patellofemoral syndrome pain

[Wahine]

Patellar taping is very effective for pain relief. It does not retrain the muscles around the knee or hip to support proper patellar tracking BUT it does help in that when there is less pain, muscle action/recruitment patterns can be improved. So, it's good to use the taping before exercises that are meant to strengthen these muscles. Eventually the goal is that the muscles take over and the tape is no longer needed.

Here is a link that shows how to do a patellar taping and this second link can show you how to do it to yourself. I don't like either video as a stand alone, but they do work well together.

Do get your PT to show you how to do it. These videos should only act as a reminder on how to do it. They do not replace one on one instruction.

[Cataboo]

Thanks Wahine.

I caused myself pain last time I tried doing it - it's been a while since I was taught.

Most of the time I have no pain, but for skiing, it'd be nice to tape it again.

[Onix]

So, forgive me---I don't know how to include text from previous posts in replies when I am replying to more than one person....

Wahine: About the speed play having less of a connected base to push off compared to other pedals.... I was under the impression that the bases of cycling shoes were made of hard plastic/carbon to counteract that sort of effect. I was thinking that once shoes were connected to the pedal, they almost became one piece together. If the base of the shoe collapsed around the pedal, then yes, extra pressure would come onto wherever the shoe was connected to the pedal. But, with hard based shoes, shouldn't there not be extra pressure where the speed play pedal connects with the shoe? Since the shoe base is hard? Shouldn't pressure be distributed all the way around??? Does that make sense? Or, are you saying that speedplays create a propensity to distribute your pressure in your foot in strange ways---not that the connection itself is not the best? Sorry if that is confusing!

NadiaMac: Bummer you can only ride 20-25 mins at a time

NadiaMac, Catriana, Ny Biker: Thank you for your personal stories/experiences with taping. That is helpful.

Wahine: Thank you for the taping links. That is helpful. I haven't been taught by my PT yet, but I imagine I will need a refresher once I am.

Trek 420: I agree. Warmth does feel good on my knee too. I hope it isn't arthritis for me, but the warmth feels good nonetheless!

[Wahine]

Wahine: About the speed play having less of a connected base to push off compared to other pedals.... I was under the impression that the bases of cycling shoes were made of hard plastic/carbon to counteract that sort of effect. I was thinking that once shoes were connected to the pedal, they almost became one piece together. If the base of the shoe collapsed around the pedal, then yes, extra pressure would come onto wherever the shoe was connected to the pedal. But, with hard based shoes, shouldn't there not be extra pressure where the speed play pedal connects with the shoe? Since the shoe base is hard? Shouldn't pressure be distributed all the way around???

That's what the manufacturers would say and in theory I wouldn't disagree with that if the interface (transition points between parts of the shoe and pedal) was perfect. But it's not. At every interface you introduce a certain amount of play. It might be very small but it's there. The more play, the more the forces at the interface can affect contact surface etc. So speedplays have a double whammy here. The have more play at the cleat/pedal interface and they have more interfaces between the pedal and the shoe - pedal to cleat, engaging part of cleat to stabilizing part of cleat, stabilized part of cleat to triangular cleat base, triangular cleat base to shoe. My Looks go pedal to cleat (which is all one piece and has less play) cleat to cleat base in shoe. I'm sure that this is a great explanation but it is the best theory I have.

So really, I'm not positive what's going on here, I've noted the difference clinically and through my coaching experience and that's the best explanation I can come up with. All I can say for sure is that my clients with forefoot issues almost always do better with a larger cleat base/pedal, especially the ultra riders I work with.


Hope that helps.

[Onix]

That's what the manufacturers would say and in theory I wouldn't disagree with that if the interface (transition points between parts of the shoe and pedal) was perfect. But it's not. At every interface you introduce a certain amount of play. It might be very small but it's there. The more play, the more the forces at the interface can affect contact surface etc. So speedplays have a double whammy here. The have more play at the cleat/pedal interface and they have more interfaces between the pedal and the shoe - pedal to cleat, engaging part of cleat to stabilizing part of cleat, stabilized part of cleat to triangular cleat base, triangular cleat base to shoe. My Looks go pedal to cleat (which is all one piece and has less play) cleat to cleat base in shoe. I'm sure that this is a great explanation but it is the best theory I have.

