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Discussion Starter #1
I just started physical theropy. Rt knee chondromalatia (spelled wrong). It seems to be under control.
Right knee strain on the back side. They have been usnig ultrasound to help healing. So far I haven't done anything for the right knee. I was wondering what you guys have done in PT that has helped you with cycling.
thanks
 

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BS the DC
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b987654 said:
I just started physical theropy. Rt knee chondromalatia (spelled wrong). It seems to be under control.
Right knee strain on the back side. They have been usnig ultrasound to help healing. So far I haven't done anything for the right knee. I was wondering what you guys have done in PT that has helped you with cycling.
thanks
I'm a doctor, I own two rehab clinics and employ two physical therapists. If I understand you correctly, you are saying your pain under the knee cap is fine now, but you are still having pain in the back of the knee. Where exactly? What makes it hurt? Did you have an MRI?

Generally speaking, bicycling is one of the best tools for knee rehab. We use it on almost all knee patients. That said, doing hill intervals or centuries is not knee rehab. Your cycling should probably be limited to short easy efforts. You should probably be doing some specific stretches and exercises, electric stimulation (interferential), ultrasound, heat/ice.
 

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Discussion Starter #3
here goes

rt knee kinda behind and towards the top of the patella. that on isn't bothering me as much. they said it was chondromalatia. left knee is a strain on the back side that is tight and hurts when my leg is fully extended and my toes are pointed inward and I try to do a leg curl. I have cut way back from around 15 hrs/week.
I only notice it during part of the pedal stroke, like 4 o'clock to 7. And it doesn't hurt alot, it hurts more just walking around.
 

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BS the DC
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b987654 said:
rt knee kinda behind and towards the top of the patella. that on isn't bothering me as much. they said it was chondromalatia. left knee is a strain on the back side that is tight and hurts when my leg is fully extended and my toes are pointed inward and I try to do a leg curl. I have cut way back from around 15 hrs/week.
I only notice it during part of the pedal stroke, like 4 o'clock to 7. And it doesn't hurt alot, it hurts more just walking around.
Right Knee Chondromalacia: Even though it's doing good, don't take it for granted. Take care of it. It can slowly creep up on you and seem to never go away. Stretch your quads. Look into orthotics.

Left Knee: It sounds like a strain of the medial hamstring and/or medial meniscus. Hamstring stretch would be real important. Again, orthotics might help. I'm a big fan of orthotics.

If you don't feel comfortable with your therapist or doctor, then find another.
 

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Could you talk to me about orthotics a little bit?

I've been having some knee difficulties, too, that I can describe to you in detail, but don't want to waste too much of your time, as I'm sure you get requests for free advice constantly.

Briefly, can you recommend a brand / source for quality ones? Are more inexpensive orthotics available in sporting goods stores of any use, or do you need an expensive, custom one to make a difference? Thanks!
 

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Argentius said:
Could you talk to me about orthotics a little bit?

I've been having some knee difficulties, too, that I can describe to you in detail, but don't want to waste too much of your time, as I'm sure you get requests for free advice constantly.

Briefly, can you recommend a brand / source for quality ones? Are more inexpensive orthotics available in sporting goods stores of any use, or do you need an expensive, custom one to make a difference? Thanks!
Some of the inexpensive orthotics in the sporting good stores are just this side of useless. Custom orthotics are WAY expensive and not needed by most people. I currently use and recommend Sole Custom Footbeds at www.yoursole.com. The can be heat molded for a custom fit and they come with a 90 day guarantee.
 

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Chondromalacia's now a generic term alot of orthopedic docs <mis>use...it doesn't mean you actually have "softening of the cartilege" of the patella. You probably suffer from a tracking problem of the patella. This can cause inflammation and pain. You're probably a bit knock knee'd and your feet probably pronate a bit (orthotics can help here). You've probably got a weak VMO (inner quad muscle, vastus medialis oblique) and a stronger Vastus Lateralis (outer quad muscle) which results in your patella being forced onto the outer groove of your femur thus pain/inflammation.

treatment...strengthen the VMO, this is the priority. do a web search on vmo, patellofemoral dysfunction etc and you'll have hundreds of web pages of examples of these exercises. Also you proabably have a tight iliotibial band (IT band) which compounds the problem...so yes stretching can help here.

