"Kneecap Training"

[HillSlugger]

Over course of the summer (triathlon training) I developed discomfort in my left knee, above the patella. When I saw a knee specialist he said that I had tendonitis of the quadriceps tendon. When rest and antiinflammatories did not clear it up I went back. This time he told me I had too much knee flexibility and he sent me for PT to strengthen the knee. The diagnosis was "bilateral patellofem pain and quad tendonitis". At my first PT session today the therapist told me that my kneecaps were too loose and that they weren't tracking straight; both are deflected outward and the left one also has a bit of twist to it. So, for treatment she taped my kneecaps into the proper position and then started exercising my quads to this new alignment. We started with 8 minutes on the elliptical, then leg presses, "thigh push-outs", "thigh pull-ins", quad extensions, and electrostimulation. I'm supposed to wear the tape 2 days on, one day off, and do PT twice a week (Tuesdays and Fridays).

Can one or more of our lovely PTs tell me if all this makes sense? How long should I expect it to be before I start noticing definite improvement? Which part of this is making my lower back hurt?

Thanks, Nicole

[Zen]

Which part of this is making my lower back hurt?


Do you mean the exercises are making your back hurt or did you already have back pain accompanied by knee pain?

[HillSlugger]

Do you mean the exercises are making your back hurt or did you already have back pain accompanied by knee pain?

My lower back aches since PT this afternoon (my knees and thighs are quite tired and achy).

[Wahine]

MD - I understand where your PT is going with this but it may not be the right way for you to start. Make sure that when you see the PT you give very clear feedback about how you felt after the session. Eg: my back started to hurt an hour later and didn't stop hurting until I took advil a few hours after that. Be as specific as you can. If you are specific the PT will take this info and use it to mold a program that works for you. If they're any good they will. If you are not specific, it may come across as whining (not that it should but unfortunately sometimes PTs can be presumptuous and I hate to say it but especially if you're a little bigger and they think that you're not used to exercise). I personally prefer to start people on a stretching progam for the hips first and maybe with some strengthening of the inner thigh isometrically before I start in on leg presses, thigh push outs or knee extensions. In fact I never give knee extensions as an exercise for patellofemoral pain. I also like to add some deep tissue massage to release the lateral quad/thigh.

I really like taping techniques for this type of problem.

Here's how I might approach this with your PT. Poke around your quad and outer thigh area and see if you can find some knots. Point these out to your PT and politely ask if they think that deep tissue massage might help that. As for the hip stretches, I would say something like, "My hips seem really tight, could this be contributing to the problem. Would it help for me to stretch them?"

I'm laying this out in this way because some PTs feel threatened when a patient comes in and suggests a different approach. I don't personally think that there is anything wrong with this and I appreciate it when my patients put their thoughts out there, regardless of if it's positive or negative. But I am confident in myself and my work. Someone not as confident will not react well and instead of keeping a nice understanding repore and taking action to adapt a program as needed, they may start to rationalize why the treatment may not be going well by finding blame elsewhere.

Please realize that I'm not saying the treatment they have started with is bad. It may be very appropriate. I just think that you need to give some feedback and ask about some other options. It could be that your PT is planning to add these things in that I have suggested, they just couldn't get to it today.

Finally, your back pain may have something to do with your knee pain and if it persists it should be evaluated by the PT.

Knott will likely add some foot stuff to this.

[KnottedYet]

Knott will likely add some foot stuff to this.

Oh, yeahhhhhhhhh...

It's all because you have compensated hindfoot varus and probably forefoot also, and so over-pronate. :D ;)
(seriously, ask your PT if insoles like Superfeet would help your knees)

Wahine said it all!

[HillSlugger]

Oh, yeahhhhhhhhh...

It's all because you have compensated hindfoot varus and probably forefoot also, and so over-pronate. :D ;)
(seriously, ask your PT if insoles like Superfeet would help your knees)

Wahine said it all!

Yes, I overpronate. I have motion control running shoes. Still, I had ankle issues after I started running and now use custom orthotics in my running shoes. I have Superfeet in most of my sneakers and shoes.

Could you please explain "compensated hindfoot varus and probably forefoot also"?

Many thanks!

[KnottedYet]

Yes, I overpronate.

