patellofemoral pain syndrome

[bluenose]

Has anyone gone through this and what sort of treatment did you go through?

I have had this for several years and it has been getting worse over time. The pain has developed from my right IT band being very tight and pulling on both my vastus lateralis and my patella. As a result I have developed a cyst on my right knee.
I have gone for ART ( which is really good, but $$), taping the knee cap into place, icing, motrin, stretching the IT band and orthotics. Some days it feels so good and squating is no problem, but other days it is so painful that every day movements hurt.

If anyone has gone through this I would like to hear what you have gone through and what has worked the best!

B.

[ubcpower]

Hey Bluenose, what i thought was an IT band issue , and i guess it was in some respects, was actually all stemming from poor hip allignment and a very tight and inflamed psoas muscle. Google psoas muscle and check out some of the symptoms and try some of the stretches they suggest. You may want to cross over to chiropractor to get some work done too.
all the best, i am struggling with the same thing atmoment

[Prisoner#22]

I have it.

Been flat footed my entire life. Didn't know it was such a problem. Spent 5 years pounding the wards on flat feet, and wondering why when i got home my knees ached so much.

Couldn't sit in a movie theatre with my knees bent for long periods of time as it would feel like knives were being stuck through them - A Classic sign (but at the time I didn't know)

Then last year after a summer of wake boarding where I really beat up my knees landing these jumps:

I couldn't even squat anymore, it felt as if I had knives going into my knees.

Tried laser therapy, waste of money... total quakery! or fraud... but the dude who was administering it, watched me walk and right away told me I needed orthotics big time. Said If I didn't get them now, by the time I was in my 40's I may need knee replacements, as the tibial rotation inside my knee was causing it to where down the cartalage of the knee - femur and patella...

I got casted and got the orthotics and wore them relegiously for like 6 months, and used a ton of glucosamine, and fish oil. Now I can sit pain free for hours in the movies, and squating doesn't bother me.

I warm up good though and always stretch the I T bands out... I purchaced a leg abducter /aducter machine for home, as I found using them in the gym prior to doing any quad work really helped put my knees in the correct alignment.

I'm thankfull that this has settled them down as really if I couldn't squat anymore I would have trouble getting bigger in the lower body.

For anyone who is flat footed, I seriously suggest you get arch support, as being flat footed can affect the rest of your body in a negative way.

[natenator]

I have it.

Been flat footed my entire life. Didn't know it was such a problem. Spent 5 years pounding the wards on flat feet, and wondering why when i got home my knees ached so much.

Couldn't sit in a movie theatre with my knees bent for long periods of time as it would feel like knives were being stuck through them - A Classic sign (but at the time I didn't know)

Then last year after a summer of wake boarding where I really beat up my knees landing these jumps:

I couldn't even squat anymore, it felt as if I had knives going into my knees.

Tried laser therapy, waste of money... total quakery! or fraud... but the dude who was administering it, watched me walk and right away told me I needed orthotics big time. Said If I didn't get them now, by the time I was in my 40's I may need knee replacements, as the tibial rotation inside my knee was causing it to where down the cartalage of the knee - femur and patella...

I got casted and got the orthotics and wore them relegiously for like 6 months, and used a ton of glucosamine, and fish oil. Now I can sit pain free for hours in the movies, and squating doesn't bother me.

I warm up good though and always stretch the I T bands out... I purchaced a leg abducter /aducter machine for home, as I found using them in the gym prior to doing any quad work really helped put my knees in the correct alignment.

I'm thankfull that this has settled them down as really if I couldn't squat anymore I would have trouble getting bigger in the lower body.

For anyone who is flat footed, I seriously suggest you get arch support, as being flat footed can affect the rest of your body in a negative way.
Nice! I love wakeboarding!!!

[bluenose]

P#22- Sounds identical to my symptoms and your right sitting feels like knives going into the knee caps. I was doing adductor and abductor prior to squating, but stopped doing abductor since I thought that is may make things even tighter. Maybe I should throw them back into the mix.
Just went today for another round of ART and had my rectus femoris and hamstrings worked on in addition to my vastus lateralis and IT band. Pretty much all the major muscle in my quads are very tight throwing the tracking of my leg out of order.

Cool Pic!!

Thanks ucbpower!

