Unsolvable case of patellofemoral pain syndrome. Help.

Go for a second opinion to a more highly regarded doctor.

I suppose a more specialized PT may help. The most reputable ortho around probably can point you in that direction. So, maybe seeing another doc accomplishes both of these.

Be cautious about accepting the routine knee jerk diagnosis of PFP unless your knee is obviously mistracking (any layperson should be able to self diagnose this condition). Do you do a lot of kneeling by any chance?

Cortisone shots and focused PT often aggravate knee problems. Not a smart choice.

I had PFPS last year. My Physio gave me the excercises and told me I could just keep on running because it wouldn't do damage. At least not in the short term, we are not talking years running through pain, of course. My pain went almost completely away in 2-3 months.

I dont know this for sure, but I think you should give a combination of running and the glute, core etc excercises a try. You strengthen and then afterwards you go run with the muscles still activated to groove in the right movements.

The two excercises that I feel helped me the most was glute bridges with an elastic band. First come up to a bridge then part your legs like a two sided clamshell. And lunges with dumbells.

PFPS sucks. I've had several bouts. I recommend getting a second opinion from another PT. Do some research in your area. Ask other runners who they recommend and don't recommend.

Some little tricks that I've used over the years to keep the knee pain away:

- Biking once a week for 30-40 minutes to keep the quad strength up.

- Seated leg extensions once a week. Usually 3x15-20 115 pounds w/ 30 seconds rest, focusing on 150-180 degrees and working that VMO.

- Run of the mill clams/straight leg abduction/glute bridge work 1-2 times a week.

- Couch stretch

- Foam roll

In regards to footwear, I've noticed that, for me, less is more. I go for neutral, light shoes with minimal to no heel drop. I used to stick superfeet inserts in nike lunarglides, thinking that all of the extra support would help my knee. Alas, it did not.

One other thing you can try is rolling out your VMO with a barbell, like so:

https://i.ytimg.com/vi/ehRirDgm1-Q/hqdefault.jpg

When I first did this I yelped in pain. My VMO felt like it was tacked down and the barbell was peeling it back. But it worked after 2-3 sessions of rolling like that.

The worst thing you can do when you get an overuse injury like this is quit running. You should be able to do at least a couple easy miles regardless how slow. This will aid blood flow and help your body heal on its own. (disregard if stress fracture)

The 2nd worst thing you can do is any strengthening exercises. You have NOTHING wrong with those muscles, you simply overused them. That overuse injury took time to develop. It will take time to go away.

One thing you can do is massage therapy. For a knee issue, it is usually the thigh muscles. Press down on them and see if there are any sore spots or knots in a muscle. If there is, press down until you feel the knot going away. This will help loosen muscles that may be pulling too hard on the knee. Rolling the muscles out like the runner above did will also help.

Cardioaddict wrote:

Be cautious about accepting the routine knee jerk diagnosis of PFP unless your knee is obviously mistracking (any layperson should be able to self diagnose this condition). Do you do a lot of kneeling by any chance?

Can't say I do too much kneeling. I'm a grad student and work in a lab so my day to day activity is an even mix of standing/walking around the lab and sitting at my desk. Nothing too physical but not completely sedentary either.

Based on what my PT reported and my own crude video "analysis" it does look like my knee turns valgus at midstance. Despite working on gluteus medius strength for a long time now. Seems like the result of a coordination issue more than a strength issue, and I have no idea how to improve that.

Marty R, 2-3 months sounds nice, I am jealous! How much did you run during that time and how much did your knee hurt while running? I was similarly told to continue running "as much as you can without pain," but found it very difficult to determine that amount since the knee aches pretty constantly and pain is never acute - it only flares up a day or so after running on it.

I ended up easy jogging 1-2 miles a few times a week while doing PT but gave up the jogging after a month or two since it wasn't working. I thought maybe I just needed to rest it more thoroughly and start up when it was totally pain free. But of course that didn't work either!

I'm hoping there's something to the whole glute activation thing though. I feel like I've got more than enough glute strength from the PT, but still quad/hamstring dominant and my coordination just feels off. Need to find a good routine to stick to.

After about 20 years of running the first real injury I ever got was related to my patella tracking. I did everything for a couple years and it didn't go away. After doing very little for 3 years, I came back, ok, but only ran on an off for about 4 years. Eventually, I got serious again and have fought it for 9 years now. It hasn't stayed the same. It has moved to my IT band and now it seems to be starting in my other knee.

While I am never trying only one thing, I think the best thing for all my problems is to make sure that I do a reasonable fraction of my running on grass so the motion is not perfectly repetitive. While glute activation may not be the perfect PF solution, it seems like it is really important to keep the problem from causing new issues related to favoring the bad leg.

