T Nation

Patellofemoral Pain Syndrome

I am not quite 35 (34 in a couple of months) but couldn’t see which area would be best to post this.

I am active, I train weights 3 times per week (focussing on the big 3 lifts plus accesory excercises) I also train for MMA 3-4 times per week.

A few months ago I had a long plane journey (30+ hrs) followed by a few weeks travelling distances each day cramped into a mini bus. Following this I started to suffer from patellofemoral pain if I have to sit for a long period, when I climb stairs or when I squat deep.

When I am squatting with weights the pain susbisdes after a couple of warm up sets but BW squats ass to grass always seem to hurt.

I have done some reading on the web and most sources seem to say rest and strengthen the inner quads (not sure how to do both at the same time) coupled with NSAIDs.

I know the obvious answer is go see a doctor but there are not any sports medicine experts here in Mexico that I trust and my insurance won’t cover me to fly back to the UK to see the Sports Medicine people I have used in the past.

I was just wondering if anyone here had any experience or ideas. Ideally I don’t want to be laying of lower body excercise for 4-6 weeks as I have the BJJ NoGi national championships coming up in a couple of months. On the other hand I don’t want to be unable to run around with my kids in 10 years time due to osteoarthritis of the knee.

[quote]Cockney Blue wrote:

I have done some reading on the web and most sources seem to say rest and strengthen the inner quads (not sure how to do both at the same time)[/quote]

Stability.
What they mean is you need to work on the muscles that will contribute to your knee stability.

I have done these and they are brill!:

Pay special attention to:

“Keep your muscles tight around the knee and hold on to something for balance if needed.”[quote]

coupled with NSAIDs.[/quote]

Diclofenac Sodium was what they prescribed me when pain was acute.
Dumb bell single leg lunges are also your friend, as well as the plate drags.

Nice to see you here cockney.

Ditto on the stability

unilateral work - and some glute work should help.
your sort of a tall lanky type, if I remember.

I would really suggest bulgarian split squats , you can load them with one db or pair, or a barbell,
barbell loading is tricky to manage the set up. they are also great variation for the long limbed.

they seem to hit the inner thigh quite hard, and the vastus medialis.

reading things like this

http://www.elitefts.com/documents/knee_pain.htm

talk about how glute activation and recruitment seems to alleviate some knee troubles.

[quote]Alpha F wrote:

[quote]Cockney Blue wrote:

I have done some reading on the web and most sources seem to say rest and strengthen the inner quads (not sure how to do both at the same time)[/quote]

Stability.
What they mean is you need to work on the muscles that will contribute to your knee stability.

I have done these and they are brill!:

Pay special attention to:

“Keep your muscles tight around the knee and hold on to something for balance if needed.”[quote]

coupled with NSAIDs.[/quote]

Diclofenac Sodium was what they prescribed me when pain was acute.
Dumb bell single leg lunges are also your friend, as well as the plate drags.

[/quote]

Wow, that is funny. I tore my adductor muscle about 6 months ago and when I was just starting training I started doing those. Hadn’t seen them anywhere (that I remember) but it just seemed like it would work the right muscles in the right way.

Will have to start doing them again. Have also just started rollerblading again, figured that would tighten up my stability in the knee and ankle.

[quote]kmcnyc wrote:
Nice to see you here cockney.

Ditto on the stability

unilateral work - and some glute work should help.
your sort of a tall lanky type, if I remember.

I would really suggest bulgarian split squats , you can load them with one db or pair, or a barbell,
barbell loading is tricky to manage the set up. they are also great variation for the long limbed.

they seem to hit the inner thigh quite hard, and the vastus medialis.

reading things like this

http://www.elitefts.com/documents/knee_pain.htm

talk about how glute activation and recruitment seems to alleviate some knee troubles.[/quote]

I have just started working on pistols (got a dvd that gives excercises that build up to it.) It is something I always wanted to be able to do and it seems not to hurt my knees the way that lunges do at the moment.

Bulgarian split squat is where I put the back of my rear foot on a bench and do a lunge right?

Well you’ve lifted longer than me, but I have some experience with this so I’ll post.