[ubcpower]

Prisoner i have the EXACT same issues. Flat feet and also duck stance with the toes flaring out when i am standing up straight. When i am driving or in movie theatre top of my kneecaps burn like a mother.
I have some $500 arch supports from Kintec Footlabs tht were casted but they are about 5 years old, any idea how long they are supposed to last ? i am thinking mine might need to be replaced

[Chaps]

Dealing with this right now, flat pronated feet, tight IT band and my VMO isn't firing properly. My IT band is almost 100%, i've learned some calf exercises to help strengthen my arch by strengthening your tibialis posterior and just finished 4 rounds of acupuncture to help my vmo. My vmo is starting to fire again but i've been dealing with all this crap for 4 months now and haven't been able to train legs at all or do much cardio :(, just started peterson step ups i suggest you all google them to help strengthen your vastus medialus and get it working properly to keep your knee is place. Stretching the IT band, getting ART done as well as using a foam roller will all help.

http://www.youtube.com/watch?v=7vZVq3ov914 here is the calf exercise
http://www.youtube.com/watch?v=kK29l_3RYP4 here is a peterson step up

I found terminal leg extensions to be crap, just started the peterson step ups and i've already noticed a difference. Also for the arch of your foot put a towel under your bare feet and scrunch it up with your toes by curling your toes in, this will also help your arch. Dealing with this has led me to look for any cure possible lol

[Chaps]

A few other things, once you make it back to squating, do split squats and lunges to help with mobility in your hips and go to atleast 90 degrees preferably lower as that's when your vastus medialus will be engaged more. And terminal leg extensions are completely useless, you just have to get your vmo to fire properly before you can really get much out of them imho. Also when squating again make sure to really try to "spread the floor apart" by pushing your knees outward to get your glutes firing properly, I have JUST started below parallel bodyweight squats and i've had to do this as well as direct glute work to get my glutes back to firing properly. Hopefully this is helpful for you guys, this has been the must frustrating injury i've ever had and i'm just starting to see the light at the end of the tunnel, i miss my heavy squats and deads :(

[ubcpower]

interesting movement that step up. I notice it really hurts when i go UP stairs. Especailly if i skip a stair

[Prisoner#22]

If you are flat footed, and already have patellar femoral syndrome, I don't see any use in trying to 'strengthen the arch’ this point the damage is done, and being done. That damage is to the cartilage inside the knee, from to much tibia rotation. The only way to heal this is to stop doing what is causing the damage. That means getting proper orthotics casted by someone who knows what they are doing, and wearing them at all times to stop drilling into the inside of your knee caps with the ends of your tibia lol.

After you have stopped that, you need to reduce the inflammation. Good old omega 3's is what I use... and to repair... I take 6 grams of glucosamine sulphate twice per day every day, and it makes a huge difference. You may not notice it for the first 3 months, but when it kicks in and eventually, it’s a big help. I was sceptical, but some old guy who was a patient of mine told me about this, and he would know because he had been riddled with arthritic pain, and after three months of taking the glucosamine the pain was substantially less.

Using nandrolone, may also help to alleviate the symptoms, I used it,.. But the important thing is NOT to train because the pain is reducing..... You need to wait until you are pain free, and been off the deca for at least six weeks before you can start loading the joint. There is no point in training on it if you still feel pain, as that just says that the injury is still there and you are making it worse.

Keep in mind Patellar Femoral syndrome if not reversed WILL lead to eventual need for total knee replacement surgery.

There are certain movements I personally won't do. One of them is squats below parallel... but I will hack squat bellow parallel... Everybody's body mechanics are different... basically if it doesn't hurt a bit then you can do it, if you feel any pain or discomfort at all, then I would avoid it.

Stretching is very important... I stretch out the legs a good 3 times per week, and try to be as flexible as possible.

Wearing knee braces that put pressure on the femoral and patellar tendons can help also. There is a good Cho-pat knee brace that I use that does this, and when I go heavy, I wrap my knees so that the pressure of the wraps is on the patella tendon and the femoral tendon, yet at the same time keeps the patella from being pulled outward. Just try to keep the knee cap floating above the joint, not smushed into the joint where it can take more damage

As of right now I have gotten to the point where I no longer have to wear the braces too much so for me things have been going well, and I had to sit through the majority of a Bon Jovi /Kid rock concert where my knees were bent 90 degrees touching a concrete wall for about 4 hours and had no patellar pain so things have really improved for myself.

For a while there I was scared that it was permanent and I would never be able to train my legs hard enough to be able to stimulate anymore growth. But it is really important to catch patellar femoral syndrome early enough that you can do something about it, because once the cartilage is worn away, it is too late.

