Anyone have treatment advice for patella femoral syndrome, while training for running?
I had been diagnosed 5 years ago, but the symptoms have been in remission since '00 so I thought I was OK, that is until I started running again 2 weeks ago, … now my right knee hurts again, same place
Advice for treatment needed… and is it possible to run the IM/marathon distance with PFS, or should I be focusing on shorter sprint events?
Thanks all
(bummed out) - Gary
I had severe PFS in both legs for quite some time. Are your symptoms that you can run OK after a mile or so but you can’t walk? Mine were.
Anyway, it is horribly frustrating. I wound up having my gait analyzed and custom orthotics made. You should have seen the misalignment issues in my legs, they were so obvious when done on the computer! Never had the problem again.
I would suggest that, if your symptoms were as bad as mine, giving it up till you solve the problem. Rest will make the pain go away but the underlying cause will still be there.
I had severe PFS to the point where I needed major reconstructive surgery on both knees :(. That being said, once the surgery/rehab were done, it felt MUCH better. The surgery consisted of moving some bones, cleaning up the old scar tissue, and putting in some pins. I followed my own rehab schedule that was approved by my doctor, and I was back playing hard squash within 6 weeks. I had each leg done one summer at a time, and now I can’t believe the difference!!! 
I play lots of squash, ultimate frisbee, and try to train as much as possible for tri’s. Before the surgery, it hurt like a SOB just to walk.
Just my own personal experience.
Gary,
I am a resident in Physical Medicine and Rehabilitation in New Jeresy based at Kessler Institute for Rehabilitation and the University of Medicine and Dentistry of New Jersey. Patellofemoral pain syndrome is one of those things that no one really knows the exact cause of. Most believe that it is a combination of our inherent body alignment (knock-knees, flat feet etc) and imbalances in muscle strength and flexibility. What this all leads to is abnormal lateral tracking of the patella with quadricep contraction. In other words, the knee cap should pull straight up when you contract your thigh but in most patients with patellofemoral pain, the knee cap is pulled to the outside a little.
If you haven't seen a doctor yet, I would strongly advise that you see one. Try and see a sports medicine specific doctor. I am a little biased but I would recommend that you see a doctor in my specialty (PM&R or physiatry) rather that an orthopedist. If and when surgery may be necessary, a good physiatrist will let you know. Until then, physiatrists are hands down the best at examining not just your knee itself but also the other parts of the body that are 'out-of-whack' that could be contributing to the problem. Taking this information they also know what specifically to tell a physical therapist to work on with you.
A few quick things:
Any doctor who examines you and the gives you a prescription for physical therapy that says something like “Knee pain, PT 3x/week, evaluate and treat” doesn’t know what they are doing and should not be seen again for a musculoskeletal issue.
The most common treatment for patellofemoral pain is flexibility and strengthening exercises. The quadriceps (especially the vastus medialis or VMO) are usually focused on. Therapists can also try McConnell taping which is application of tape to the knee to guide the knee cap as it is being pulled by quads.
Other things that have been shown to work include orthotics for your shoes so you might want to have a physiatrist or podiatrist check your feet as well. If you have flat feet or overpronate when you run, you are transferring more force to your knees than if you have “normal” feet.
Any more questions, I’d be happy to try and answer them for you.
Kyle Stier, MD
Gary,
I have been deeling with this for 25 years! I have found that the Cho-pat knee strap seems to help…I’ve used the Cho-pat in 12 IMs so far.
Good luck!
What’s worked for me:
ice after longer runs, or any run in which it bothered me.
leg raises with foot turned out - I mix up doing these while laying on the floor and sitting in a chair.
Making these two things a habit seems to keep the problem at bay. I’ve done a couple of IM’s and a number of stand-alone marathons.
I do have to be careful about my mileage. If I’m running over 50 miles a week I seem to have a lot of problems, even when being diligent about icing and the leg raises.
Oddly, when I keep my mileage low (less then 20 miles/week) I also seem to struggle with the problem more.
scott
My wife and I have both suffered from PFPS for years, but have been able to do many marathons and even a few Ironmans. But at one point I went more than a year without being able to run a step. Keys for me are:
recognize when you are having problems and stop immediately, take as much rest as needed to let it heal. I can sometimes train through it but only if I keep the milage low and slow.
my wife likes to put a zip-lock full of ice around her knee for an hour or so after a run
can’t run intervals or fast paced at all. I can do marathons but I could never train for less than a 1/2 because I can’t take the speed work. Maybe I could build up to it gradually but have never had success with speed work for more than a couple weeks before I started having problems again. Mostly I do “speed work” on a treadmill at an incline. Definitely I would say stay away from the short events and concentrate on the long. Try doing a run at 12 minute mile pace, if that works, try 10, etc.
orthodics can help. They are not a cure. Probably stretching and weight training can help a lot too, but I don’t spend enough time on them to say honestly. I wore a neoprene knee brace (with the hole in it) and that was much better than a cho-pat for me. Pilates and Yoga would probably work wonders if I had the time and dicipline.
don’t waste your time and money talking to a general practice doctor about it. Even the so called “specialist” my former HMO sent me to didnt’ have anything to tell me that I didn’t already know in greater detail from a little internet research. There is basically not much they can do about it.
thanks everyone, hurts real bad, having trouble walking, should have known better … as my knees occasionally hurt from sitting incorrectly
will see how it goes with some light riding, this is not so good as I just signed up and paid for IMAZ
… I hope it is temporary … may have to go back to the doc
Ice and eat ibuprofen until your liver shuts down.
Gary,
Kyle Steir is absolutely right about PFS. I don’t think you could have received a better answer for this one. I have been working in Orthopedics for 8 years now in the Navy and have seen countless Marines diagnosed with PFS. What has helped them from an Orthopedic/Physical therapy standpoint has been 2 things: Strengthening of the VMO which causes the patella to track properly or improperly through the femoral groove. Most of the time the VMO is too weak which causes the tracking issue. Thus, you need to strengthen it. Easiest exercise for this is a wall squat with increases in time up to a minute. Hard as hell at first but it will get easy over time. Another thing we would do is give our patients what is called a PTO brace. Patella tracking orthosis brace to be exact. This kept our Marines out there running as it forces the patella in line with the femoral groove. Breg makes a good PTO brace and I believe they only run about $60. PM me and I’ll see what I can find for you as far as exercises or even a brace.
Jason
Have you had an MRI to make sure it is not something else. I think the total of things that could be wrong with a knee and all feel about the same is 1.2 Billion.