So really, I'm not positive what's going on here, I've noted the difference clinically and through my coaching experience and that's the best explanation I can come up with. All I can say for sure is that my clients with forefoot issues almost always do better with a larger cleat base/pedal, especially the ultra riders I work with.


Hope that helps.

Gotcha. That does help. I can definitely feel more pressure in the ball of my foot...but couldn't make sense of it all Thank you for all of your help with this issue.

[Kathi]

I was diagnosed with patellofemoral pain many years ago. Cycling really helped and for many years I had no pain even though I used Speedplay pedals. I even used them on my trainer when I tore my ACL. Then I started having foot pain and progressed to knee pain which progressed to hip and back pain. My old knee exercises, leg lifts, etc did nothing to alleviate the pain. Because of the negative things I had been reading about Speedplays I really started to believe the they were causing the problem. After 4 months of PT I changed therapists and he looked beyond the site of pain and found my left SI joint was locked, whereas the 1st PT had been treating the site of the pain, my right side.

2,000 miles of riding this summer with Speedplays, X1's and Frogs and no pain with knee or foot.

BTW, the podiatrist said I had 2 neuromas in my foot. I now can walk barefoot with no issues, no burning in the morning, no pain while riding. I'm using my orthotics less and less.

For some reason this time I rejected the ortho's suggestion of surgery and braces, the podiatrist injections and decided to let things run its course. And for me, I can confidently say the Speedplays were not the issue.

[Onix]

I was diagnosed with patellofemoral pain many years ago. Cycling really helped and for many years I had no pain even though I used Speedplay pedals. I even used them on my trainer when I tore my ACL. Then I started having foot pain and progressed to knee pain which progressed to hip and back pain. My old knee exercises, leg lifts, etc did nothing to alleviate the pain. Because of the negative things I had been reading about Speedplays I really started to believe the they were causing the problem. After 4 months of PT I changed therapists and he looked beyond the site of pain and found my left SI joint was locked, whereas the 1st PT had been treating the site of the pain, my right side.

2,000 miles of riding this summer with Speedplays, X1's and Frogs and no pain with knee or foot.

BTW, the podiatrist said I had 2 neuromas in my foot. I now can walk barefoot with no issues, no burning in the morning, no pain while riding. I'm using my orthotics less and less.

For some reason this time I rejected the ortho's suggestion of surgery and braces, the podiatrist injections and decided to let things run its course. And for me, I can confidently say the Speedplays were not the issue.

Thank you for your post Kathi. I appreciate the perspective. So far, my knee exercises also don't seem to be changing anything. I keep getting told that it is a lengthy process of strengthening the muscles that over time will help with the pain. What is an SI Joint? Do you think that working on that issue is really what helped you with a lot of your pain?

[Wahine]

The SI joint is the joint between your sacrum and your ilium, parts of your pelvis. It's there to allow a little motion, (only about 12 deg each way at each joint if they are healthy), so that torsional forces during leg movements can be dissipated, especially when walking or running. Without them in combination with the pubic symphasis, our pelvis would be one solid bone constantly under torsional stress and getting microfractures. Not to mention the important role of the SI joints in childbirth.

Sometimes this joint can become dysfunctional by moving too much or too little. This can lead to all kinds of compensation during movement and will result in pain locally and/or elsewhere... knee included. So yes, if your PT hasn't looked at your low back-pelvis-hip mechanics. It's worth having them check it out. A messed up SI often goes right along with the "dumb butt" syndrome Knott mentioned earlier.