[Ron Partlow]

I took Ben Pakulski's advioce and started wearing much flatter shoes to train legs in. It really helps. I worked on increasing my ankle flexion, which is kinda shitty from rolling my ankles so bad riding BMX bikes on halfpipes and playng football....one ankle has less flexion than the other, so I have tried to even them out.

I am even trying to get my hands on a pair of those Vibrams. Ben told me all about the different models, so I know exactly what I want, they are just always out of stock on the website.

Also, the IT band seems to be the key to my left knee problems, and keeping my glutes stretched out and the IT bands loose really helps.

Also, time and time again, when I develop knee pain that lingers and hinders my training, I always seem to be in a "heavier leg extensions" phase. I just can't seem to do leg extensions with any real weight. I have to keep them to the very end and use 50-100 pounds for higher reps and pump the quads.

I love using them at the beginning to fatigue the quads, but the weights needed get out of control. All fun and games for a couple weeks and then I wonder why my knees hurt.

So flat shoes, lots of stretching, and using leg extensions only as a finisher....all keys to keeping my knees decent.

Also, I never use wraps. Went 10 years without them, then I used them for a few months in 09, and was doing it with the mentality that the heavier loads would help thicken up my glutes/hams and general thickness.....but they caused some real long term knee problems, so I had to put them away again. They are fun to use, but I just can't do it. Too much friction on the underside of the patella.

At 34, with 20+ years of training, I have to find creative ways to hammer my legs. I now squat 3rd or 4th in the workout and only use 225-315 for really deep, explosive, constant tension/pump tempo reps to near failure, then I grind out several more with lockouts and rest pause breathing. Blows the quads out without hurting my knees.

[steve_d]

I took Ben Pakulski's advioce and started wearing much flatter shoes to train legs in. It really helps. I worked on increasing my ankle flexion, which is kinda shitty from rolling my ankles so bad riding BMX bikes on halfpipes and playng football....one ankle has less flexion than the other, so I have tried to even them out.

I am even trying to get my hands on a pair of those Vibrams. Ben told me all about the different models, so I know exactly what I want, they are just always out of stock on the website.

Also, the IT band seems to be the key to my left knee problems, and keeping my glutes stretched out and the IT bands loose really helps.

Also, time and time again, when I develop knee pain that lingers and hinders my training, I always seem to be in a "heavier leg extensions" phase. I just can't seem to do leg extensions with any real weight. I have to keep them to the very end and use 50-100 pounds for higher reps and pump the quads.

I love using them at the beginning to fatigue the quads, but the weights needed get out of control. All fun and games for a couple weeks and then I wonder why my knees hurt.

So flat shoes, lots of stretching, and using leg extensions only as a finisher....all keys to keeping my knees decent.

Also, I never use wraps. Went 10 years without them, then I used them for a few months in 09, and was doing it with the mentality that the heavier loads would help thicken up my glutes/hams and general thickness.....but they caused some real long term knee problems, so I had to put them away again. They are fun to use, but I just can't do it. Too much friction on the underside of the patella.

At 34, with 20+ years of training, I have to find creative ways to hammer my legs. I now squat 3rd or 4th in the workout and only use 225-315 for really deep, explosive, constant tension/pump tempo reps to near failure, then I grind out several more with lockouts and rest pause breathing. Blows the quads out without hurting my knees.

I also just got the vibrams and squatted in them, but I think this is part of the problem that isn't allowing me to heal properly. Try holding a bar overhead and squatting down with flat shoes, or barefoot. How low can you go? Now, put your heals up a couple inches...now go down. I couldn't believe the difference in depth you can get. I don't know if this means anything, but it sure made sense to me that I shouldnt be squatting in flat shoes. But who knows - I change my mind so often because everything I do doesn't result in improvement nor make things worse...

[bluenose]

I was thinking about the type of shoe that I wear when I squat might be bad. I wear shox's and maybe the shoe's allow too much movement side to side verses a completely flat/board shoe. Since I already have a orthotic issue with my foot having the tendency to roll out maybe Nike Shox's make it worse.

[ubcpower]

ya shox = no good
also , imo, they are developed for asians with thin little feet

[Ron Partlow]

Ben said some stuff that I had already read in articles about bio-mechanics and proper human movement. Basically, we are brain washed into thinking our feet need tons of support, when in fact it makes our feet muscles and ankles weaker and they basically stop firing all together. The vibrams allow activation of those muscles again, and the chain reaction within the nervous system results in better nervous system performance all the way to the floor, including prioperception.