Oooh, wow, did I have a lucky guess or what? :D :p

Perhaps ask your PT if you should be wearing your custom orthotics all the time, or ask if the PT can "post" your Superfeet for everyday wear. (Posting is just putting wedges on the underside of your Superfeet so they correct your mechanics like the custom orthotics do. Shouldn't cost you anything other than the PT's time and *maybe* a few bucks for the wedge material.)

"fore- and hind-foot varus" is just the $64-phrase for the structural pattern of your feet at sub-talar neutral, and "compensated" means that your ankle/foot have collapsed during weightbearing to help the sole of your foot reach the ground. (that compensation is overpronation) If you had uncompensated varus, you'd be over-supinating and you'd've talked about a different set of symptoms in your knees and back.

And, everything Wahine said!

Edit: darn, I just did a quick search trying to find this nifty online video of feet and what they do, and I can't find it. Sorry!

Edit #2: and your PT at some point should assess your posture of your entire body. Especially with the back pain popping up, you might have some underlying posture habits (like locking your knees, or anterior pelvic tilt, or poor transversus abdominus control, or glutes that take a holiday, etc.) that could be playing games with your bod.

[HillSlugger]

MD - I understand where your PT is going with this but it may not be the right way for you to start. Make sure that when you see the PT you give very clear feedback about how you felt after the session. Eg: my back started to hurt an hour later and didn't stop hurting until I took advil a few hours after that. Be as specific as you can. If you are specific the PT will take this info and use it to mold a program that works for you. If they're any good they will. If you are not specific, it may come across as whining (not that it should but unfortunately sometimes PTs can be presumptuous and I hate to say it but especially if you're a little bigger and they think that you're not used to exercise). I personally prefer to start people on a stretching progam for the hips first and maybe with some strengthening of the inner thigh isometrically before I start in on leg presses, thigh push outs or knee extensions. In fact I never give knee extensions as an exercise for patellofemoral pain. I also like to add some deep tissue massage to release the lateral quad/thigh.

I really like taping techniques for this type of problem.

Here's how I might approach this with your PT. Poke around your quad and outer thigh area and see if you can find some knots. Point these out to your PT and politely ask if they think that deep tissue massage might help that. As for the hip stretches, I would say something like, "My hips seem really tight, could this be contributing to the problem. Would it help for me to stretch them?"

I'm laying this out in this way because some PTs feel threatened when a patient comes in and suggests a different approach. I don't personally think that there is anything wrong with this and I appreciate it when my patients put their thoughts out there, regardless of if it's positive or negative. But I am confident in myself and my work. Someone not as confident will not react well and instead of keeping a nice understanding repore and taking action to adapt a program as needed, they may start to rationalize why the treatment may not be going well by finding blame elsewhere.

Please realize that I'm not saying the treatment they have started with is bad. It may be very appropriate. I just think that you need to give some feedback and ask about some other options. It could be that your PT is planning to add these things in that I have suggested, they just couldn't get to it today.

Finally, your back pain may have something to do with your knee pain and if it persists it should be evaluated by the PT.

Knott will likely add some foot stuff to this.
This is my first experience with PT so I don't yet know how it's all supposed to work in regards to the decision making. Thanks for you comments and suggestions.

The PT knows I'm a triathlete (she seemed quite impressed); she even commented on how "cut" I am (maybe she was coming on to me ;) ). Do you think she may have taken this into account when she chose my exercises? I see her again tomorrow, but then switch to early AM sessions next week with someone else. Just wondering if different PT might do things differently and how much control I need to take.

[KnottedYet]

Every PT does things a bit differently. (for example, I *always* fixate on feet and posture first) But, every PT knows their own habits and knows how to branch off from there; and every PT is going to adjust what they have you doing based on how your bod responds.

Lots of feedback to the PT is always good. Lots of questions are good. I love it when my patients come in saying, "Hey, I looked this up on the internet; how does such-and-such apply to me?" "Why am I doing this exercise, and how does it help my problem?"

Here's one of my favorite quotes: (I have it hanging at my desk)
"No physical therapist can possibly match the work of an educated patient."

If you think of your PT as education sessions rather than work-out sessions you will get even more out of the whole process. The more you can learn, the better you will be able to manage your muscles and joints both now and later.

[KSH]

Well, it sounds like you are working on getting better and fixing the problem. That's great.

I can't really address your questions... but I wish you the best in getting yourself all healed up and ready to run again in the future.

[Wahine]

Here's one of my favorite quotes: (I have it hanging at my desk)
"No physical therapist can possibly match the work of an educated patient."

