Far forward bike position puts loads of stress there.
Mine disappeared a couple of years after stopped tri geometry.

I would search for a PT that specializes in overuse, endurance stuff. At least shop around. I’ve got a PT that is awesome and can pretty much get me healthy from anything.

it seems fishy to me that the they would say rolling is the answer. Mine would balance treatment with strength probably.

I had surgery for the condition you’re describing in my early 20s and thought I would have pain the rest of my life. It wasn’t until I went to a good PT, 15 years later, that I started believing I could do whatever I want. No limits right now

I occasionally suffer patella issues caused by letting my quads get too tight and pulling on the patella. Off memory the physio referred to it as patella tendinopathy. I don't know how different that is to your issue.

In general, I find total rest does not help with most injuries. Light training that does not aggravate the injury gets the blood flowing through the muscle/tendon/fascia/etc which greatly improves recovery.

For my knee, I foam roll and stretch my quads every day. I also include bodyweight squats and single leg arabesque in my strength routines (as long as their is no pain).

Training wise, with my injury, it hurts during slow to medium pace runs and whenever I apply power on the bike at a lowish cadence. However running at race pace, or riding at race power with a high cadence (ie. 100rpm) seems fine. I judge how my knee feels in the morning and choose my training accordingly.

Physical therapy has a long way to go in the US. Of course your quads are not 'too tight', they cant be unless you're stuck in bed for weeks and develop contractures.

What you describe is typical for patellofemoral pain: worsening or at least maintained pain from rest. I see it this way: you gotta see a good sports doc. One who can differentiate actual chondromalacia from regular patellofemoral pain. You will then need to find a good and up-to-date PT who can help you gradually build load tolerance in your patellofemoral joint and get you back to valued activities. Foam rolling and stopping valued activities is a horrible way of managing any non-traumatic injury.

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Endurance coach | Physiotherapist (primary care) | Bikefitter | Swede

Strength exercises. See a PT as commented by others. Deep stretching of the hammies works miracles for lots of people. I'm talking about sitting down and grabbing your feet and holding for 3-5 minutes. work up to it.

I had the same last winter, experimenting with bike position and a saddle too far forward and too high loads on the trainer are what caused it together with some tightness in the upper leg muscles from not stretching and foamrolling enough. After 5 months (of which 2 with PT) I could slowly start running again while the pain got less and less, all through a lot of tension relieve, needling, rolling, stretching, together with strength training and plyometrics later on. Have been hard at it again ever since while daily stretching and foamrolling without issues.

strengthen your glutes. Also, foam roll the IT band
hope it clears up.

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maybe she's born with it, maybe it's chlorine
If you're injured and need some sympathy, PM me and I'm very happy to write back.
disclaimer: PhD not MD

I went through 4 bike fits, one surgery, several rounds of PT and still had no success. Stretching, foam rolling, nothing improved it. The last bike fit helped, but 3 years of trying and I was still unable to ride.

I took a 3/8" steel bar from Home Depot and bent it to look like a mustache, and used that to get deep into the tissue. It ended up being a really tight up by my hip flexor. Once that muscle released, I improved steadily. I also used a piece of flat bar steel that was 1/4" thick and filed it down like a chisel. It worked well to get deeper into the tissue and improve the tissue quality. Kind of like the Graston Technique.

Still took 8 months, but now I can ride and run without any issues.

It also could have been the essential oils.

"Physical therapy has a long way to go in the US"


Sounds like you have it all figured out mortcyst. ;-) I can't believe the 20 years I've been in this profession has all been for naught! darn!...oh well.


To the original poster...


PFPS can have several different contributing factors. Typically (not always...but typical) when I see patients in the office for this, the following come up


1) Bike position.


2) Stride a bit to long...increasing patellar forces.


3) Too much correction of "over pronating" foot with the use of a "stability shoe" and/or orthotic.


find a health care provider who will look closely at these areas....or just go visit mortcyst!

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CB
Physical Therapist/Endurance Coach
http://www.cadencept.net

What is your athletic background? How long have you been doing s/b/r? What does your annual volume look like? Any significant changes leading up to this injury?

Im a PT in the US and find mortysct to be making completely unfounded statements. Realize that CMP is a structural diagnosis found on imaging. Having “soft cartilage” doesn’t equal pain. In fact, the cartilage behind your patella is aneural so it can withstand the compressive forces you put through it all day every day. The pain may be coming from a consistent, now not tolerated, overloading of the sub chondral bone behind the cartilage. Or you may have a derangement ( something out of ace within the PFJ or tibiofemoral joint. Typically a balanced program of stretching and strengthening resolves this along with relative rest. If you consistently overload this joint so as to create pain time and again it cannot heal. You need to do less than what produces pain. PTinAZ is right about places and positions to look for causation. Good luck, this takes work.