# Patello-Femoral Knee Pain (Chondromalacia Patellae)



## Vikeonabike (8 Feb 2010)

Self diagnosed at the moment....Dr's tomorrow.
However does anybody have any good strengthening exercises for the Vastus medialis (inner thigh) I can do at home?
Looks as if I am going to be off the bike for another 2 weeks. 

And whoever it was that overtook me on the A15 without even a word or a or grunt or anything whilst I was riding at a paltry 13 mph...as soon as I'm fit I'm gonna make you suffer!

PS sorry for swearing at you if you heard me!


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## ttcycle (8 Feb 2010)

oooh dear....Vike that's not good...

The docs should send you to physio - they'll have some good exercises there. Take it easy and hope it fixes itself soon


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## Vikeonabike (8 Feb 2010)

Cheers TT...


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## montage (8 Feb 2010)

Don't self diagnose. I was told many things about my knees - didn't see the right people. I think I have created new knee problems as I solved old ones, by strengthening certain muscles, creating a muscle imbalance by attempting to fix one in the first place. I've been struggling for a year...more or less off the bike for 6 months. See proper people!


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## Rohloff_Brompton_Rider (8 Feb 2010)

i self diagnosed with this. i cycled steadily and slowly built it up. much beter and improving daily


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## Nigel-YZ1 (9 Feb 2010)

In November I finished 5 months of physio for injuries that started with severe sprains, leading to chronic patellar bursitis and bad knee alignment problems.
I started with all leg muscles wasted (couldn't bend my knees properly for the previous 4 months).

Heres the list that I'm still doing at least twice a week:
45 step downs per leg
45 calf raises
90 clams (with 1 kilo weight)
90 sideways leg lifts (with 1 kilo weight)
45 gym ball bridges
90 squats with gym ball against wall
I also did 5 minutes rowing machine and 5 minutes exercise bike before each session.

+10 miles of 'interesting' hills on the MTB every sunday.

The onus is on building everything in balance, and improving the rotation of the thigh by strengthening the pelvic muscles.

I can see and feel the improvements in the muscles and the patellar pain is gone. Unfortunately in my case I'm told I'm looking at another year for the walls of my bursas to thin out (hence some RICE sometimes after rides).


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## Globalti (9 Feb 2010)

Vikeonabike, pain behind the kneecaps is due to riding with your saddle too low. I achieved the same result by skiing in deep powder and leaning back because I was afraid my tips would dig in. It took several months of rest and only gentle exercise before the pain went away. It will go away, you just need to give it a chance - start by seeing a bike fit specialist and getting your position checked out. Ask at local bike shops for the names of physios who specialise in bike fit.


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## Vikeonabike (9 Feb 2010)

Cheers Globalti,
I have physio appointment tomorrow, will be going to my LBS sometime this week with the bike.
Vike


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## Vikeonabike (24 Feb 2010)

*WooHooo*

First ride in 3 weeks.....only 5 miles at a paltry 13mph but it was pain free....hope It feels ok tomorrow!


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## MacB (24 Feb 2010)

Vikeonabike said:


> First ride in 3 weeks.....only 5 miles at a paltry 13mph but it was pain free....hope It feels ok tomorrow!



excellent, hope it carries on, the advice from Globalti is good as well. I had knee issues, nothing as bad as yours, at first, and only resolved them by getting saddle height and setback in the range I'm good with.

Below a certain level, or too far back, and it's pain behind the knee, any lower and it's pain at the bottom of the back as well. Above a certain level, or too far forward, and it's pain in front of the knee. It can be quite hard to sort this yourself, I went too high at one point, but I had the assistance of Teef and others when I got it wrong Having ridden behind me for a while he advised on moving my saddle forward and lowering it slightly. I then did a detailed online fit that gave me a range for optimum saddle height and setback, for my type of riding and bike. Lo and behold the Aperitif adjustments fell bang smack in the middle of those ranges

Remember that moving the saddle further back lengthens reach to pedals and vice versa. I also ended up using a spirit level to get my saddle angle correct, I have nose down a fraction.

Of course this then through my reach/height of bars out, but that's a whole other tale


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## mangaman (24 Feb 2010)

Hi Vike - I had a similar pain and had an MRI which you can see on my avatar!

The surgeons were all for injecting it / snipping off bits of cartilage (there is a small tear in my retropatellar cartilage)

Cartilage won't heal as it has no blood supply but I went for conservative treatment.

As everyone said saddle position is key and muscle strengthening.

I believe cycling gives better balanced knee muscle strengthening than any other exercise (if you have your set up right). I was told that my knee was stable - ie I couldn't make it worse by exercise, and the more I strengthen my quads the less it has hurt.

It still is a bit sore after a long ride but I'm getting older and it doesn't stop me doing any exercise I want. The only thing I avoid is specific quad strengthening weight training eg squats / quad machines in the gym.

They just hurt and don't give such a naturally balanced strong knee as cycling.

