I've being suffering from knee pain in my left knee now for over 3 months, wasting the best part of summer off the bike. It started to come on at the end of longer rides +100k, but then on shorter rides and effecing my commute too. So I stopped riding in Dec, and did some research on the net, deciding the symptoms were itb sydrome - pain is outside of knee. Despite doing no end of stretching, I was seeing no improvement & and even noticing it walking - so went to see a physio.

Diagnosis was Patella Femoral Syndrome (actually a general term) and said that weak inner quads was to blame. I was given some exercises to concentrate on (mainly squats with back to wall, crushing a pillow between the knees) and side ways leg raises when on the floor. I've been doing these regularly and other similar exersises now for 3 mths now, with no noticeable improvement. I got a second opinion a few weeks ago, diagnosis again the same PFS, and told to concentrate on the squats and itb stretch.

Still seeing no improvement and it's beginning to get more than annoying. I was managing to keep active kayaking and swimming (the latter which though deadly boring didn't have any negative effect), but have now got a sore wrist from the kayaking, so that's going to pot too.

My subsidised phsyio runs out now, I was getting in on ACC as prior to these problems I was knocked off my bike by a car, and badly damaged my ankle, with a little pain in the knee and back too. Once I was able to walk fine, I was ok back on the bike for a month, until I started to get back problems on my daily commute - I fixed that by using panniers on the commute instead of rucksack (never had back probs on the bike before mind), then shortly after the knee problem started.

From regularly commuting 2 1/2 hrs + per day and long weekend rides, I can now can barely ride any distance without pain, and even when walking I have the regular pain in the knee, it's usually the outside of the knee, but sometimes the inside too, hence the Patella Femoral Syndrome diagnosis.

But I'm seeing no improvement, and becomming lost for ideas. Has anyone had any similar knee problems, and advice?

Maybe some advice in this thread?? http://www.vorb.org.nz/patellofemoral-p ... it=patella

Oh mate - quite simply, I know your pain.

First thing is first, and I hope I don't offend you, but is your bike set up correctly? Cleats/reach/seatpost/frame/crank arm lengths all make such a huge difference. May pay to go and get some advice on your setup, from someone who is experienced at fitting.

I've got the same thing as you - I managed to dislocate my patella simply by jumping in the air to receive a Football and beforehand I had patella femoral issues. Strengthening quads is going to help a shite load so keep going with that...

It may also pay to see a specialist orthopaedic surgeon (claim on your current ACC). Have you had previous knee issues?

I changed my bike setup and it virtually disappeared. If you aren't in clip-in shoes it also may be the way you are placing your stroke. If you are a boy - do you stick your knees out? Quite a bit of it is to do with your leg alignment and how you walk. Get your physio perhaps to watch you on the bike..

All the best with this - it's pretty common for cyclists! Be prepared to pay to get fixed cos if you don't it can lead to bad issues later on (me being a prime case..)

Your case sounds pretty serious.

I've had a very similar problem in one of my knees with ligament damage. Physio identified PFS and suggested the exercises you've mentioned.

Physio did also mention rolling the outer thigh to stretch it, either by lying on a rolling pin (or wine bottle) or getting someone else to do it while lying down. Quite painful, there's no easy and effective way to stretch the outer thigh.

Apparently I had a major disparity between outer and inner thigh strength pulling the joint out of alignment during pedalling.

What I found most effective, without a doubt, was reducing the float on my pedals and lowering my saddle height slightly.

I screwed my knee up trying ride to 12 hours solo on a singlespeed last April ( ) and have been doing knee rehab exercises since September, and have noticed improvements since. I think my knee exercises (and stretches) are more targetted for riding as opposed to general activity which is why they've worked though.

Three months and still having the problem could be almost normal for PFS it's a beeatch! The VMO is very hard to isolate apparently, the squats are supposed to be good, but for me they just made my knee feel worse.
Perversely I found doing single leg press on a good gym machine really good for my knees and have continued to do this. Must be something about the angles or load (or lack of load) or something.

Also glucosamine does help I reckon, and you can get it cheap at the Supermarets now, the Redseal stuff is good.

Ta for the replies, and the other link. Re-assuring that others have similar symptoms and being able to manage it.

