh off of the chair - in other words, only move your leg at the knee joint. You just moved your leg through 90 degrees of extension at the knee joint. Now drop your foot down about 12 inches. That is about 15-20 degrees or so depending on the length of your leg. My main point, however, is not to tell you an exercise plan, but to tell you to go see a physical therapist. IT WILL HELP.
 

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I developed PFS a couple of years ago. By far the single greatest thing that helped me recover was weight training. Start with 2 days a week of very light squats, leg extension, hamstring curls, lunges etc. In the begining concentrate on proper form and high reps, and ever so slowly increasing the amount of weight you lift over an extended period of time. Avoid the urge to go too heavy too soon, you have to start light and not worry about what a weakling you look like. I started with just the bar! Continue the weight training ALL season long to avoid recurrence. Also try running in a pool, it's a great low impact exercise.
 

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Bryan said:
I developed PFS a couple of years ago. By far the single greatest thing that helped me recover was weight training. Start with 2 days a week of very light squats, leg extension, hamstring curls, lunges etc. In the begining concentrate on proper form and high reps, and ever so slowly increasing the amount of weight you lift over an extended period of time. Avoid the urge to go too heavy too soon, you have to start light and not worry about what a weakling you look like. I started with just the bar! Continue the weight training ALL season long to avoid recurrence. Also try running in a pool, it's a great low impact exercise.
This is probably a good idea- once you are already free of pain. As a Family Medicine doctor who sees a fair amount of sports related and overuse (this is considered an overuse injury) injuries, the most common thing people do to set back their recovery is to go too hard once they have started to feel a little better- all they end up doing is exacerbating the problem again. By putting excess pressure on the joint with weights when the patella (kneecap) is still tracking abnormally, you might (probably) will just make the problem worse. Like otoman said- Physical Therapy is the place to be at this point in time. Whether you go for only 1-3 visits and do the exercises at home or go for a couple of months using their weight machines, you will end up happier and most likely get on the bike much sooner with their help. It doesn't hurt that physical therapists are normally althetes of some sort themselves, and many have had overuse injuries and understand how to deal with them.

Again- this may help in itself, but I would drop by the LBS to get the fit checked as well.

-jmchase76
 
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