If you think of your PT as education sessions rather than work-out sessions you will get even more out of the whole process. The more you can learn, the better you will be able to manage your muscles and joints both now and later.

I love that. I'm using it.

[HillSlugger]

Is it reasonable to expect that this line of treatment will lead to long term improvement and that I can expect more triathlon in my future?

Is it reasonable to think that I might be able to start some easy spinning in a couple weeks? My doctor has told me that swimming is OK and "biking as tolerated".

[KnottedYet]

I love that. I'm using it.

I miss-quoted it. Instead of "can" put in the word "could". That's from James McGavin PT.

[KnottedYet]

Is it reasonable to expect that this line of treatment will lead to long term improvement and that I can expect more triathlon in my future?

Is it reasonable to think that I might be able to start some easy spinning in a couple weeks? My doctor has told me that swimming is OK and "biking as tolerated".

That's the main goal. The more you can learn, the more you can improve, and take it from there!

[Wahine]

Is it reasonable to expect that this line of treatment will lead to long term improvement and that I can expect more triathlon in my future?

Is it reasonable to think that I might be able to start some easy spinning in a couple weeks? My doctor has told me that swimming is OK and "biking as tolerated".

Yes and yes. It is very possible to recover from this sort of problem and very possible to return to triathlon. I had a lady with a similar problem last year who was an avid telemark skier and had been competetive in her past. She got better in 6 treatments and was able to go back to hard core skiing with her knees taped soone than that. Tele skiing is much harder on the patellofemoral joints than triathlon.

If you get the right stretches in you should be able to get back to spinning in a couple of weeks.

[HillSlugger]

Wahine and Knot,

Thanks for all of your insight and encouragement. I will definitely go to today's session as a better informed patient!

[HillSlugger]

So far, the cure is worse than the condition. I've had two PT sessions, on Wednesday and Friday and I'm physically uncomfortable. Since the first, my back is hurting and it's making me very unhappy and grumpy. I don't know if the back pain is due to the knee taping itself, the exercises I'm doing, or that maybe I'm not doing the exercises correctly. On Friday, before they made me do anything they asked how I was doing and I told them that my back was hurting. They didn't really respond to this. I've had two sessions and two different therapists so I don't know if I can expect any real continuity of treatment. I guess for my next session on Tuesday I have to force them to listen to me.

I assume I shouldn't be hurting this way! Do I need to find a different approach?

Thanks, Nicole

[KnottedYet]

Knee tape shouldn't make your back hurt.

Did they say anything about your back at all?

Is your back still hurting? (and how are the knees?)

Does the PT stay with you while you exercise, correcting your form and talking about the exercise and what you should be feeling and how to check your form at home?

You should have fatigue-y muscle-y soreness after PT, but you should not be suffering. And, ummm, I don't think new body parts really should be getting miserable... Did they change any of your exercises to make it better for your back?

[KnottedYet]

Can you describe the "quad extensions?" Are you sitting on a machine with your feet dangling with a padded bar across your shins and then straightening your legs?

Did your back start to hurt on that exercise?

Did they give you any stretches yet? (these could be sort of active stretches, like 'walk with your lower belly flat and hold yourself tall with long strides and feel a brief stretch in your groin with each stride' kind of thing. Or they could be the sort where you hold yourself in one position feeling the stretch for 30-60 seconds)

[Wahine]

+1 what Knott said. All of the above.

But I really want to bring up that if you're not doing stretches by now you should be. You can strengthen til the cows come home but if there are tight structures preventing the proper movement patterns you may not be doing yourself any favors.

[Starfish]

(This is just a little interjection...as a non-medical type...I sure am grateful that all the PTs and docs and nurses and others on TE are so generous with their knowledge & experience...Thank you so much Wahine & Knot!!) :)

[Kalidurga]

I'm no PT and I have no idea if this applies to your situation (or if my self-diagnosis is even correct), Nicole, but I used to have low back soreness from doing yoga. What I think was happening was that I was flattening the lumbar region of the spine during certain postures and it seemed to be straining the muscles around the sacrum. After I learned how to maintain a more natural curve to my spine in those postures, the strain went away. A similar thing also happened when I used to lean forward from the hips when cycling, instead of curving forward from the stomach. Knot & Wahine, is it possible that something similar could be happening if Nicole's flattening her lumbar spine during leg presses and quad extensions?