The 2-3 months was a miscalculation, it was more like 6-8 weeks. But let me say that the PT told me that I had a mild case of PFPS. I could feel my kneecap maltracking with every bend of my leg, it was a very annoying, burning, inflammation ache, that was constantly there, just like with you. On a 1-10 scale the pain was never above a 6 I think. But it was very clear that something wasn't right and of course fear of doing real damage.

Before going to the PT my knee was already bothering for more than a year. So to be 99% free of pain after two months was something I couldn't have predicted. At the same time I wanted to hit myself in the head for walking and running around with pain that turned out to be so easily resolvable.

Running didn't make the pain much worse. Like you said, the pain is already there. I was running 5 days a week, maybe 35 miles. So no high mileage at all.

Biking was another story. 5 minutes on the bike was enough to make my knee really sore.

My PT told me that I could just go run, even if there was pain. But I can't feel your painlevel, so I don't know if that's good advice for you.

From the moment the PT gave me excercises the pain just became less and less.

I agree that it's probably [for the most part] a coordination issue. You don't need powerlifter strength but you have to be able to use what strength you have in a biomechanical right way of running. Bad coordination can be caused by lack of mobility/ flexibility.

A combination of different excercises is probably the most effective. A good dynamic warming up with some movements for flexibilty in the hips, legs, ankles. A little strength: bridges, clamshells, leg raises in all directions with an elastic band, lunges with a broomstick, barbell, dumbells. And some simple drills like heels to butt can make you feel what it's like to put your feet on the ground in the right way.

Good luck man, I know how depressed it can make you if you have an injury that just doesnt go away.

There may be something in this article that you find helpful:

http://www.runningwritings.com/2012/03/injury-series-uncovering-role-of-hip.html

I had PFPS several times. Pain was such that I couldn't run. Eventually had surgery to remove my plica in 2012 which solved the issue for me. Might be worth you researching this. I'm no expert, but it's maybe useful to remember that PFPS is a syndrome and not actually a diagnosis. Good luck and hope you get back running soon.

Interesting! I have read about plica syndrome and wondered if it might be the source of my pain. It would fit all my symptoms. My orthopedic doctor said it was unlikely though since the knee did not respond to the cortisone injection, if it did that would have been good evidence of plica or other soft tissue problems. Did your doctor do anything similar? Do you remember how they determined the plica was the problem?

Very true that patellofemoral pain is a very vague diagnosis. I sometimes wonder if the exact mechanism causing mine is not quite what the standard treatments are designed to target.

Hi, I didn't get a cortisone shot so sorry I can't really comment on those. I had PFPS on and for years, like you usually associated with ramping up the miles. The final flare up had been dragging on for over a year and my physio (PT) thought it might be a torn meniscus so on that basis I got an MRI which didn't show anything. Bit the bullet and paid to see a private orthopaedic surgeon (I'm in the UK) who on initial diagnosis advised I had an inflamed plica. He was able to tell this from 'pinching' the knee. I opted to have surgery (it wasn't an easy decision) and right enough the images from the surgery showed my plica crumpled up like a sweetie paper. The plica got totally removed during surgery. He also trimmed some aggravated tissue from my fat pad, about 10 percent. Obviously every case is different, but I suppose my advice would be to seek second opinions if you can as diagnosis of these sorts of injuries is imprecise. Surgery to be avoided if possible, but it did work out for me. Mid twenties is far too young to be sidelined from the sport you love!

Hey, my name's Jesse. I was also diagnosed with pfps. I served 5 years in the active duty Marine corps and developed a moderate pain in my right knee/ quad area that would get much worse at night. It's been 3 and a half years of having to rely on pain killers to sleep. I recently got out of the Marine corps and that is where I found the true cause of my pain. I had an X-ray done of my upper quad area which revealed a bone mass on my femur. I had developed an osteoid osteoma. A benign bone forming tumor. It will not kill you and is certainly not cancerous but it causes alot of pain. If you haven't found resolution I suggest getting x-rays of your legs done in detail. Also do some research in regards to benign tumors, it may help you or someone else on this forum.

Curious if you’ve solved your PFPS issues since you first posted? If so, what worked for you? Have been struggling myself with similar knee issues and not able to run...

I did PRP therapy for my jumper's knee and I could barely believe the results. I hadn't felt pain free in months, but after getting the shots, I felt like I had a new knee. I had pain relief and return of mobility that I had been missing for so long. While it may not work for everyone, it did wonders for me. I am so happy that I tried this and thankful for my doctor at prpinjectionmd.com for suggesting it. Now, I tell my friends that suffer that it is life altering.