Patellofemoral pain syndrome (knee pain)

melissa2807

Hi all,

I have just got back from the doctors after suffering from some knee pain. He's diagnosed patellofemoral syndrome, and although he has referred me to a physio for it, he said that the only way to help it is to stop impact exercise for a while.

I'm gutted about this because I'm really enjoying the gym at the minute, I love my combat classes and I don't want to get out of the habit or lose my new found fitness level, however I also don't want to make my knee any worse than it is.

I've got a few combat classes lined up so will do these for the time being but will use a knee support and step and march instead of bouncing and jumping, but after that I'm thinking of taking a short recovery break.

Has anyone ever had PFPS and if so, how long did you rest for? Did you take a complete rest or did you go to low impact versions of your workouts? My research tells me it's good to try and strengthen quad and hip muscles so will ask the gym guys about that, but if anyone has any other advice I'd be most grateful!

Thanks very much,

Mel

wellbert

I was having some serious knee issues a few months ago. But my doc said it was patellofemoral arthritis. Strengthening the joint has done wonders for it. I did this by doing squats. Really helped in Muay Thai too. (That and I stopped hitting the bag hard with my knees... d'oh)

The caveat is, squats done incorrectly can really adversely impact your knee.

melissa2807

Did you do squats with weights? I've cancelled my pump classes because I don't want to risk aggravating it like you say by doing poorly formed squats. Although I guess I could just drop down a couple of weights to help keep the form.

wellbert

Yep, started with the bar and went up to about 160lbs before I injured my back doing something else.

Once I started squatting correctly, I never felt it in the knees at any point.

Before I was squatting wrong (not low enough, didnt have toes pointed out, let knees come in the middle) and that cause a lot of problems.

Squats are the ONLY one that doesn't cause me any knee trouble. Lunges can be hard on your knees. Leg extension machines are your enemy.

Willbenchforcupcakes

I've been dealing with PFS more than half my life. There are a few different causes, some people develop it because of the angle that the femur connects with the tibia and fibula, and sometimes it has more to do with a muscle imbalance between the hamstrings and quads. Your physio will be able to diagnose the cause of yours and give you specific exercises that will help. By staying active and working at keeping the muscles balanced, I've had barely any pain for years.

melissa2807

I think that mine *might* have something to do with my very flat feet. I do wear motion control trainers and try to wear 'sensible' shoes as often as possible. I did mention this to the GP but he was pretty non committal about it, I will mention it again to the physio as a possibility. Just got to wait for the referral letter to come through now!

melissa2807

I'm glad to hear that you have been able to manage it wobbs - I was starting to worry that I'd be stuck with horrible old lady knees forever, I'm only 27!

Azdak

Hi all,

I have just got back from the doctors after suffering from some knee pain. He's diagnosed patellofemoral syndrome, and although he has referred me to a physio for it, he said that the only way to help it is to stop impact exercise for a while.

I'm gutted about this because I'm really enjoying the gym at the minute, I love my combat classes and I don't want to get out of the habit or lose my new found fitness level, however I also don't want to make my knee any worse than it is.

I've got a few combat classes lined up so will do these for the time being but will use a knee support and step and march instead of bouncing and jumping, but after that I'm thinking of taking a short recovery break.

Has anyone ever had PFPS and if so, how long did you rest for? Did you take a complete rest or did you go to low impact versions of your workouts? My research tells me it's good to try and strengthen quad and hip muscles so will ask the gym guys about that, but if anyone has any other advice I'd be most grateful!

Thanks very much,

Mel

You might have to lay off jumping and high-impact exercises for awhile. There are two stages of dealing with PFS--one is decreasing the pain and inflammation; two is correcting the underlying issues that are causing the problem. Sometimes if the inflammation is severe enough, an almost complete cessation of exercise activities is required. That's really a medical question.

Sometimes if the pain is mild, a method of taping (or perhaps a brace) can help the person continue some type of workout program WHILE THEY ARE REHABBING. Decreasing pain w/out addressing the causes is not a cure.

The rehab will focus on strengthening the quads and correcting flexibility issues and muscle imbalances. It will also focus on stabilization and functional strengthening of the knee.

The bad news is that, in severe cases, getting rid of the pain can be a long and frustrating process. The good news is that, if you can be successful, you will likely end up with knees that are stronger than ever AND you will learn how to quickly intervene if you notice the symptoms returning.

My worst case of PFS occurred 18 years ago. It contributed to a meniscus tear and then for a variety of reasons, returned with a vengeance after the surgery. It just so happened that I was slow getting into therapy and I ended up not being able to run for 14 months.

The good news is that, once I finally got things under control, the program I followed got me in great shape. 18 years (and two non-exercise related knee surgeries) later, my knees are still in better shape pushing age 60 than they were when I was 40.

I have seen some severe cases of PFS, so I don't want to make a 100% global statement, but I think for most people, PFS is very manageable and, if caused by muscle weaknesses, relatively straightforward to correct.

mlb929

Azdak always has the best advice and information.