[KnottedYet]

Yup, could be that too. That's why it's sooooo important that PT's stay with their patients and correct their form on everything.

There are a couple other things that could be causing back pain, too. Darn, wish there was a way we could do a quick TE PT session in person!

[HillSlugger]

The PTs leave the exercise supervision to the assistants. They don't necessarily stay with you either as they may be ushering around a few people.

[HillSlugger]

Something about the taping, or the exercises, is restricting the mobility of my knees, making it hard to bend them. Is this normal?

[Wahine]

Taping will restrict the ability to bend the knees. That's pretty normal. But I don't like the back pain and achy joint bits. The next time you go in I would make it very clear that your back has gotten sore since starting the exercises and it's not getting better (or maybe worse?) and that you want to make sure that the exercises you are doing are not irritating your back. It doesn't sound to me like you're getting enough one on one input.

[HillSlugger]

I know I can't expect overnight improvement but I'd like to have confidence that I'm being treated correctly and that the therapists are properly looking out for me. I guess right now I have neither.

[Sheesh]

MD - I am not a physical therapist, and have sought much PT advice on this same forum. But, that said, Mr. Sheesh was having knee issues related to cycling and went to PT. While that helped stretch some muscles that were tight in the knee area, he found the most help when he went to a club-sponsored biomechanics study. The doctor team (mostly chiropractors, but trained in sports medicine and one specifically does custom orthotics) video-taped the participants as they cycled. Then they reviewed the footage and found that Mr. Sheesh had an abnormal pedal stroke which was leading to his knee pain (tibial torsion, he says). A few wedges in his cycling shoes later, and his pedal stroke was drastically improved and knee pain went away!

I was also going to PT for tight calves which were leading to other issues (including plantar facitis and lower back pain). Anytime I mentioned a pain or something like my feet going numb after 30 miles on the bike, my PT just said "Hmm, that's strange." That was her entire response. She has now "released" me from PT and says my issues are solved, but I'm still not convinced that the underlying cause of my pain has been addressed. If the pain returns, I plan to ask for a different PT because I'm not convinced that my original PT did much more than look at the symptoms and treat that.

Good luck! I hope you're able to find relief!

[KnottedYet]

Wahine and I need to open a clinic. TE PT.

MDHillSlug - If the PTAssts are covering more than one patient at a time, you should NOT be charged for that time. (check your bill) In fact, it is illegal to charge you for non-one-on-one time, as "group" charges only count if the entire group is doing the exact same thing. (check your bill, really. go in and ask for a complete charge sheet for your last two visits)

Sheesh - I'm sorry your PT was a dork. The foot numbness/plantar fasciitis/ tight calves are probably very related, and I'm surprised she didn't address it or look at how your posture (maybe due to the leg stuff) was effecting your back.

[Sheesh]

Sign me up for TE PT! :D

Yes, Knot, after reading your advice on my previous post, I became pretty convinced that my PT was only interested in relieving the symptoms. During one of my visits when she was out of town and I had to schedule with another PT, the new PT gave me some other stretches to release the nerves in my ankles, and that really helped the numb foot issue. I was amazed at what a difference that small change in stretching made!

[OakLeaf]

Hi, new here... I had to reply because I experienced this exact issue years ago. This is probably too obvious an answer, but have you tried shorter crankarms? By my height and frame size I "should" be fine with 167.5s, but I have patellofemoral issues on the bike unless I use 165mm cranks. (Anyone here want a brand new 170mm Shimano 105 triple?) Plus, it really helps smooth out my spin.

I've never had a complete professional bike fitting, but it might be in order for you, since it doesn't sound like your PT has a whole lot of experience in bicycling body mechanics. Obviously seat height, cleat placement and cleat rotation will directly affect your knees, but it's possible that what seems right to you isn't actually what's best for your knees.

When I've aggravated my knees doing other things, a simple stretch before I ride helps a lot. Just kneel on the floor (butt on my heels) for 1-2 minutes to stretch my quads and knee ligaments out.

I overpronate too, and this spring I started working the Chi Running program for correcting my body mechanics, which is doing wonders for me. Just being aware of which direction your toes are pointing when you walk or run - paying attention to how you're balancing your body weight on your feet - is more than most PTs will teach you.

Hoping you're healed up and back on the bike soon.

