Elevation

I was diagnosed with both of these today at the doctors office for both of my knees. No bike riding for 6 weeks plus 6 weeks of P.T. Then see what happens.

Asked about braces and the doctor wasn't to familiar with braces that worked with cycling so I figured I'd ask here.

Anyone have any experience with either of these syndromes that have used braces that have been helpful?

I was looking at this one:

https://www.braceshop.com/productcart...nee-35p267.htm

Thanks

topflightpro

I was diagnosed with either a partial tear of the patella tendon or severe tendonitis last fall. (It's an "either" because we opted not to get an MRI done because the treatment is the same, so it was difficult to justify the cost of the MRI)

Anyway, I went about six weeks of no riding to get the swelling down to a manageable point and then began PT. I only used a Patella strap, like this https://www.braceshop.com/productcart...rap-38p350.htm, so nothing as intense as the brace you linked to. Things seemed to be going well, and I was feeling pretty good. Until February.

I did my first race the first Saturday in February. I made it halfway through then pulled out because it hurt too much. On Sunday morning, my knee had blown up again. I am now back in PT and taking it very easy. I am now just starting to try to ride again.

The Pattela Band that I used worked OK for cycling. I found I needed to have knee warmers or something on to help keep it in place.

I hope that helps. Good luck healing, and do take it easy. The relapse has been horrible.

Elevation

Yeah thanks, might give a strap a try.

Also wouldn't mind hurry any success stories with either syndrome and what made it better!

Need some hope

Carbonfiberboy 

The usual problem is a leg muscle imbalance, very common in cyclists. Simplest thing to try is High Kicks. With the leg held straight, kick as high as possible. 15 reps each leg, once or twice a day. Should make a difference in less than a month. Also, raise the saddle. Also if there is no pain in doing this, pedal 30 minutes/day in zone 1 on rollers with that raised saddle. Gradually increase as pain subsides. Also, anything else to restore leg muscle balance: walking, hiking, stepmill at gym, various leg weight exercises like lunges, squats, leg sled, anything that can be done without pain that isn't cycling.

You could also try glucosamine sulfate. Might help, might not.

lazerzxr

Also look at your bike fit in general including cleat wedges and arch support - well worth a go. And if any cleat adjustment remains set them as narrow as possible so your feet are close to the bike

Elevation

Do you think a retul fitting would be beneficial?

StanSeven

A good experienced fitter, maybe a retul specialist, should diagnose the problem and perhaps refer you to a medical specialist. If you have a structural problem starting with your feet, inserts or orthodics might help. If it's muscular, PT and/or stretching/strengthening exercises might help. Don't try a brace all by yourself because you can cause other problems or make things worse.

SanDiegoSteve

Go to a few Physical Therapy (PT) sessions. Maybe even look for a PT who does a lot with runners or cyclists. This is fairly common, but there are so many variables no one can diagnose or properly advise on the internet.

I've had 2 knee surgeries, post surgery and during rehab, the knee cap will not track right because I lost muscles and tendons got tight. My PT taught me the right exercises to do. Also taught me about the swelling. Some of the treatments do help a lot, but much of it comes to rest, stretching, properly strengthening the right muscles and managing swelling.

Now, I periodically get some swelling, if I don't notice, things get out of whack fast and I'm badly swollen. I'm in this spot now. So, I'm able to go through the process and work on healing. As soon as I got the swelling under control, I can then start the right exercises. Continued stretching and some rest and I see quick progress. Rest may be the hardest part... I really want to be on my bike.

531Aussie

I worked minor miracles with straight leg raises after I was diagnosed with chondromalacia. They tone the middle quads, which helps pull the cap up and out of the way of the end of the femur during knee extension (EDIT), as it should. For the little weight necessary, I put on an old rollerblade with a 2.5lb taped on it.

It's also handy to inhibit the lateral connections: the outer quad (lateralis), IT band, glutes and tensor fasciae latae

Nachoman

I was diagnosed with some sort of chondromalacia years ago. My knees bothered me almost every time I got on the bike.
Then I got a professional fit, switched to speedplay pedals, and I never had knee pain again.

dpicare26

I can perhaps offer some advice for a brace:

The hinged brace IMO would be overkill. They are typically for medial/lateral instability, ie. MCL/LCL lesions. Also, IMO, the strap probably wouldn't offer any patellar support as it's used for the patellar tendon (soft tissue beneath knee cap). I would instead recommend something like this:

https://www.braceshop.com/productcart...FQdU4AodFgQAVw

or similar neoprene sleeve that will help compress the patella in the femoral groove during knee extension.

+1 on proper seat height/ prof. fitting.

of course, these are general guidelines. Each person is different and injuries are manifested as such.

dpicare26

While it's true that the medial most quad (VMO) helps with medial tracking of the patella, straight leg raises do not work this muscle. Hip flexion (straight leg raise) is done primarily by hip flexors (rectus femoris and illiopsoas). VMO, or vastus medialis obliques is strictly a knee extender as it originates distal to hip joint and inserts on the tibia via patellar tendon.



note its medial attachment to patella.
How does one "inhibit the lateral connections: the outer quad (lateralis), IT band, glutes and tensor fasciae latae"?

Elevation

Thanks everyone for all the great advice so far!

First, I start my P.T. session next week!! For 6 weeks.

Also, I was professional fitted twice because of my knee problems, each time making them feel a little better. I also switched to speedplay pedals around when my knees started to really hurt again, they definitely felt better. They felt a lot more natural than the keo classics. I was still really inflamed when I changed to speedplays so the pain was still horrendous, but the feeling of the pedals was a lot better.


