I’m 55 now and I was diagnosed with Weak VMO - Patella Femoral syndrome 5.5 years ago. I worked with many physical therapists and got advice very much like what you listed. Didn’t help much.
My pain is located mostly in the lateral patella area and trying to exercise my way to recovery only made the pain worse… loading the quad to strengthen it puts a lot of stress on the patella and Femur cartilage. I probably damaged my cartilage trying to get stronger.
The good news is I have tried just about everything and found what works for me. I am nearly recovered! I had a fantastic ski season last winter and am having a great MTN bike season this year… activities that have been problematic for the past 5 years.
You got to strengthen and stretch. The right stretches are critical. The quad stretch and the IT band stretch are common, but not sufficient.
Here is my stretch routine I perform several times a day;
- lay on your back and pull knee into your chest. Hold for 15 seconds.
- pull your foot into your butt with knee straight up. Hold for 30 seconds.
- ***** This was the winner for me***** Lateral quad stretch. On your back, pull your foot into your butt and then to the outside. Lie your knee down such that the knee is close to the other knee and the foot is still outside your butt. Now, take your other leg and put it on top of your bent knee… and force that bent knee down. Your tight lateral quad will make it difficult for the bent knee to touch the ground. Hold for 45 seconds.
- Lateral hamstring stretch - laying on your back, lift your partially bent leg upwards and grab outer foot with opposite side hand. Pull your foot across your body and feel the stretch in the outer hamstring area.
- Piriformis Stretch - open window - 45 second hold (arm though hole formed by bent knee)
- Piriformis Stretch - closed window - 15 second hold (arms wrapped around the legs)
Squats- leg press - leg extensions are certainly helpful, but they can be too much. You should consider the curtsy version of these exercises at first to load the quad without overly stressing the patella.
I have had great success with a workout DVD called Cathe’s gym style legs. It’s a 20 minute lunge oriented workout with modest weight. I started with body weight only and now do the workout with a 15# weighted vest and a pair 20# dumbbells.
I also do the 3 way clam shells with a pair of 5# ankle weights on one leg (10# total). I do 30 reps for each position and I do the 3x30 set 3 times (270 total reps).
This last part is a little weird, but I believe it to be true. At some point, my knee cartilage was severely injured. At the time I was taking a good amount of Vitamin D. My research has convinced me that high blood levels of vitamin D soften injured cartilage. I could not successfully train my quad (vmo) until I stopped all Vitamin D supplements and avoid sunshine produced Vitamin D.