[HillSlugger]

Welcome! How are your knees now?

No, nothing is obvious to me ;) Actually, it was obvious that I should do a full fitting and had one on Tuesday. We never spoke about crank length. Currently I'm riding 170's (105 triple). I should get the bike back this weekend, but don't expect to try spinning for a bit yet.

Yesterday afternoon my back pain started to subside and today I'm doing much better. I got to remove the tape this morning so my knee mobility is improved. I haven't been doing the sorts of things that typically aggravate my knees, but it's been a pretty good day. Hopefully I can get someone to listen to me on Tuesday and can start thinking positively about therapy.

[HillSlugger]

Today, before we started, I spoke with the therapist about my back pain after therapy and about stretching. She said that stretching was definitely in order, that tight muscles contribute to pulling my kneecaps out of alignment, and that stretching should also help my back.

Three sessions, three therapists, three ways of taping. Today my knees are taped lower down, directly over the kneecaps, and are restricting my flexibility less. Yea! As long as I stick to early morning sessions I should keep seeing the same therapist. I was sent home with stretching assignments.

Elliptical: 8min/0.56mi
Knee taping
Electrostim (russian): 15min
Hamstring stretching on foam roller: 2min
IT band stretching on foam roller: 2min each leg
Hamstring stretching with band: 30sec x3, each leg
Leg press: 20 x 78#
Thigh abduction: 20 x 68#
Thigh adduction: 20 x 68#
Leg extension: 20 x 78#
1 hour total time

[OakLeaf]

My knees are good now, thanks for asking. I haven't had a flareup in almost 10 years (touch wood). I wear PF straps for aerobics (stepping and lateral movements) but I'm weaning myself off them when I run. I don't use any straps or tape for cycling and it's fine. I do get a twinge now and then, just a little grindy feeling. Taking shark cartilage or glucosamine/chondroitin mostly prevents that.

The last time I went through PT for PF dysfunction, they had me doing straight leg raises with my leg rotated outward, to develop the vastus medialis. From what I've read, a weak VMO is implicated in a lot of women's kneecap tracking issues. The Chi Running method is definitely developing that muscle, too.

Hope you're starting to see some improvement.

[Wahine]

Elliptical: 8min/0.56mi
Knee taping
Electrostim (russian): 15min
Hamstring stretching on foam roller: 2min
IT band stretching on foam roller: 2min each leg
Hamstring stretching with band: 30sec x3, each leg
Leg press: 20 x 78#
Thigh abduction: 20 x 68#
Thigh adduction: 20 x 68#
Leg extension: 20 x 78#
1 hour total time

That sounds a little better. I'm glad you're stretching. I still wonder about the knee extensions tho.

[KnottedYet]

Yeah, I wonder about the knee extensions, too. Ask your PT to explain why they are doing "open kinetic chain" exs rather than all "closed kinetic chain"? (open chain, you aren't putting weight thru your feet. perhaps not an optimal situation with the quad/knee business.)

(and what's with the Russian stim? was that on your VMO? Are you unable to contract the muscle on your own?)

Very glad to hear you are stretching! And glad they put the McConnell tape in the right spot!

Straight leg raises with the leg rolled out a little are really fun, cuz you can FEEL and SEE the vastus medialis obliquus contract. Way cool. Hillslug, you might get a kick out of them, ask your PT to show you.

3 diff PTs in 3 visits is pretty interesting. It will be nice if you can keep the current one for the rest of your visits.

Edit: BTW, I really like ChiRunning.

[Wahine]

With Knott's support on this, I'd have to say that I'm really not a fan of knee extensions for a person with patellofemoral problems. I'm with Knott, you should be doing almost all of your exercises with your foot planted on something so that you have a better chance at acheiving good alignment of the Hip-knee-foot. The exception to the rule tis the straight leg raise with the knee turned out and that's only an exception because it heavily biases the VMO.

[HillSlugger]

The only exercises I do with feet planted are the elliptical and the leg presses. Why no concern about the thigh abduction and adduction? What other exercises would you see me doing?

The vastus medialis obliquus (VMO) is above the knee to the inside? The first two times I had electrostim, one pad was here and one pad was on the outside. Yesterday, one pad was on the outside and the other was further up the thigh (can't remember if it was inside or outside). Last week I was told to contract and relax my muscles (push knee down into the table) while the stim was on and rest while it was off.