Right now I'm just using the flattest shoes I have which are the ones I usually train in.....Adidas Adi-Racer F1s. I love them for calves, but used to use basketball shoes or cross trainers for legs. Now that I use the Adi-racers for legs, I have better ankle flexion and feel my quads better.

Apparently, Nike Shox are the worst possible shoe for training legs if you want nervous system activation and connection with your base.

If you get your ankle flexion to increase, your need for elevated heels will go away.

Also, I don't think everyone HAS to squat ass to grass to get big legs.....in fact I think some people with certain geometry get more constant quad tension by stopping a bit before ass to grass, or even slightly above parallel. I go ass to grass on most sets, but stop AT parallel on others, right when my calves and hams start to really touch.

Looking forward to trying those shoes.

[Prisoner#22]

I used racket ball shoes for years, and have just recently bought two pairs of Free trainers... some Nikes and some under armors.. Shoe companies are finally making shoes designed for weight training.

Basically any pair of flat shoes that don't set you on your toes and that you are comfortable in will do. You don't need shoes that absorb shock... you want actually the opposite.. to feel the floor through the shoe so to speak.

If you have orthotics, you should make sure your orthotics fit in the shoe before you buy it, so always bring your orthotics with you when you go shoe shopping!

I don't always use my orthotics now, as I have purchaced extra arch support from the drug store for every shoe I have, however, if I am doing heavy leg training or cardio e.t.c ... I will make sure to wear them.

When I first started wearing them on the wards, after the initial 2 week period to get use to them the difference was amazing. I used to come home from work after a day pounding the floors with aching knees. After I got the orthotics and was able to wear them the entire day my knees no longer hurt at all.

[ubcpower]

Prisoner, two questions:
1. If I have good quality orthotics (500$) range from Kintec footlabs. Do you know how long they are supposed to last? They gave me my mold if i ever needed to create another pair. Mine are about 4 years old now.
2. I only have been wearing them out or at the gym, do you suggest buying some slippers and inserting them in the slippers for walking around the house?

[Big D]

thank god for this thread, my knees have been killing me lately,
specially sitting down. I have orthotics but do use them in my dressy work shoes,
I think its time for me to change that.

[natenator]

thank god for this thread, my knees have been killing me lately,
specially sitting down. I have orthotics but do use them in my dressy work shoes,
I think its time for me to change that.
I walked down an escalator today (cause I didn't want to be the lazy ****tard who stands) and that even hurt the knees... :(

[Prisoner#22]

Prisoner, two questions:
1. If I have good quality orthotics (500$) range from Kintec footlabs. Do you know how long they are supposed to last? They gave me my mold if i ever needed to create another pair. Mine are about 4 years old now.
2. I only have been wearing them out or at the gym, do you suggest buying some slippers and inserting them in the slippers for walking around the house?

I have a therapist who tells me he wears them (his orthotics) always, and also has those custom birkenstocks for sandals at home.
visually inspect your orthotics and see if the orthotic has changed or not...

I'm definitely not an expert on the making of them or their lifespan.

Everybody is different and everybody's needs are different, but the recomendation I had was to wear it at all times.

[ubcpower]

ok thanks man

[ScorpioChiq]

This is nuts ... I was literally about to google PFS and found this thread. I had surgery on my left knee in February for a meniscus tear and unfortunately I work at a clinic with four flights of stairs (brutal!) so in the end it really aggravated the PFS that was likely there for a while. I will probably do a round of adequan and see how it helps.

Keep the suggestions coming ... they are a big help.

[tiramisu]

This sounds like one problem I should be happy I don't have.

[bluenose]

Thanks for the input everyone! The feedback has given me a bit more insight on the changes in foot wear that I should make.

B

[warlock]

Arch support is crap most of the time.

use a roller on you it band, when you can use a PVC pipe you will be good to go.

If in Toronto I can find a person that will solve this to you in a few (very painful) treatments.

Pm me

[ubcpower]

my bro just got in to chiropractic school, cant wait for all the free treatments in the near future .........droool

[Chaps]

Must have book for everyone with knee issues or those wanting to prevent knee issues, i picked this up 2 weeks ago, Bulletproof knees by Mike Robertson. Only two days into phase 1 of the recovery program and my knees feel wayyyyyyyyyy better. You'll be doing flexibility, mobility, soft tissue and strengthening work as well as improving motor recruitment patterns. Most people have shitty ankle and hip mobility in addition to their glutes not functioning properly. Ya the book is expensive ($100) but worth every penny, my mobility has improved 10 fold, my glutes are firing better and my vmo is snapping right back.