Is your PT an athlete....probably not, find one who is (where does the local college athletes get therapy...start there). Ultrasound will not help you with this problem (but it may help with the left knee/hamstring)

left knee sounds like a Hamstring strain/overuse injury...do the PT, lower your saddle 1cm and forward 1/2 cm, spin with lower/easier gears for a while, take lots of ibuprofin or aleve consistantly for a week or so.

oh yeah...YMMV.
 

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Scary Teddy Bear
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Yep

Mr_Mojo said:
Chondromalacia's now a generic term alot of orthopedic docs <mis>use...it doesn't mean you actually have "softening of the cartilege" of the patella. You probably suffer from a tracking problem of the patella. This can cause inflammation and pain. You're probably a bit knock knee'd and your feet probably pronate a bit (orthotics can help here). You've probably got a weak VMO (inner quad muscle, vastus medialis oblique) and a stronger Vastus Lateralis (outer quad muscle) which results in your patella being forced onto the outer groove of your femur thus pain/inflammation.

treatment...strengthen the VMO, this is the priority. do a web search on vmo, patellofemoral dysfunction etc and you'll have hundreds of web pages of examples of these exercises. Also you proabably have a tight iliotibial band (IT band) which compounds the problem...so yes stretching can help here.

Is your PT an athlete....probably not, find one who is (where does the local college athletes get therapy...start there). Ultrasound will not help you with this problem (but it may help with the left knee/hamstring)

left knee sounds like a Hamstring strain/overuse injury...do the PT, lower your saddle 1cm and forward 1/2 cm, spin with lower/easier gears for a while, take lots of ibuprofin or aleve consistantly for a week or so.

oh yeah...YMMV.

Right Knee- VMO strengthening as this poster has suggested. It does not mean that the "chondromalacia" cannot recur, but it will help to lessen the probability.

Left Knee- Start with Posterior knee stretching, some cyclists discover through overtraining and overuse a potential tightness of the posterior structures of the knee, this is thought to be due to lack of absolute extension while pedaling...start with these, if symptoms persist, orthotics as suggested above MAY be the correct answer.
 

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Yes

Ultrasound will be useless for the anterior portion. As far as the VMO strengthening there have been recent articles in the Journal of Orthopedics and Sports Medicine that indicate this may or may not be helpful as well as patellar taping. There is some evidence to suggest that it is not always a muscle weakness problem but a firing problem. It fires too late (VMO) thus the lateral tracking. But all of this is complete speculation until you can be examined. 90 % of General Care Practitioners are useless when it comes to a competent orthopedic evaluation you should see an MD (orthopedist) or a competent Physical Therapist.
 

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Mr_Mojo said:
your rational for this is...
Occasionally excessive pronation can cause posterior knee pain, it is of course more likely to medial or lateral knee pain, which is why I capitalized MAY..........a more likely cause of posterior knee pain, besides overuse/tightness, would be seat height, and leg length issues....I take it you know something of sport's medicine?
 

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Agreed

jnwarner0 said:
Ultrasound will be useless for the anterior portion. As far as the VMO strengthening there have been recent articles in the Journal of Orthopedics and Sports Medicine that indicate this may or may not be helpful as well as patellar taping. There is some evidence to suggest that it is not always a muscle weakness problem but a firing problem. It fires too late (VMO) thus the lateral tracking. But all of this is complete speculation until you can be examined. 90 % of General Care Practitioners are useless when it comes to a competent orthopedic evaluation you should see an MD (orthopedist) or a competent Physical Therapist.

I practice ortho, and have a master's in sport's med, and I saw those articles you are mentioning, I still refer for VMO strengthening, because it does help some people, not everyone though.
 

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Sorry...

I re-read my message and it sounded like I waas disagreeing with you and that was not the case. I just wanted to let him know that it may not work and why. But yes VMO strengthening does help some people. I DO have my doubts as to weather the IT band can actually be stretched. I know it is a common stretch given and the biomechanics of the stretch make sense but have you seen it? Maybe if you were able to hold it under constatnt stretch for...a year you might get some lengthening out of the TFL. Again sorry if I came off as disagreeing with you. My regards.
 