I'm confident the bike set up on each of my bikes was fine (reach, seatpost, frame, crank arms), as I've not altered thrings. It's possible the cleats on my left foot were moved in the accident and I'd not noticed, but I've readjusted those since and got new shoes too. I'm a bloke but don't stick my knees out, probably more in if anything.

I've not cycled since Dec, and been doing the strengthening exercises and stretches since then, but not noticed any improvement and generally feel it simply walking. I did a short cycle today, first time for ages, as I dropped my car off for a service and thought it couldn't do any harm. It's not made things worse, but I noticed all the same, outside and also inside of the knee.

Really frustrating as I've never had any knee problems before, and only things that have briefly kept me briefly off the bike before have been fractured ribs.

I'm not usually one for supplements but got some glucosamine tablets from supermarket today and will give them a try.

after a quick perusal of thread. . . . . . Glucosamine - never seen good scientific evidence about glucosamine and PFPS. Sounds like it needs a diagnostic re-assesment to me after ?? 3 months. - reassessment - should always occur if standard treatment fails. Do you have PFPS, Patello-femoral Osteoarthritis, Patella tendinosis, fat pad impingment. osgood-schlatters. iliotibial band friction syndrome, congenital or degenerative bone or cartilage condition. In short I dont think, and no offence intended to the vorbii, that the diagnostic and treatment options on Vorb are as good as seeing a sports doctor . . . .which is where its probably time you went methinks??

bubbaa wrote:after a quick perusal of thread. . . . . . Glucosamine - never seen good scientific evidence about glucosamine and PFPS. Sounds like it needs a diagnostic re-assesment to me after ?? 3 months. - reassessment - should always occur if standard treatment fails. Do you have PFPS, Patello-femoral Osteoarthritis, Patella tendinosis, fat pad impingment. osgood-schlatters. iliotibial band friction syndrome, congenital or degenerative bone or cartilage condition. In short I dont think, and no offence intended to the vorbii, that the diagnostic and treatment options on Vorb are as good as seeing a sports doctor . . . .which is where its probably time you went methinks??

Ta, for the reply. Sports Doctor?
I've been seeing the these guys, Active Physio http://physio.co.nz/therapy.html
I've had a second opinion a few weeks , the second simply confirmed the same as the first, Patello-femoral pain in the knee caused by a slight weakness in the inner quads, which I have been working with no great effects.

ITB, again is a general term. I have been doing regular ITB stretches, the second physio acknoweldged that while my left itb was tight, my right was no less so and I have no knee pain on the right side

yea ive had similar probelems on and off for the last ten years ,pretty much caused by racing downhill at a national level on a hardtail, did well but paid the price.
Now i ride fullys only and avoid big hits and for the most part im doing OK.

so do you expieriance weakness decending stairs?

Ive done physo and all that it seemed like nothing was working either ,also did reading up but it didnt really help.

In the end i think it came down to a couple of excercises and always stretching prior to and after rides.

the main excercises that seemed to make the differeance for me was strechin hamstrigs etc to enable me to touch my toes.

secondly , sitting on the floor trying to touch your toes ,but instead grabing a belt around your feet and pull your feet back , can also do calf raisers on steps.

also another thing that helped was ankle weights walking to work, for me i had no strength when the lower half of the leg was trying to push forward ,hense the staircase question.
the weights encouraged me to lift my leg up further and swing the calf more.

not sure if this will help ,but you do seem to be trying a few options mentioned.

lloydy wrote:

bubbaa wrote:after a quick perusal of thread. . . . . . Glucosamine - never seen good scientific evidence about glucosamine and PFPS. Sounds like it needs a diagnostic re-assesment to me after ?? 3 months. - reassessment - should always occur if standard treatment fails. Do you have PFPS, Patello-femoral Osteoarthritis, Patella tendinosis, fat pad impingment. osgood-schlatters. iliotibial band friction syndrome, congenital or degenerative bone or cartilage condition. In short I dont think, and no offence intended to the vorbii, that the diagnostic and treatment options on Vorb are as good as seeing a sports doctor . . . .which is where its probably time you went methinks??

Ta, for the reply. Sports Doctor?
I've been seeing the these guys, Active Physio http://physio.co.nz/therapy.html
I've had a second opinion a few weeks , the second simply confirmed the same as the first, Patello-femoral pain in the knee caused by a slight weakness in the inner quads, which I have been working with no great effects.

