patellofemoral syndrome pain

[OakLeaf]

That sounds so similar to Jolie Bookspan!

I haven't read her book, but I really enjoy her blog.

[Onix]

Good question! I will have to look when I get home! I think it is so work/sweated in that the tag inside has worn off! I will let you know!

It is a "J Brace" patella stabilizer in genre.

Yep. I have sweat off the label. No idea on brand....sorry!





Interesting about the posture book... thanks for the reference.

[NadiaMac]

no worries!

can you wear this brace while exercising (eg, riding)? Or is it for walking/activities of daily living? Have you tried anything that helps when you are riding? Thx for info

[Wahine]

There are a ton of issues here. First I have to say +1 to everything in Knottedyet's post.

1. Feet: I have seen a podiatrist. They diagnosed me with nerve neuromas in the ball of my feet. And, gave me shots in my feet to try to calm them. This has worked about 80%. (thank goodness!) Feet are largely addressed. Occasionally though, I get numbness/pain in the ball of my feet (like I used to when I was walking) when I am peddling. Despite the fact that I really try to focus on not only the pedal push down, but the stroke up/having heel down---this continues to be a problem sometimes

Are you using orthotics when you ride? Chances are you need them if you have these types of foot issues. You may not need a custom orthotic but Specialized makes and orthotic with a forefoot wedge and a metatarsal button that might work.

2. As for perfectly aligned pedals/cleats...do you have any advice on this? I use light action speed plays. (My first, and only cleats/clip pedals). They are free floating. However, sometimes I wish the position could move further back on my foot (they're as far back as they go)...but...I'm not really sure where they are supposed to be. It seems to all be guess work? Any positions you have found particularly helpful for knee pain?

I know that a lot of people out there swear by speedplays but I have to say that in your case they are probably contributing to your problem. If not your knee pain then they can make your foot pain worse. I often recommend a Look or Time style pedal to people with forefoot neuroma/pain and yes, you want the cleats positioned farther back on the shoe. Ideally the knuckle that joins your baby toe to your foot should be in line with your pedal axle when you are clipped in.

4. My PT has never seen me on a bike. How did you guys find PTs that know a lot about cycling? I have been fit on my bike. So, presumably, the seat height is good. The fitter also noticed that I rolled my knee out a bit with my stroke, which I have been trying to correct. He also noticed that I rock my hips a lot when I ride, despite having the right saddle height. Go figure.

You may be able to find a PT that does bike fitting. I do and so does Knott. But we're in the PNW... I have no idea where you are. I would ask around at PT clinics for a PT that does fitting, ask at the bike shops and any local teams you might know of.

8. Things I'm doing with my PT: muscle strengthening exercises for the muscles above the knee/inside the knee. Apparently, these are not muscles you develop with cycling. (And, since I haven't been able to walk more than about 15 minutes without intense pain, and I definitely can't run anymore---I was way lopsided. So, lots of half-leg lifts, balance exercises, stability exercises, etc. I can be more detailed about these muscle exercises if desired.

This all sounds pretty good except the bit about not working your muscle on the inside of the knee while riding. If you are riding well (good pedal stroke and painfree) it's actually a very good exercise to develop this muscle. If your pedaling is compromised by form issues, muscle imbalances or pain then it's not so good, but it's not bad either.

I always recommend a lot of hip stretches, foam roller work and stability exercises for the core and hips with these problems. You might want to ask your PT about these things if they are not already being addressed.


Hope that helps.

[Onix]

no worries!

can you wear this brace while exercising (eg, riding)? Or is it for walking/activities of daily living? Have you tried anything that helps when you are riding? Thx for info

So...I have trouble wearing the particular brace that I have for riding. It is tight fitting, so, whenever I have my knees bent up (like in a peddle stroke, or sitting with them bent in a chair), I start feeling like my blood circulation is being a bit cut off. However, I imagine that there are braces that are designed more for more bending movement while still stabilizing.

I have no problem wearing the brace for walking (or, I'm sure running, if I could do that still), stairs, hiking etc.

Hope that helps!

I am interested in learning how to tape my knee to provide more support to the knee cap. It seems this might make it easier to get support while still giving a bit more knee bending freedom??

[Onix]

Wahine,
Thank you for all of that feedback!

I didn't even think about asking my LBS for a PT fitter reference. What a dork I am!

Thank you!

[Trek420]

So...I have trouble wearing the particular brace that I have for riding. It is tight fitting, so, whenever I have my knees bent up (like in a peddle stroke, or sitting with them bent in a chair), I start feeling like my blood circulation is being a bit cut off. However, I imagine that there are braces that are designed more for more bending movement while still stabilizing.

I have no problem wearing the brace for walking (or, I'm sure running, if I could do that still), stairs, hiking etc.

Hope that helps!

I am interested in learning how to tape my knee to provide more support to the knee cap. It seems this might make it easier to get support while still giving a bit more knee bending freedom??

Disclosure: no medical training, don't play a PT on TV but I do have totally non functional joints. I'm a wreck.

Please ask your own Dr & PT but according to mine the brace is a preventative measure. I wear a brace that makes me look like a Borg when training martial arts or anything else that has a lot of lateral movement (and with me that's only MA).

If I rip, tear, shred or otherwise damage anything else ever again it's over.

My understanding is a knee is a hinge. Knees generally do the hinge thing pretty well, they looooooove to do circles. And cycling, well cycling's great for knees.