[Onix]

The SI joint is the joint between your sacrum and your ilium, parts of your pelvis. It's there to allow a little motion, (only about 12 deg each way at each joint if they are healthy), so that torsional forces during leg movements can be dissipated, especially when walking or running. Without them in combination with the pubic symphasis, our pelvis would be one solid bone constantly under torsional stress and getting microfractures. Not to mention the important role of the SI joints in childbirth.

Sometimes this joint can become dysfunctional by moving too much or too little. This can lead to all kinds of compensation during movement and will result in pain locally and/or elsewhere... knee included. So yes, if your PT hasn't looked at your low back-pelvis-hip mechanics. It's worth having them check it out. A messed up SI often goes right along with the "dumb butt" syndrome Knott mentioned earlier.

Awesome. Good to know. Thank you Wahine. My PT actually hasn't checked out my back-pelvis-hip mechanics. I will address this. Interesting.

[Kathi]

Onix, yes working on the joint definitely helped. The 1st time my PT worked on it I immediately felt the tension go out of my right hip. He told me to go ride my bike no limitations. I rode a 20 mile ride with a few good long hills and no pain.

In my case my lower back started locking up when I'd bend over. At first I thought this was unrelated to the knee/foot pain. By the time I sought medical care my entire right side hurt down into my right leg. And yes, walking seemed to make me more uncomfortable.

An MRI didn't show anything except for osteoarthritis in my right SI joint and right hip. Ortho said something was causing the arthritis but didn't know what.

1st PT focused on painful side and did some things to loosen the right SI but I ended up feeling worse. He also said my right glute was weaker than left but his prescribed exercises made me feel worse.

2nd Pt, with information in hand, examined my left SI. One thing to note is 1st PT did lower back exam but had me laying on my stomach. 2nd PT did it with me on my back. I could tell the difference between right and left SI when he moved them, left had no movement and was hard as a board, right had lots of movement.

Before discovering the SI issue I used to sit on my left glute no matter how hard I tried to sit balanced and when sitting for long periods, like traveling in car, I'd feel very stiff and have a hard time straightening up. After walking around for a few minutes I would loosen up. Often the left glute would be very sore from the pressure on the car seat.

Finally, I tore my ACL in 06 and had surgery. In spite of faithfully doing the exercises my right leg never regained the muscle that it had pre surgery. My ortho was concerned but didn't pursue this. This summer, in spite of doing no quad exercises my muscles have returned to pre surgery size and are pretty symmetrical with the left side.

Also, be sure your cleats are clean and lubed and placed properly on your shoe.

Hope this helps you find the solution to your problem.

[Onix]

Kathi,
That is all great information!

Thank you so much for that!

[OakLeaf]

Also, be sure your cleats are clean and lubed and placed properly on your shoe.

Did you mean lube the pedals... or are cleats supposed to be lubed? If so, with what... surfboard wax or something? I'd never heard that before.

[Kathi]

Did you mean lube the pedals... or are cleats supposed to be lubed? If so, with what... surfboard wax or something? I'd never heard that before.

From the Speedplay website:

Where should the X cleats and pedal surface be lubricated?

"Apply a dry-type(PFTE) lubricant such as Super Lube Dry Film, RZ-50, DuPont Performance Dry, Liquid Wrench Dry-Lube, Pro Gold, or Blaster Dry Lube to the cleat springs and the center area of the cleat where the pedal nests. Be sure to keep the cleat cavity free from dirt and debris. Additionally, be careful not to apply lubricant to the outer plate of the cleats as it may cause the cleats to become slippery on some floor surfaces."

Occasionally I run a very thin screw driver between the springs and the metal bottom plate to clean debris or grit out of springs. If they get really dirty I take them apart and clean them. Also, I replace cleats when the springs start to look flat and the metal piece is wearing thin at toe.

I also lubricate my Frogs.

[OakLeaf]

Ah, okay, I didn't know there were moving parts on the Speedplay cleats.

Another reason to love my Looks.

[Kathi]

No big deal, just a squirt of lube on each cleat before riding. Easier than checking the air in your tires. I don't lube them every ride.