Tom_hampton wrote:
Hmmm....I seem to be posting in the overuse threads way too often. I think that means I've had too many issues myself...
Are you experiencing PF tendonitis, or a PF tracking issue? You mentioned the tendon...so that's why I ask. The causes and remedies of the two would be different.
I have more personal experience with ITBS on the bike, than PFP. But, I've spent time at the ortho and PT for PFP on the bike once or twice. PFP can be the result of a several different or combined issues: 1. muscle strength imbalance, 2. muscle firing sequences, 3. inflexibility, 4. bike fit. If you've had multiple occurrences (it sounds like you have), then I think its important to sort out which of these issues is involved before going too far down any one road. Seeing a doc/PT who specializes in cycling (or is a cyclist) would probably be helpful to sort out your cause(s).
I had one bout of PFP on the bike caused by a seat that was too low/forward (knee angle too acute over the top), and another which was caused by a firing sequence problem...which was actually as a consequence of compensating for a different injury.
I resolve the bike fit issues at the Boulder Center for Sports Medicine. Back then I actually had a sequence of knee issues on the bike: I was alternating between ITB issues and PFPS issues on both legs. Ultimately, this is what drove me to BCSM to get a comprehensive workup and quality fit.
The firing sequence issues were resolved with stability exercises and electro-stim targeted at my specific errors.
Possible bike fit issues all relate to the knee as it transitions over the top of the pedal stroke. How acute is the knee angle (seat height, fore/aft, crank length all relate to this angle)? Is there any lateral movement of the knee through the pedal stroke (indicative of possible ankle instability, or other strength instability)? Is the Q-factor correct (pedal width...too wide/narrow can put tension on the patella one direction or the other)?
Low cadence pedaling will put additional tension on the patellar tendon, and will likely exacerbate any biomechanical flaws. But, high cadence/low tension pedaling will not alleviate PFPS that is caused by an underlying TRACKING issue.
Hi Tom,
I've experienced PFPS in the right knee in the past (per an Ortho). PFPS and Patellar Tendinitis in the left knee (verified by MRI and Ortho). I am very familiar with both of these conditions. Of the two, PFPS is substantially harder to tackle in my personal experiences. I'd take PT over PFPS any day of the week. Both suck for sure.
There's tons of talk about these issues with symptoms, theories/causation, stretch this-roll that, do these exercises, etc. Consequently, I find there's not nearly as much talk in terms of bike fit + component design (e.g., Q factor, crank length, cleat placement, pedals and float design), shoes to wear (minimalist versus XYZ), gait changes, etc. This is were it gets frustrating for me and I think there's a lot of blanks to be filled in here when it comes to the equipment that might help with abating these issues.
Thoughts?
G