Hope it fades away - I feel mine is improving all the time. (Physio should know best)

Good luck


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## ttcycle (26 Feb 2010)

Hi Vike

How are the knees at the moment?


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## Vikeonabike (27 Feb 2010)

ttcycle said:


> Hi Vike
> 
> How are the knees at the moment?



Getting better slowly, hoping to ride everyday next week, 5 miles each way. Doing lots of stretching now. Although that hurts more than the injury does. Got to be more flexible before I go back to physio. She scares me more than the dentist does! Sorting out bike fit next week just to make sure I have the saddle hight and position correct.
My boss has banned me from riding at work until further notice....but didn't tell me I couldn't continue to ride into work. He says if you're riding 30 miles a day just to get to work, you can find another way of getting around at work. Cool..More time on my motorbike then! Hope to be fit to ride al day at work as well as commute by May/June time


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## Vikeonabike (5 Mar 2010)

Fingers crossed for me...riding into work tomorrow (15 1/2 miles). Done a few shorter rides pain free so going to give it a go getting into work...Promise I'll take it easy though.


Yay...made it 1.03 and fairly easy. Knee felt a bit tight on the hills so I'll use an alternate route next week!


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## bigjim (8 Mar 2010)

I had/have this problem. Really suffered and was considering stopping cycling. Looked on Armstrongs health site. Evidently this common problem caused by the inner muscle above the kneecap not working as hard as the outer whilst cycling. This stops them pulling evenly and controlling the patella so it slips out of the ridges it slides in. The advice on the site is to work to strengthen the inner muscle. I do this in the gym using the leg raise machine and spreading the feet wide apart and holding the weight for a few seconds before lowering. You can feel that inner muscle working. You can also do this at home by sitting on a hard backed chair. It has certainly worked for me. I do not have knee pain now in that area though I always excercise this muscle after a workout.


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## Vikeonabike (14 Mar 2010)

*The road to recovery*

First full commute last night....31 miles. Awesome ride home at 1am on empty country roads under a cloudless Lincolnshire sky...I was giggling like an overgrown schoolboy.


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## Bill Gates (20 Mar 2010)

I've got sore knees at the moment, and the worse one is my good knee; the one I've never ever had any problems with before. The other one has had four operations. 

I've put it down to tendonitis and am taking Ibuprofen tablets and pain relieving gel plus resting up for a few days to see if the pain goes away.


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## postman (21 Mar 2010)

Four op's on one knee .How long were your recovery periods .Before you could get out on the bike .

You see i am into week 4 and have been doing all the exercises given to me .Past two weeks i have been on reasonable short walks tolocal cafes .And still got this feeling of a build up of fluid behind the knee .Like a small balloon being blown up .Then it slightly goes down .

But i am beginning to get stir crazy .And i may have another 3 weeks before i see the Surgeon .Having to miss the first meeting this week .No transport to Harrogate .


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## Bill Gates (22 Mar 2010)

postman said:


> Four op's on one knee .How long were your recovery periods .Before you could get out on the bike .



The first of my knee operations was performed nearly 40 years ago on a snapped medial ligament injury from playing football. There were then 2 aborted attempts at a football comeback with first another ligament repair attempt and then a torn cartiliage before football gave me up. It was only then I started riding a bike for strengthening the quad muscles.

If I remember it took about 3 months to get aerobic fitness and strength back after each operation, but in those days recovery took a lot longer due to the prevailing surgical techniques and longer immobilisation of the knee following the operation.

The knee arthroscopy recovery time was brilliant; I was riding again within a couple of weeks. Now both knees are very sore and I'm monitoring them on a daily basis before attempting to ride. Might be a week, 2 weeks a month or 2 months or longer but if I don't get them right then they'll always be inflammed. 

Getting back any sort of form for racing is getting harder and harder and right now I can't see it happening ever again.


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## postman (22 Mar 2010)

Wishing you all the best .I am getting a littlt fed up .I am not one for wasting time or sitting about 

Light training after three weeks is mentioned in thr bumf i was given .So i might just tootle on some flat ground .
I should then get a reaction good or bad .

Take care of those knees .


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## Bill Gates (23 Mar 2010)

postman said:


> Wishing you all the best .I am getting a littlt fed up .I am not one for wasting time or sitting about
> 
> Light training after three weeks is mentioned in thr bumf i was given .So i might just tootle on some flat ground .
> I should then get a reaction good or bad .
> ...



I've been contributing to cycling forums for 5 years or so, and to my knowledge in that time, I have seen very little posted about sore knees. Then over the last few weeks there seems to be a whole spate of riders who are suffering from them. Coincidence or the cold weather?


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## Vikeonabike (26 Mar 2010)

My knees are on the road to recovery, not able to ride flat out yet, but have done 100 miles the last two weeks. Half of it into a fairly strong head wind. 
Hopefully by next week I will be able to go back to my usual route that has a few rolling hills on it.
I have found since returning from the injury that my "good" knee has been a little sore recently (overcompensating for the injured one?).


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