Thanks again everyone!

keep'em coming
So yeah start P.T next week for the next 6 weeks. Then when I'm aloud to start riding again going to ask a fitter, doctor, Physical therapist about orthodics and fit and hopefully I'll be pain free!

Colonelmom

Get some KT tape, I have STAGE IV chondromalacia in my right knee, left knee has Stage III, I use KT tape to help with the tracking. IF you put it on correctly then it will stay on for a couple of days, through cycling and shower. I have had multiple injections of Synvix (sic) and I go to a PT. ICE is your best friend for in the inflammation; warming oil / embrocation to help keep the knee warm on cold days... I also take NSAIDs; cycling within the pain, and l have learned to spin a high cadence, over 100rpm's and also spin up hills.. GOOD luck.. you just have managed...

knowledgdropper

^ This, with an addendum:

The VMO is small, in comparison to the other three heads of the quadriceps- it must essentially "fight" against their influence all by itself. The much stronger lateral components of the quad pull the patella out of alignment when the VMO is weak, injured or simply unused.

While the VMO is indeed a knee extensor, it only plays an active role during the last 25-35 deg. of extension. Unfortunately for many cyclists, it's a muscle that rarely gets used during a normal, seated pedal stroke. Remember, the vast majority of us have saddle heights that leave us with a 25-35 deg. bend in the knee. To effectively strengthen it, short arc quad sets and shallow squats are very effective.

As for performing SLRs (striaght leg raises) to strengthen it, another function of the VMO is to "lock" the knee into extension. SLRs will work the VMO in this capacity very well, albeit isometrically, i.e. the muscle is strengthened only at that particular position, rather than through its entire range.

531Aussie

Firstly: oops! I wrote 'flexion' up there instead of extension.

Hmm, it sounds like you might 'know stuff', so I better be careful. Are you a health pro? I'm just an old grinder who's had some success with the odd injury over the years.

As I said, the leg raises work the middle quads (a long with other stuff), but what I should've added is that it's meant to help with a 'lazy' tracking of the patella, not necessarily maltracking. (As we know, the VMO is tricky to isolate and strengthen)

My PT explained it to me like this: sometimes the firing order of the quads can get out of whack, due to overuse, or coz cycling doesn't work the middle quads enough (although, he said it can also happen with other activities). He said that one job of the middle qauds during knee extenion is to pull the cap up and out of the way of the end of the femur. When the firing order is out of sync, the "slackly-toned" middle quad doesn't pull the cap up quickly enough, causing it to rub on the end of the femur, which then can eventually cause grinding, roughness, inflammation and pain.

A long time ago, I was misdiagnosed by 2 PTs as having patella tendonitis, and rest, icing and (eventual) stretching for a month did nothing, The 3rd PT did the "chondro" test, which is rubbing the cap from side to side while my leg was flat on the bench, and he felt roughness on the meant-to-be-smooth surface(s?) underneath. He prescribed the straight leg raises (with light weights), and I was back riding pain-free in less than a week. I realise I may have been lucky, compared to others, but it's still cool story, hey?

My PT said that this stuff has, for some reason, gone on the back-burner of diagnosis, and most PTs look straight for tendonitis or medial maltracking (PTF syndrome).

As far as the thread-starter is concerned, I obviously don't know if they have roughness under the cap or maltracking, but my experience has taught me that the straight leg raises are more than handy.

Even though my first/main chondro episode was nearly 20 years ago, I still occasionally get minor flare-ups, so I do the straight leg raises every now and then.

Hmm, I was just looking for a fancier word for 'stretch' or 'loosen'. Maybe I should've just stuck with that.

I recently had an issue where I was continually straining my left VMO, so i went down the usual route of PF syndrome treatment. Anyway, part of it was stretching the glutes, IT band, and lateralis, and thumb-massaging the tensor fasciae latae. However, I suspect I had better results using a roller and a tennis ball on these tissues. Man, I found some tender spots on my lateralis and IT band. Ouch!

I found an article in which a guy said that the tensor fasciae latae is often overlooked, even though its tightness can be a major cause of lateral tension problems. The best part is is that you can do it just lying on the couch in front of the TV

Carbonfiberboy 

Raising the saddle always helped mine the most. A bike fit might not help at all, since one wants to raise the saddle more than a fitter would want. I raise it enough to put some air between my pedal and bike shoe heel, leg locked out. This is therapy. The high kicks do help, too. If one doesn't think they activate anything other than the hip flexors, one simply has never done them or done enough of them. A good thing about them is precisely that they are isometric for the quads - no patellar motion.

valygrl

Do you have anything to show how the tape should be applied? I don't mean to make it stick, I mean, to correct the kneecap tracking.

Colonelmom

Go to kt tapes web site they have video's for every application. Knees you probably won't need an extra set of hands. Shoulder back. You'll need someone to help

valygrl

Thanks

knowledgdropper

Occupational therapist and former certified athletic trainer.

You've done well to remember all the pertinent information for your injuries/maladies. It's always nice when clients can remember little nuggets of info that they can use for continued wellness.


+1. Keep the quads tight throughout the range of motion. Don't allow the lower leg to "lag" as fatigue sets in.

+1. I use online info all the time, as a refresher, for taping techniques that I haven't done in a while.

dpicare26

Don't know a lot about kinesiotape. Physiologically it doesn't make a lot of sense, also it isin't really applied in a supportive function, but some people swear by it. Also consider 'Leukotape' which can be used for what's known as McConnell's taping for PFS/Chondro.

Elevation

Does it stay on for consecutive days of riding without having to push against your to keep it on? Or do you replace it after every ride?

valygrl

I used kinesio tape for a shoulder separation last year.

Seems like a placebo. Placebos can be very effective, however.

It stays on for a few days through showering, as long as you get the edges nice and round and well-adhered to start with.