For my knees I've been continually told that ultimately wearing a brace would be worse for me. Muscles supported by a brace can become complacent and even weaker. Since there's nothing that can be done surgically to my legs my option is just sit in front of the computer and sadly read about cycling and miss it and my glory days of being outdoors or on the mat or build up allllll the muscles that support my joints from the inside.

I've been ordered in no uncertain terms: stand up straight, line things up, get stronger, get flexible, fix your core or go sit down and go sedentary.

Your mileage may be different.

I had a prescription brace that I did not like, when I needed to replace it I got another one 'cause that's what my Dr. prescribed ..... it's worn out, I'll be getting this till I can get a referral for a carbon one http://www.rei.com/product/745518 but I've likely got different boo boo's than you.

[Onix]

For my knees I've been continually told that ultimately wearing a brace would be worse for me. Muscles supported by a brace can become complacent and even weaker. Since there's nothing that can be done surgically to my legs my option is just sit in front of the computer and sadly read about cycling and miss it and my glory days of being outdoors or on the mat or build up allllll the muscles that support my joints from the inside.

I've been ordered in no uncertain terms: stand up straight, line things up, get stronger, get flexible, fix your core or go sit down and go sedentary.

Yhttp://www.rei.com/product/745518 but I've likely got different boo boo's than you.

Interesting. The ortho and PT both told me that I can wear the brace if I find it helpful, because it can't cause harm. Neither of them demanded I wear it. I usually only wear it when I know a considerable amount of walking is going to take place (i.e. not just between classes in the same building), or when my knee is really swollen/full of fluid. Then, it just feels good to have the pressure on my knee. I am in the process of trying to strengthen my muscles to help my joins as well! Good luck to you!! I hope your join problems improve!!

[Onix]

I know that a lot of people out there swear by speedplays but I have to say that in your case they are probably contributing to your problem. If not your knee pain then they can make your foot pain worse. I often recommend a Look or Time style pedal to people with forefoot neuroma/pain and yes, you want the cleats positioned farther back on the shoe. Ideally the knuckle that joins your baby toe to your foot should be in line with your pedal axle when you are clipped in.

Wahine,
Why do you say that speedplays might be contributing to the foot/knee pain? Because they float??

[Wahine]

Not because they float but because they might be irritating your metatarsal area. If your foot isn't happy you will change your pedal stroke to compensate and that might put more pressure on your knee. Speedplays seem to irritate the metatarsal area more than other pedals with a larger base to push off of, like Time and Look pedals. Having said that, more float is not always better. Some people actually do better with less float as long as the cleat position is properly aligned.

[NadiaMac]

My ortho also says to wear a brace as much as I want if it is helping. Bearing in mind that I have hypothesized patellar tracking issue (further to an impact injury) and my current brace is very low profile -- just a little collar/horseshoe thing that rests against the patella and keeps it on track-- so my muscles continue to work even with the brace.

Braces vary a lot depending on your condition and I can totally see that support braces or stability braces would have different roles in the rehab process per the remarks above.

Yes, cycling is a very knee friendly activity, generally, but unfortunately, I can't tolerate more than 20-25 minutes at the moment due to my extreme sensitivity to load. My bad luck to have a knee injury that precludes even knee friendly cycling. Hopefully this is temporary...

On the bracing/taping while cycling topic: I asked my PT about this today and he said that there is nothing that works due to the range of motion in a cycling pedal stroke. none of the braces or taping schemes tolerate that much motion, basically. rats...

[NadiaMac]

Onix: on your taping question. I've been getting taped at the PT-- the taping is similar to McConnel taping, to keep my patella tracking. It is super tight, and my range of motion is much more restricted than when I wear my tracking brace. So I am not sure that taping will give you more flexibility as compared to your brace (but I suppose this depends on your brace and how it fits). Taping is wayyy more comfortable than the brace from the hot and itchy perspective, and also no-profile so getting your pants over the brace is not an issue. The taping works super well for me, from a pain-relief perspective but your mileage may vary...

[Cataboo]

I don't know - My PT used to tape my knee & then I'd get on the bike at the therapist office without any problem.

The tape they used was really really strong - I had to put down a layer of white tape, and then this strong brown tape over it - and it just went from my knee cap to the inside of my knee. I was told never to put the brown tape on my skin because it would rip it off.

I didn't bike back then, but I never really had problems with doing anything that taping didn't support my knee.

[ny biker]

I don't know - My PT used to tape my knee & then I'd get on the bike at the therapist office without any problem.

The tape they used was really really strong - I had to put down a layer of white tape, and then this strong brown tape over it - and it just went from my knee cap to the inside of my knee. I was told never to put the brown tape on my skin because it would rip it off.

I didn't bike back then, but I never really had problems with doing anything that taping didn't support my knee.

When I was going to an orthopedic surgeon and PT several years ago for a patella tracking issue, the doctor said I could try the taping, and the PT taped my knee several times so I could try it out. I decided I didn't need it, but the plan was that if I wanted to do it regularly the PT would sell me a kit and show me how to do it myself. And the clear purpose of the taping was to support my knee during long bike rides.

[Trek420]

I usually only wear it when I know a considerable amount of walking is going to take place (i.e. not just between classes in the same building), or when my knee is really swollen/full of fluid. Then, it just feels good to have the pressure on my knee.

Just speaking for my knee since I have arth as well as structural issues warmth feels good. I've learned to tell what it is by the kind of pain I have; is it the arth, the structural issues or both. if it's the arth the knee aches, the sharp stabbing "I should not have done that move" is the ACL, tendons etc.

If it's the arth keeping the joint warm feels good however I do that; tights, leg warmers and even the brace. I imagine if I was only structural that would feel good too.

But that's my knee