Knee Injury - Patellofemoral Syndrome

Hi,

Finally, after many weeks of knee pain and going through naturpathic / accupuncture / traditional treatements my knee pain is patellofemoral syndrome.  It turns out that that this take a long time to heal, but I was wondering if anyone else had had this and how did they deal with it?

Any advice?

Thanks.

I've been struggling with it for years.  There are a couple of causes:

1. 
   Overuse.  Easy one to figure out.  Reduce training volume and build back up slowly.
2. Poor biomechanics.  Arch supports, better shoes, orthotics, or (for bicyclists) varus/valgus forefoot wedges help a lot.
3. Tightness in the lateral fascia that help to secure the kneecap, pulling it towards the outside of the body so that it doesn't track properly in its groove in the end of the femur.  This irritates the back of the kneecap => pain.
4. Muscle imbalance between lateral superior quads and vastus medialis oblique (the big lump of muscle by the kneecap, towards the inside of the body).  Again, this leads to pulling the kneecap one way or the other out of its track.  Usually, the VMO is too weak, and this gangs up on you with #3 above, and ouch.

How to fix?  You have to reduce your training volume and intensity while you heal, but you do not want to cease using the knee--it will heal better if you use it gently than if you rest it completely.  You can use McConnell taping to help keep the kneecap aligned while you are healing and while you are correcting the causes of your injury, and ice it down after exercise.

Strengthening the VMO involves, usually, straight leg raises (add ankle weights when you are able), abduction and adduction leg raises, "step ups" (stepping up and down from about the height of a thick phone book, but in a controlled fashion), and stretches for the lateral fascia.  You'll want a physio to show you those--the rough description is that you want to block your kneecap in proper position with the thumb of the hand of the same leg (right hand--right leg, left hand, left leg), and then use the other hand to press down on the inside edge of the kneecap to *gently* tilt it until you feel a stretch, hold for a 10 count, relax for a five count, repeat.

Of these exercises, I find the straight-leg raises to be the most challenging.  I mean absolutely dead straight--you start with your leg on the floor, locked straight, and you raise it 6" off the floor WITHOUT LETTING YOUR KNEE BEND *AT* *ALL*, hold for a 2 count, and lower it.  Repeat 10x.  Eventually, you want to build up to 3 sets of 10 on each leg, and then add ankle weights.

Most exercises we do don't exercise that very end range of knee extension, and that's the range that very effectively strengthens the VMO, which will help your kneecap to track properly.

You'll be sweating bullets the first few times you do these exercises--it takes a lot of concentration while your VMO's are weak to accomplish the straight leg raises.  As an alternative, if you can't get your leg up without bending the knee, you can do "quad sets"; i.e., lock the leg straight and tense up your quads, hold for a five count, then relax, and do your sets that way to build up strength until you can do the leg raises.

I am not a physio--these are the exercises my physio showed me, and they work.