How do I do the "straight leg raise with the knee turned out"?

At PT I stretched my IT on the foam roller, but at home I'm using other stretching methods. Would it be worth it to get a roller for home? It hurt so good :rolleyes: (I own The Stick, but the roller seemed more effective).

[OakLeaf]

You've got it. The VMO is the quadriceps muscle nearest to the inside.

Straight leg raises: recline on the floor with your legs extended straight in front of you, supporting your upper body on your elbows. Rotate one leg from the hip so that knee and toe are pointing to about two o'clock. Then lift your leg straight up while maintaining the rotation. Hold for a few seconds, lower and repeat.

I've never used the foam roller. As an alternative, I like to use an elastic band to stretch the IT band. (You can use either the tape type or the round type elastic.) Lie on your back with your leg perpendicular to the floor. Pass the elastic band around the arch of your foot. Hold both ends of the band in the hand opposite the leg being stretched. Keep your hips square and both buttocks flat on the floor, and gently pull on the band to bring the foot toward the opposite shoulder.

I'll let the PTs answer your other questions. I'm just an aerobics, Pilates and strength training instructor with personal experience of issues similar to the ones you're having. Why don't I teach spinning? Because the bikes' crankarms are too long for my knees - which is a perfect excuse because I HATE all cardio machines :)

[Zen]

you should be able to get a foam roller from the PT clinic. I don't know that they're used directly for stretching but for myofascial release which would facilitate stretching.

I don't know how leg extensions can be good for anything except to drum up business for chiropractors. I cringe every time I see some guy kick up a heavy load and arch his back to assist. I cringe just thinking about it.

[Wahine]

It would totally be worth buying a foam roller. As Zen said, you should be able to get one at the PT clinic. We charge $22 for ours. If they want to charge you a lot more, let me know and I'll send you some links to order one online.

[crazycanuck]

Foam rollers :eek: but they're oh so nice :D on the ITB..ahhhh..

I also use a ball with soft spiky points on it to massage my right ITB..oh so nice..

C

[Rumblefish]

This was a very interesting and informative thread for me...I just saw my doctor on Friday with knee pain and he's leaning towards patellofemoral issues as well. I'm starting physical therapy next week and now I have a much better idea of what to expect and look out for. I feel a bit less anxious now about my first PT session :o :)

My doc also recommended I get a professional bike fit (but yikes they are expensive around here!! one guy charges $300!!! :eek: waaaay more than my poor college funds can spare!) So for now my boyfriend and I have been gathering as much info about bike fittings/posture and whatever else to try and see what and if there's anything we can adjust on my bike to alleviate symptoms and possible causes...

Right now we think my cranks are too long as Oakleaf mentioned and want to try getting shorter ones...riding with 175mm.....If I had a triple Oakleaf I'd totally jump on your 170mm!!

Hillslug, hope your knee improves! and thanks everyone for so freely sharing info, as always TE members rock :D

[HillSlugger]

I got by bike back from the fitting on Monday. This morning I did a very easy ride on the trainer stand. My knees did not complain. I guess this means I'm improving. That's a very good thing :) I don't know if it's from the fitting, the rest, or the physical therapy (all three?). If I need to tape my knees for the foreseeable future to be able to bike and run it would be an acceptable price to pay to do what I love.

I followed the biking with 15 minutes of stretching, including the foam roller.

I probably won't try riding again until next week.

[OakLeaf]

:) :) Good thoughts your way as your knees continue to improve.

[Wahine]

That's good news MD!! I wouldn't wait til next week to ride though. You might go every other day, just don't go more than 15 min since you know you can tolerate that and don't go out if you're more sore the next day.

[HillSlugger]

That's good news MD!! I wouldn't wait til next week to ride though. You might go every other day, just don't go more than 15 min since you know you can tolerate that and don't go out if you're more sore the next day.

Actually, I rode 30 minutes and then stretched 15 minutes. I'm afraid to do too much too soon. Between swimming and PT I have Wednesday mornings and one weekend day I can ride again. Twice a week will have to do it for now.

[Wahine]

Ooooops, miss read your post. Sounds like you've got a good plan!! Take care.

[HillSlugger]

I did my third biking session on the trainer stand, longer and faster each time. I can now definitely say that my knees are feeling much improved. Yea! :D

PT will continue for another 2 weeks, at least. I'm glad to see that it's having an effect. Definitely worth it!