I have had similar issues that you describe above. Do you have a desk job? I started to notice this in my mid-thirties, and after about 3-4 years of consistently sitting on my ass.

The glute work and lifting have helped, but I think that fish oil has given me the most relief. I really notice the pain in knees and lower back when I don’t take this consistently.

Also, are your hips tight? If so, then your knees could be paying the price for a lack of flexibility in your hips. I’m gradually gaining more flexibility in my hips with lots of static stretching, and a ridiculously long warm-ups on leg days that include dynamic warm-ups and foam rolling. Also, I’ve recently refused to sit longer than an hour at a time. I get up and walk for 5-10 minutes then go back to my desk. All of these things are helping.

Don’t underestimate the impact of inflammation from what you eat. Try to avoid anything with High Fructose Corn Syrup; It’s nasty crap. Check out fish oil if you’re not already on it. Good luck, and I hope your knees get better.

Check this video out… it may help.

Personally, I had patellofemoral pain from basketball in the past and I found stretching/foam rolling my IT band along with TKEs really helped.

Thanks guys, I do have a desk job, I am hrs per day sat at a desk on phone conferences. I think tight hip flexors could be contributing.

I do foam roll but not as dilligently as I should. Also take fish oil.

This is also known as runner’s knee. I had a case of this and discovered it was my poor gait that was cauing the issue in both knees. I got orthonic inserts for my shoes and after a bit of time it self corected.

Guys, I was a physical therapist in one of my past careers (I get bored easily), and I have suffered from this exact same problem. It is caused by irritation on the back of the kneecap due to posterior pressure of the kneecap against the femur. That pressure could be due to a number of different problems like a weak VMO and/or tight ITB.

The terminal knee extensions are a great help but like many of the body’s orthopedic imbalances, weakness is not the only problem. It’s usually a combination of weakness of some muscles exacerbated by tightness of other structures. Here are the things that really worked for me:

TKEs (on a step or just sitting)
ITB stretch and massage (foam roll works great, but is really painful at first I recommend warming up beforehand)
quad stretches (making sure that you also try to incorporate hip extension without rotation in the process to get the quad that crosses the hip joint)

Patellar tendon “stretch” - now this is a weird one and much easier if someone does it for you. Basically the kneecap needs to be pulled up towards your hip. I had to use a theraband so my hand wouldn’t slip when I did this on my patients and your leg needs to be straight and totally relaxed for you to do it on yourself. You won’t see a lot of movement on this one and you shouldn’t. You’re just trying to keep the kneecap from being pulled into the wrong spot, therefore relieving the pressure. I did this in combination with patellar tendon massage

I’m 6’2" with a long inseam so sitting on a plane for longer than on hour would kill my knees until I started doing the above. Once I relived the pressure and the pain stopped, I stopped the patellar tendon stretches and would recommend the same.

Good luck!

[quote]captcb wrote:

TKEs (on a step or just sitting)
ITB stretch and massage (foam roll works great, but is really painful at first I recommend warming up beforehand)
quad stretches (making sure that you also try to incorporate hip extension without rotation in the process to get the quad that crosses the hip joint)

[/quote]

This combination was precisely what I did to get rid of my knee pain.

I’m 34 now and have been high-bar squatting for two years with full ROM. Two weeks ago I was moving furniture/boxes into a new home and overdid it on the knees. Crepitus (rice krispies sound) set it on my left knee, and both knees were cracking alot, accompanied with behind-the-kneecap aching. Especially after sitting for extended periods of time (I work in software development).
I followed the advice above after self-diagnosing with PFPS, took two weeks off (minimum) from squats/deadlifts and had immediate relief on my knees. The TKEs (with resistance bands or cables) are an absolute necessity if you are high bar squatting and don’t like to lock your knees out at the top of the lift. I would like to thank you guys for the sound advice and add some more of my own:

Get the lacrosse ball out and make sure to release your hamstrings, glutes, and TFL. Do not do any direct IT band work as it doesn’t help (you cannot foam roll or stretch a tendon. You must attack the musculature).
Generally, I follow these videos to guide my mobility work:
TFL and ITB release
Hamstring Release
TKE standing with resistance