ITB, again is a general term. I have been doing regular ITB stretches, the second physio acknoweldged that while my left itb was tight, my right was no less so and I have no knee pain on the right side

at the risk of sounding like a stuck record - if ehat yr doin aint workin - get reassessment - If you ask people with the same basic training and skill set, the same question - you will probably get the same answer - in short - yes - sports dr. we see things for the physios when the treatment aint workin - sometimes with a bit more of a delay than is ideal. Worst you can get from a another opinion is the loss of a few bucks and failure to progress (relative to cost of machines we ride . . . .) best you could get is a cure via different diagnosis and treatment or management alteration on current diagnosis - no brainer - to me anyway. Actually you could get a rare and horrendous side effect of treatment too but thats exceedingly uncommon . . . .

everybodies condition is different so hard to give specific advice. when i had this trouble i did exercises to stretch the tendons and muscles in my legs that don't get much use pedaling. also started to use cleats so would use a wider range of muscles. found that small adjustments to seat height and cleat position made a big difference. also angled cleats to force me to keep my heels in line with the bike. dropped my target speed by 5km's. all little things but made small improvements over a year. had many peaks and troughs but was always slowly getting better.

Barbsarama wrote:I've got that. Had bi-lateral (that's both knees operated on at the same time) chrondoplasty, repairs to both meniscus, lateral releases (where they cut the outside tendon to get the patella to track properly) and a bit of arthroscopy just cause they were there by a top orthapedic surgeon in London (gotta love that free health insurance that I got over there) that was nearly 3 years ago. I've also had months and months and months post op physio, osteo, more physio (from sports physios) etc etc. Zero improvement. One physio even gave me a tens machine to use when doing the squats that you've been told to do (funny, he told me not to use it on my abs. Of course i did )

Seen specialist drs who've just wanted to operate again. Now I just take large doses of anti-flams whenever my knees swell up. I'm sorry it's not good news for me but you might be different?

That aint PFPS - time for some knee transplants

bubbaa wrote:

lloydy wrote:

bubbaa wrote:after a quick perusal of thread. . . . . . Glucosamine - never seen good scientific evidence about glucosamine and PFPS. Sounds like it needs a diagnostic re-assesment to me after ?? 3 months. - reassessment - should always occur if standard treatment fails. Do you have PFPS, Patello-femoral Osteoarthritis, Patella tendinosis, fat pad impingment. osgood-schlatters. iliotibial band friction syndrome, congenital or degenerative bone or cartilage condition. In short I dont think, and no offence intended to the vorbii, that the diagnostic and treatment options on Vorb are as good as seeing a sports doctor . . . .which is where its probably time you went methinks??

Ta, for the reply. Sports Doctor?
I've been seeing the these guys, Active Physio http://physio.co.nz/therapy.html
I've had a second opinion a few weeks , the second simply confirmed the same as the first, Patello-femoral pain in the knee caused by a slight weakness in the inner quads, which I have been working with no great effects.

ITB, again is a general term. I have been doing regular ITB stretches, the second physio acknoweldged that while my left itb was tight, my right was no less so and I have no knee pain on the right side

at the risk of sounding like a stuck record - if ehat yr doin aint workin - get reassessment - If you ask people with the same basic training and skill set, the same question - you will probably get the same answer - in short - yes - sports dr. we see things for the physios when the treatment aint workin - sometimes with a bit more of a delay than is ideal. Worst you can get from a another opinion is the loss of a few bucks and failure to progress (relative to cost of machines we ride . . . .) best you could get is a cure via different diagnosis and treatment or management alteration on current diagnosis - no brainer - to me anyway. Actually you could get a rare and horrendous side effect of treatment too but thats exceedingly uncommon . . . .

Sorry, didn't intend to question your advice, just wondering what a Sports Doctor is? I'd never heard the term and whenever I've seen a GP about a sports injury before they have always suggested rest, which is what I have been doing.

Anyway visited my Doctor today, who took a few xrays which didn't reveal anything (which I didn't expect it to as I was confident no bones were broken) and he has referred me to a Orthopeadic knee specialist. Hopefully I'll get some progress there.