"Kneecap Training"

[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 (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 but they're oh so nice 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

My doc also recommended I get a professional bike fit (but yikes they are expensive around here!! one guy charges $300!!! 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

[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.