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Discussion Starter #15
First I'd like to thank you all for the time and info. It is hard to find useful sport specific info

i have only gone to PT twice and have some leg/hip strengthening excercises to do at home. one is the flex the quad and hold. The others are using a large rubber band and focus on the hips. I am stretching everything , but I am freakishly flexable. and must muscles are real loose naturally.
The ultra sound seemed to loosen up the back of my left knee, but the pain came back.
I have a indoor spin bike and I can ride that without any pain. I have decided I'll stay inside till I heal. I tend to not notice the pain until I get home.
I am curious about the insoles, I tried all of them Sole, superfeet, the assie ones and numerous dr scholls and they all hurt like hell. I have super flat narrow feet. I shaved the outside of some cork soles and it seems to work No pain and my rt knee tracks really straight, LT knee is close.. do real orthotics work in cycling shoes? I can use superfeet in my street shoes and they work. --- I do get more cleat wear on the left...Mabe another cleat fit? I had a pro fit, but that was when I was riding a tenth as much.
thanks
 

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BS the DC
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BS the DC
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The role of the VMO is controversial. The VMO is a difficult muscle to isolate. Research suggests that common methods use by physical therapists to isolate and strengthen the VMO simply don't work. General quad exercises are adequite. I doubt many people on this list have weak quads.

Cerny K. Vastus medialis oblique/vastus lateralis muscle activity ratios for selected exercises in persons with and without patellofemoral pain syndrome. Phys Ther 1995;75:672-83.

Powers CM, Landel R, Perry J. Timing and intensity of vastus muscle activity during functional activities in subjects with and without patellofemoral pain. Phys Ther 1996;76:946-55.

Laprade J, Culham E, Brouwer B. Comparison of five isometric exercises in the recruitment of the vastus medialis oblique in persons with and without patellofemoral pain syndrome. J Orthop Sports Phys Ther 1998;27:197-204.

Mirzabeigi E, Jordan C, Gronley JK, Rockowitz NL, Perry J. Isolation of the vastus medialis oblique muscle during exercise. Am J Sports Med 1999; 27:50-3.
 

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b987654 said:
I have a indoor spin bike and I can ride that without any pain. I have decided I'll stay inside till I heal. I tend to not notice the pain until I get home.
I am curious about the insoles, I tried all of them Sole, superfeet, the assie ones and numerous dr scholls and they all hurt like hell. I have super flat narrow feet. I shaved the outside of some cork soles and it seems to work No pain and my rt knee tracks really straight, LT knee is close.. do real orthotics work in cycling shoes? I can use superfeet in my street shoes and they work. --- I do get more cleat wear on the left...Mabe another cleat fit? I had a pro fit, but that was when I was riding a tenth as much.
thanks
This new information makes me think about bike fit and custom orthotics.

How does your indoor spin bike fit differently than your road bike? What pedals/shoes do you use on each bike? It's interesting that you hurt on your road bike but don't on your indoor trainer. Figure out the diffence.

Super flat feet will really change your lower extremety biomechanics. Where did the orthotics hurt? Your knee? Your arch? Custom orthotics may be in order. I find it interested that your customization worked the best. Sole orthotics have quite a substantial arch. Your feet may not be able to tolerate that much correction. You may need an orthotic customized to your feet. I've read a bit about Specialize new cycling shoes and orthotics. They are suppose to allow for a fair amount of customization and they are relatively cheap.

http://www.specialized.com/bc/SBCEqProduct.jsp?spid=13778
 

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ive been in PT for 3 weeks and i dont know when im goign to get out

it sucks, i have a small tear in my biceps femours tendon, and i can ride slowly at 15mph but i went a lil to hard and now it hurt through the weekend, witha race in 4 weeks im gettin discourged
 

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I'm not a doctor of anything

But I "pulled" my hamstring the first week of December. From what I could gather ( from the internet... where everything is true) I had a slight tear in my biceps muscle. There was no bruising and no missing muscle mass as in a complete rupture.

I still am unable to run very well, but pedalling is fine. I would reconsider racing. Tearing a tendon further would lead to a much longer time off the bike. The most important thing is to get your leg healthy again. That's just my opinion.

There was very little I could do for a rehab program. Time is the best healer.



footballcat said:
ive been in PT for 3 weeks and i dont know when im goign to get out

it sucks, i have a small tear in my biceps femours tendon, and i can ride slowly at 15mph but i went a lil to hard and now it hurt through the weekend, witha race in 4 weeks im gettin discourged
 
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