Help me with my patella/PFS knee problem

Lots of people mistake PFS with plica syndrome.

Like 80% of people develop an extra bit of tissue when your knee ligaments grow called a plica, and if large enough and irritated enough (from many miles) it can become inflammed.

I experienced this and ended up having both removed from surgery. With proper PT, I recovered 100%.

Wall-sits. Lots of them through out the day!

Had the same thing.

1) I strengthened both quads and hamstrings.

2) Deep tissue massage. It hurt like hell but loosened up quads.

3) Got a shot of cortisone.

4) No running for 10 days

5) Gradual build up.

6) Stayed with strengthening exercises and massage..

Had something similar

Working on the assumption that 90% of knee problems originate outside the knee I do a variety of exercises

Back stretches

Myrtle routine

Reverse lunges

Bridges

Misc. Stretches

I have to avoid hill sprints and squatting

Sounds like you know the problem! Work on that dorsiflexion and plantarflexed first rays. Maybe some more specific strengthening is needed could you try gaithappens or the gait guys?

Maybe you have weak invertor or evertor muscles - try a resistance band tied around a chair leg or bed post and do side to side reps with the band around your foot. For dorsiflexion something like this

I had a bout w/ knee issues a while back. What helped: 1) a period of down time (a few weeks really light post marathon); 2) using a knee strap; 3) concerted effort to strengthen the hip girdle (someone mentioned Myrtle routine, which is good; I love the hip/glute routine in Jay Cardiello's "Run and 10"); also 'Monster Walks' w/ a band to fire up glutes; and 4) working on lengthening the hip flexors, especially, If you sleep in the fetal position, and you sit a lot (as most of do).

Good luck.

Could it be chondromalacia, caused by over-pronation due to either Morton's Toe or a foot imbalance?

Thanks very much for the input everyone! The variety of responses speaks to what a mysterious and inconsistent issue PFS is.

For plica and chondromalacia, I tend to think these aren't my issue since they haven't shown up in either my MRIs (two of them, viewed by multiple orthopedists) or my diagnostic ultrasound.

Right now I'm leaning towards getting the cortisone shot, not so I can run for a little while but so I can work hard on PT and strengthening. I'm too limited in what I can do without pain right now, and am having trouble making progress. In the meantime adding routines like myrtl, run and 10, etc sounds great. I'm also trying sorekneesolution.com, not because I'm convinced it will fix me but because I seem to be bad at the stuff they say to get good at. Can't hurt.

Or maybe it's Patellofemoral Pain Syndrome (PFPS) aka Runner's Knee where the patella gets subtley out of it's groove creating inflamation. It's caused by a muscle imbalance which results in the patella getting pulled to one side. I suffered from that and PT had me do wall sits amongst other things and did stim to strenghten my Vastus Medialis (huge on cyclists). BUT THE KEY was that they first taped my knee using a McConnell taping technique. It was the first time I had excercised pain free in years. I learned how to do it myself and was running pain free. That and the PT got me going again. I'd first take some time off and ice to get the inflamation down. Check these out and see if the symptoms match. Maybe just try the taping and see if the pain is reduced too.

https://www.physio-pedia.com/Patellar_Taping

https://www.running-physio.com/pfps1

For a high-force repetitive motion activity like running, everything works better in balance. Your feet/ankles are some pretty big red flags. Even if you can't correct them 100%, you can make sure other areas are able to handle any increased workload.

Very often a tight rectus femoris is involved with PFS. Most people's RFs are tight. Even if you don't think yours is, I would highly recommend stretching them. For rehab, I prefer a low-load, high-duration stretching protocol. So, a mild to medium stretch held for 5-8 minutes once a day works well. A prone lying RF stretch with some type of strap works well.

If you followed this routine, I would expect you to see improvements in running in 3-4 weeks.

(You should probably also do calf stretches (bent knee and straight knee) for each ankle also. )

Tensor Fascia Lata and IT band may need attention also. Hard to tell from here.

Research and learn all about what the Vastus Medialis Obliquus does - and how to strengthen the Vastus Medialis Obliquus. (wall-sits are in your future)

knee pain comes from the knee being "pulled" from its natural position by tendons transferring energy from irregular muscle contractions. the major muscle group above it (thigh) engages in irregular contractions as a result of muscle knots or stride imbalances that the muscle has to constantly compensate or cushion down. however, irregular contractions in the thighs may come from other major muscle groups that are inflexible or are able to transfer their imbalance to the thighs. one thing about your post, everybody has muscle imbalances, but our bodies have adapted through years of use and given us a "custom" pattern of movement that works for us majority of the time.

if from an orthopedic standpoint nothing has been found, focus less on movement-based solutions and go back one step, concentrating on taking care of the muscles that allow you to move in the first place. if you have a million knots in your back and they're never loosened up that tightness may find its way down to your legs if your body is incredibly able to compensate. another example, if you neglect the tightness in the plants of your feet, it can have negative effects going up to your neck. sounds strange, but it is all connected.

Years ago I had lateral knee pain just below the kneecap that would appear after a run. At first a PT said it was a tracking issue and to strengthen my Vastus Medialis. This just made the pain worse. Then two doctors and a number of other medical professionals said it was arthritis. I ran with pain for 2 years and then quit running for a year. Then my brother found the solution which was to massage the Vastus Medialis. Knots in this muscle were causing pain at it’s insertion point. 15 years later I’m still running pain-free.

Strengthening or stretching a muscle with knots can just make things worse. A great reference book for massaging is The Trigger Point Therapy Workbook by Clair Davies. Just my 2 cents. Good luck!

Quad Smash with a barbell and also calf smash with a barbell. You'll be amazed at how many knots can live in those two muscles.

It's really painful at the beginning, but you eventually get used to it. It will ruin regular massages for you as no one can get deep as a 50 lb point load from the barbell.

curl bar with 25lbs either side works well.

Make sure to support the underside of the knee when doing it. Twice a day for 10 mins will work wonders.

Chondromalacia is not the sort of thing to "show up" on an MRI or an ultrasound.

I'm in my seventies. In 1970 I developed pain around my patella (where I felt the pain varied from one day to another). I did a host of exercises, saw three doctors, had a cortisone shot--nothing worked. I mentioned my problem to George Sheehan (I was running road races in the NY area) and he recommended I see Richard Schuster, a podiatrist. I remember how thrilled he was: "classic chondromalacia"! He took pictures of my feet and knees and apparently they wound up in a podiatry journal. In any case, he made cork and leather orthotics for me, and I've been wearing "soft" orthotics for the last half-century; and I've not had a recurrence of the problem, and I've been able to continue to run.

I wish you well. I know how frustrating it can be to be hurt, and more frustrating still not to be able to have a diagnosis you are confident in. Hang in there and good luck.