When I was in PT for knee pain, they never told me to not do what I mainly did. They made me stop plyometrics for a while, but not completely until I was rehabbed, and could get right back into it. I learned a lifetime of great information and advice. Treated the problem and it solved numerous other issues at the same time, felt great and I was back in service soon.

TGKvr

Try doing squats with a wall ball to make it less strain on your knees while you re-hab. A proper tape job can work wonders as well in helping your patella track properly. I also do static lunges with a parallel bar - so if you have something to hold on to in order to reduce the stress, it can help strengthen your muscles around the knee.

Also, what Azdak said.

mibrewer413

I have had this problem for 12 years and it's been very frustrating and now I have chronic pain. I think the trick is to strengthen your quads. I've been to physical therapy several times and have my knees taped, worn braces and nothing has really helped. I just avoid doing any activities that involve bending the knees while bearing weight on them. My left one is the worse one, have permanent "crunching" in there. I think I am going to see this orthopedic doc I heard about that works with the Arizona Cardinals and he operated on a friend of mine with the same problem. My advice is to do anything to avoid making them worse, avoid pain and stretch your quads. Put ice on them after working out.

melissa2807

Some fantastic advice here, thank you very much everyone for taking the time to read and make such detailed comments.

I am still waiting to hear from my Physio referral - I'm expecting that to be a while though, I don't have huge faith in the urgency of the NHS! But in the meantime I am going to continue my combat and pump classes at a lower intensity. I've cut out the jumping completely but am putting more energy and effort into the arms in the hope that it will keep my fitness levels up and burn at least a few calories.

Do you think some of the isolation machines at the gym might help to strengthen the relevant muscles? I'm thinking probably the hip ad/abductors, maybe the leg extensions? I'm going to lower my weights at pump and focus on good form for the squat and lunge sections, plus I will have my ears wide open to what my body is telling me!

Thansk once again,
Mel

mlb929

Do you think some of the isolation machines at the gym might help to strengthen the relevant muscles? I'm thinking probably the hip ad/abductors, maybe the leg extensions? I'm going to lower my weights at pump and focus on good form for the squat and lunge sections, plus I will have my ears wide open to what my body is telling me!

Thansk once again,
Mel

Yes that is exactly what the pt had me doing hips in 3 directions. Inner and outer thigh and back kicks side kicks front kicks with a tension band just below my knees

opus649

... maybe the leg extensions?

Nooooooooooo..... PFPS sufferer here, and PT told me the exact opposite - leg extension machine BAD! It puts a lot of stress on the knee. Leg press is ok... leg extension is not.

Azdak

... maybe the leg extensions?

Nooooooooooo..... PFPS sufferer here, and PT told me the exact opposite - leg extension machine BAD! It puts a lot of stress on the knee. Leg press is ok... leg extension is not.

It depends on how you do it. Too often, there is a blanket condemnation of the "leg extension" machine, but usually that is referring to the full 90 degree movement. For a variety a reasons, yes, that movement is contraindicated for PFS (and other things).

However, doing an exercise known as a "terminal knee extension" can be helpful. TKE essentially means doing the leg extension exercise, but only the last 20-30 degrees of movement. In other words, from full extension, you just lower the foot a few inches, then go back to full extension. It's best to do this one leg at a time.

Many leg extension machines allow you to change the starting position of the lifting arm, so you can set it at the proper position so you can't lower the leg pad very far. Otherwise, you can use two legs to lift the pad into the starting position, then do the exercise with one leg.

The most common starting exercise for people with PFS is straight-leg lifts--sitting on the floor with legs straight in front and lifting each leg as high as possible (usually only a few inches). These are also know as "quad sets". This is a good beginner exercise, but it's one that the user outgrows pretty quickly. TKEs are the next progressive step.

The TKE can be especially helpful for strengthening the vastus medialis oblique (VMO), which is a key stabilizer for the patella. I was fortunate when I had my first experience with PFS to go to a therapist who used a biofeedback device so that I could see exactly when I was activating my VMO. The TKE exercise was a crucial part of my rehab.

opus649

Too often, there is a blanket condemnation of the "leg extension" machine...

Because there are other, safer options available.

dvisser1

Been there, a couple times. Spent 2 months going to a physio for therapy and learned how to correct it.

Leg extension machine = bad can make it worse due to the direct stress on the knee and possibly pulling the patella out of alignment.

Squats & leg press = good. start with body weight or low weight. Concern when starting is more about proper form and strengthening the many little stabilizer muscles around each joint (ankle, knee and hip).
Lunges = good. My PT had me doing back step lunges to avoid the impact of normal walking lunges.
Standing side leg raises to strengthen the hip abductor and adductor muscles.
also had an exercise with a resistance band to target strengthen the vastus medialis part of my quadricep (the lump of quad muscle on the inside of your knee), since all my strength was on the outside of my quad (vastus lateralis and iliotibial band).