I am NOT a 'doc' of any kind. When we were on TeamTBB last year, James Cunnama had a mysterious knee pain. One of the first docs he went to said it was a plica...this was July. He would rest, try to train, feel the pain again, repeat until like late-November when he got an MRI that showed it was probably a plica. He got it scoped right after, they removed the Plica, and was getting back to training pain free a few weeks later. Just a data point. He said it felt like a catch or a click in his knee.

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Brandon Marsh - Website | @BrandonMarshTX | RokaSports | 1stEndurance | ATC Bikeshop |

Interesting. I don't feel what I would call a catch or a click. Just an ache to SHARP pain on the inside to upper region of my knee. It's always in the same place. Lately I have been taping and really improved my glute strength which seems to have helped. But yesterday was a real wakeup call. 5 minutes into running and it hurt like hell. Tried the bike, and applying weight to the pedals out of the saddle causes it to hurt a lot as well.

James was not able to ride either. I assume you've had the bike fit, etc. analyzed, cleat position, etc.?

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Brandon Marsh - Website | @BrandonMarshTX | RokaSports | 1stEndurance | ATC Bikeshop |

I was FIST fitted for the bike, but that was a season ago, so I'm definitely due.
I had mostly dismissed bike fit considerations since the symptoms had surfaced during a pure run build, but this is making me reconsider it.

I suffered this in both knees. I've had both knees scoped to have the plica removed and got to see the pictures of the pinched tissue. I have had no problems since. But know this; it's knee surgery, you won't be running the next day.

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"I can eat 21 plus a deep-fried turkey!"

I have been dealing with medial knee pain for almost 2 years. My PT suggested that it could be a plica but felt that surgery was an inappropriate way to go with plica syndrome.

In the end that PT didn't fix my pain, nor did the next one; but eventually I found certain strengthening and flexibility regimen that did. My solutions tended to be more with various hip flexor strengthening.

In my experience, a plica is over-diagnosed and sometimes used as a finding to justify an otherwise negative scope. The "plica" is often a normal fold in the synovium and not a source of pain.

But true plica syndrome is real and certainly a source of pain. It can be sometimes diagnosed clinically with a palpable band gliding over the medial femoral condyle. Sometimes a cortisone injection can be used for both diagnosis and treatment. If it is thick enough it may be seen on MRI. It is usually obvious arthroscopically, and simple to excise.

I would suggest revisiting the orthopedic surgeon with this specific question. And, also in my experience, runner's knee (patella-femoral pain), is usually tender or symptomatic along the lateral patellar facet. Good luck!

I suffer from it every season. My response? I ignore it. If it gets REALLY bad (really really) I may back off on cycling intensity a bit (running does nothing). stretching the lateral tendons of the knee seems to help, with the knee cap tracking being the culprit. that seemed to help. again this isn't technically plica though, as mentioned previously.

Thing that helped me, for w/e reason, was lengthening muscle groups that were tight and causing other problems (glutes, hip flexors). putting my seat back a bit may have helped? seat height? I dunno, it all seems sorta negligible. Time and caution tend to prevail- it gets bad when I get over-trained.

It is a bitch though. I'll be interested to hear what some say.


Edit- I also wanted to say that, especially for me, doing "nothing" does NOTHING. Granted if you tear something or break something then yes...but I don't get better from just sitting around. Active recovery is the key. Find things you can do. Yoga. Swimming. Field hockey. Whatever. But I made the mistake once with "ITBS" (not really IT band at all, thats a whole other thread) in not doing anything for 6 months and it made absolutely no difference. 0. All I did was make myself depressed. Find the cause, and fix it. Get to the root of it. Find a really good PT that will help you. Search for one. With help you should be able to continue ticking things off a list of possible causes or issues- plica or no plica.

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I don't suffer from insanity; I enjoy every minute of it--

I had a similar experience many years ago. Chronic knee pain, I tried everything without relief. Finally had an MRI that was read as a meniscus tear. Had a scope and the dx was a synovial plica. I've been pain free since the scope. It relitively rare, but you will only find it if you look.

I just returned from the Ortho. He was pretty skeptical of Plica syndrome("...an easy out"). He ordered up some bloodwork to rule out Rheumatoid arthritis and an MRI to see what exactly his happening in my knee. The potential for RA is disconcerting. I'm sure there are a handful of athletes here dealign with that.

I am diabetic which from what I understand, sortive predisposes me to autoimmune conditions like RA. We'll see what this MRI says...

Smart to get an MRI if it's available. I have a Plica in my left knee , it showed on an MRI as "symptomatic" but I was able to manage it with ice and rest. It hasn't bothered me since. Makes me think that wasn't really the problem to begin with but if it's still there, it doesn't bother me.

That is good that they are not too quick to assume Plica. I had a doc look at my knee for two seconds and say "Plica" we need to operate next week to clean it out, after a second opinion and an MRI it was just a simple bursitis of the patella tendon, cleared up in three weeks. In my opinion always have multiple people look at an issue.

Get an MRI.
Not quite sure that without this anything can truly be diagnosed with assurance that it's what it really is.
I had similar pain this past May.
Tried backing off for a while and it never got much better.
Went for an MRI and found that it was a torn meniscus (I had done nothing traumatic to it mind you .....it just started hurting).
Surgery in July, rehab August, back slowly into it during September, and did a sprint in October.
Each one of us is different so really tough to say.
I am no doctor so take my advice FWIW.
-YT

Just heard back from the doctor. They already have my MRI and some bloodwork back. Kind of blows my mind how fast that was...

