Arthroscopy?

[ehirsch83]

I did about 4 years ago. I was able to get around on crutches starting the next day, granted I lived in an apartment building with an elevator though.

Stairs will be a challenge until you get used to them

One more thing, I know you have been over your fit- but have you had your cleats gone over by a professional fitter?(someone who is a certified fitter)

[OakLeaf]

One more thing, I know you have been over your fit- but have you had your cleats gone over by a professional fitter?(someone who is a certified fitter)

Or your crankarm length? And did the PT assess your feet (which can be a source of all kinds of knee trouble) and/or hips?

It hardly sounds to me like three weeks of PT is enough to decide that you aren't getting stronger. Does the PT think you won't continue to get stronger enough to resolve the issues?

[Wahine]

You've seen a few posts already about the success of a lateral release. In my 17 years (OMG, how is it that long since I graduated!!!!) experience as a PT, I have not seen a successful lateral release, except in those cases where recurrent patellar dislocations (much more serious than a subluxation) is an issue. I think that Possegal falls into that category.

Hips have a huge part to play in these problems as mentioned by Kathi. Often there is a lack of flexibility in the hips (usually they don't turn out well) and/or a lack of strength (of the muscles that turn the hips out. There can also be a problem with the feet. If you have very flat arches that will cause bad things to happen at the patella. So be sure to have your PT look at your hips and feet.

Treatments that can be very effective:
1) Manual treatments to release the quads, IT band complex, tensor fascia lata, gluteus medius and minimus. Including trigger point dry needling.
2) Exercises to increase hip external rotation and gluteus maximus strength
3) Exercises to increase the medial longitudinal arch height and control in the foot and/or foot beds to support the arch
4) Bike fitting and analysis of pedaling technique!!


3 weeks is definitely not enough time in PT to decide if conservative (ie non-surgical) treatment can be effective. If it was me, I'd go through at least 3 months of PT before making that decision.

I hope that helps.

Sincerely,
Your friendly neighborhood PT, triathlon coach, personal trainer person.

Cassie

[Wahine]

Here are some links to tests that I use on runners to see what their stabiliaztion strength in the pelvis and hip area is like. They can give you some great ideas for places besides your VMO where you can work on strengthening.

Single leg mini-squat
Supine Bridge
Front plank
Side plank

Hope that helps.

[Blueberry]

Thanks, Wahine! I expect I'll find those useful (along with the rest of your youtube channel). No wonder my IT Rollering hurt - I wasn't taking enough weight off!

[westtexas]

Thanks all for the support and advice. I've already done ~6 weeks of PT prior to this at 3x/week and am still experiencing pain. We're doing lots of IT band stretches and have been doing most of the exercises suggested as well (plus laser therapy). I don't have access to a certified bike fitter out here, but the guy who fit me was a racer and very experienced cyclist. I have high arches in my feet and I know that my hip muscles are weak. I'm all lateral thigh muscles and nothing else.

The reason my doctor is already talking about surgery is because I am about to go off my parents' insurance (really good, no deductible, etc.) and onto my own insurance (bare minimum as I have no money and my job doesn't help pay and this is now a pre-existing condition). I trust my doctor to make the right decision - he was highly recommended by a close cyclist friend and he was trying to avoid surgery until I told him about my insurance situation. My patella is pretty rotated, but the groove of my bones is good, so my doctor thinks that with increased VMO strength we have a good chance of avoiding surgery. I'm just a researcher - I like to know about all possibilities, just in case.

In addition to PT 3x/week a friend of mine that I work with used to play collegiate level basketball and she is going to take me as a guest to the Y to use the machines there the other days of the week (I know nothing about gym equipment, I generally hate those places). My right side is >50% stronger than my left according to my evaluations, which is probably why I haven't had a problem yet on that side. I've always been inflexible/weak on the left as long as I can remember.

Thanks all for the replies. I really appreciate the insight and things to consider. I am going to ride today for the first time 2 months to see how my knee behaves (on the order of the PT). But it will just be a short out and back so hopefully it will go well. I didn't experience any pain last time until the next day, so I won't know until tomorrow if things are ok.

[Wahine]

Other things to explore if you haven't alreday is McConnell taping for the knee. Your PT can show you how to do it. I tape my patients and leave the tape on for up to 2 days to allow the tape to help stretch out the soft tissue that affect the patellar alignment. I also teach patient how to do the taping prior to activity to minimize pain during the activity.

Yoga is very helpful too.

And don't forget to look into trigger point dry needling if you can. It has helped me a great deal with my own chronic patellar pain (related to thigh and hip issues).

I feel like I'm bombarding you with stuff, but really it would be so great if you could find a solution without surgery being necessary.

Good luck.