It came back as "Quad Tendonosis". He seemed skeptical, thinking it was more likely regular inflammation. Anyone dealt with that before?

How old are you? How much do you weigh?
What sort of taping have you been doing, taping the kneecap?
Can you move your knee through full range of movement repeatedly pain-free?
Can you do body weight squats pain-free?

Age: 30
Weight: 176
I've been taping on the outside, wrapping around the outside, encouraging the kneecap in.
Keeping my knees bent sitting or in a car can be quite a challenge, so I try to keep them outstretched. Since spending a lot of time on physio, I can now walk around and go up and down stairs with a lot less pain. I notice it most when I twist or move laterally.

I definitely can't do body weight squats pain-free.

You're young and not overweight (unless your only 5 feet tall), so you'll recover.
Sounds like runner's knee, the knee cap not tracking smoothly. Ask your physio to do McConnell taping on the kneecap, then wear that most of the time (it is just one piece of tape across the kneecap, helps with tracking).
Do lots of reps of unloaded knee full range of motion, 400-500 per day (sit on a table and swing your legs).
Don't run until you can do a single leg squat pain-free.
Ride your bike easy but be sure your seat isn't too low and that your knee/spindle alignment is correct.
Keep going to PT.

I was in your exact same situation. Symptoms do sound a lot like yours. I wanted to believe strengthening helped at the time, but in reality it did not. You say strengthening has helped but is it that or is it not running?

My path started in Dec 2009, diagnosed with nearly every medial knee injury from stress fracture in the knee cap to quad tendonitis. Even got some cortisone shots and was almost convinced to do synvisc injections. Struggled to find the correct diagnosis and was convinced i would never be pain free again. Finally went to my original doctor and had the plica diagnosis. Had surgery August 2010 and am pain free now. If you haven't run since Sept. 15, I don't see how it can be the quad. Also, your knee should be lubricated enough as you are still young. It is not normal to not see any progress for 3 months of no running. My plica definitely hurt while cycling. If the pain persists, try a bent knee MRI or even a different doctor. I would not recommend getting it scoped unless the doctor is sure it is plica. It is surgery on your knee so be prepared to be sidelined for more than just a few days.
I am under 35 and under 160 lbs, and have been running 50+ mpw for years. It can happen to anyone after some time off.

While I completely respect my doctor, I wish he would at least give me a bit of a lead here. We're going to have a followup after my full bloodwork comes back to rule out lyme disease and rheumatoid arthritis. But really, 6months without running and limited to no cycling?! WTF.

How is a bent knee MRI different than a regular one? I put it in a holder with my knee slighly angled up.

--Alan

Lyme disease and rheumatoid arthritis do seem like a stretch, but anything is possible i guess. I am just suggesting a bent knee MRI from personal experience. I had multiple mris, xrays and the one where my knee was bent showed the plica problem.

Plica is just really a touchy subject with me and I dont want you to go through the same experiences as me. I can just foresee another 3 months of physical therapy and off training, and nothing is better. You can strengthen and rest but if it is plica, it will not get better. Another key that helped hint my doc was the cortisone shot. If it is tendonitis, the shot will help. For plica however, the shot should not help. If you are not satisfied with your current diagnosis, you have to get another orthopedic opinion.

Hi Alan,

Wanted to see where you are with this injury? I am experiencing something similar. I've done Airrosti which is a type of myofascial release technique which helps but the pain cycles back every few months. Hopefully you have reached a remedy by now. Thanks for any insight.

Hey,
Eventually, with about two months almost completely off, weekly dry needling, physio and leg strengthening, the pain receded. It still pops up every now and again. I have reduced my run volume a lot this season, but I should be ready for Placid next weekend.

Hope you get sorted out.

--Alan

Came across these posts. I am also very much suffering from Plica pain, to the point that I have gone from being an elite cyclist to not being able to ride at all. Two surgeries on my left knee for Plica section, but pain remains. Now I have the same symptoms in the other knee. Has anyone beat this? I have heard the surgical solution is a Retinaculum release. Anyone?

SHock
After bilateral knee pain for the last year, tons of PT, and on/off rest, I am pretty convinced after a second opinion from an ortho that I have plica syndrome. I am getting another opinion next week (first ortho thought chondromalacia, second said plica, MRI is normal, but plica are visible, although I know this isn't necessarily a problem in many people).

I was wondering how your recovery went after you had them removed - how long until you were biking at a decent effort for 2 hours, how long until running 3 miles, etc.

Have basically stopped my normal training the last 2.5 months and opted for varying my exercise to see if doing non-repetitive activity lessened the symptoms, its definitley gotten better since I stopped cycling 250mi/wk, but I can still feel it nearly all the time (at about 18 min into run can feel the pinch/tug at medial side of knee). I can complete all of the strength exercises, included weighted squats pretty good at this point (lots of core, hip, glute stuff that takes about an hour, do 2-3X per week).

I hate to think about getting surgery, but at this point I'm wondering if I will have to go that route, I just can't take much more of this, I'm only 27 and have been a great athlete prior to this last year. Would very much appreciate info about your recovery.
Elizabeth