17 year old with major knee problems; help!

Discussion in 'Health Nutrition and Supplements' started by Mike_Rides_Red, Aug 24, 2005.

  1. Mike_Rides_Red

    Mike_Rides_Red New Member

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    I’m 17 and have not been able to ride or do anything except walk short distances for almost 5 months. My knee pain first started when winter was ending in March when I went from 40 miles in a week to 90 miles. I always have my cadence above 90 and have the correct saddle height. I kept on riding not making a big deal of it and just thought that a little knee pain after a ride was normal. It got worse and worse until mid April I had to turn around on a ride because it was so bad. The pain was around the lower part of the knee cap and was really bad if I stood up.

    I went to the orthopedic surgeon and he said everything looked fine on the x-ray and was probably patella femoral syndrome. I went to physical therapy and the therapist thought my legs were very tight (since I never really made a effort to stretch before riding) and that put pressure on my patella which aggravated cartilage. She aggressively stretched my quads, hamstrings, IT band, and calves. My quads were extremely tight and after a week of almost painful stretching my quad were much more limber. The therapist also assigned me exercises to help strengthen the muscles around it. A few months went by and my legs were much more flexible but still had pain but then the pain changed from being around my knee cap (symptoms of patella femoral syndrome) to the patellar tendon below the kneecap. I don’t get why symptoms just change like that but after reading a little it could possibly be from the therapist being extremely aggressive stretching my quads it stretched out or made micro tears in my tendon. I went to therapy for 3 months and stopped because I couldn’t really tell I benefited from it.

    The orthopedic surgeon ordered an MRI of my knees to make sure it wasn’t a tendon tear but the MRI came back normal. The orthopedic surgeon said I probably now had tendonitis and that I should just try to not aggravate it and just let it rest. He said it might take a long time since tendons don’t heal very well. The therapist said I should do leg exercises to strengthen my leg muscles but that brings on irritation. The Doc says I should just rest it and have tried both and neither seem to make it better. That was 2 months ago….

    Walking short distances is not a problem but if I try to do anything strenuous my knees get hot and start hurting. I was taking NSAID’s to keep the inflammation down but I’ve read that they slow the healing process. I have to ice my a few times a day to control it. Tendons have a hard time healing because they don’t have a lot of blood flowing to them to repair the damaged cells so sending more blood to the . Why is inflammation bad? It should help the healing process since there is more blood going to the damaged area. Shouldn’t that be good? I know that inflammation is bad when you have arthritis since it starts deteriorating your joints and that inflammation attracts free radicals but what about to heal injured knees?

    Next week I am going to see a sports medicine doc that was a team doctor for the Tour De France. This is so frustrating to me because a major part of my life was riding/racing bikes and I haven’t been able to go on a ride, run, or do any sports for 5 months! Right now I would do anything just to be able to ride again. I have learned a lot about how to take care of your knees on a bike such as faithfully stretching, lots of float, and don’t jump mileage too quickly. Does anyone have any advice? Should it take this long? Should I try to strengthen my muscles are just let my knees rest? Sorry I wrote so much but I’m just hoping someone can point me in the right direction. Any help would be greatly appreciated.
     
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  2. bobke

    bobke New Member

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    Find a sports doctor who knows cycling, sounds like you have.
    Coordinate rehab with doctor who knows cycling with Physical therapist who works with doc or knows cycling.
    Your injuries are not serious but will take a while to sort out.
    You may in fact need to have complete rest and no exercise no stretching and no PT till pain goes away.
    Then careful rehab.
    Been there done that.
    Tom Danielson this season, same story.

    Good luck.
    I think muscle training and PT are the way out, stretching is often suggested but plays a smaller role than muscle imbalance and correcting that before milage is increased.

    Also very low gears, higher cadence 95 rpm, professional bike fit, shoes/orthotics, frame size, length of cranks--all should be looked at by people who know.
     
  3. bobke

    bobke New Member

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    Find a sports doctor who knows cycling, sounds like you have.
    Coordinate rehab with doctor who knows cycling with Physical therapist who works with doc or knows cycling.
    Your injuries are not serious but will take a while to sort out.
    You may in fact need to have complete rest and no exercise no stretching and no PT till pain goes away.
    Then careful rehab.
    Been there done that.
    Tom Danielson this season, same story.

    Good luck.
    I think muscle training and PT are the way to go, stretching is often suggested but plays a smaller role than muscle imbalance and correcting that before mielage is increased.

    Also very low gears, higher cadence 95 rpm, professional bike fit, shoes/orthotics, frame size, length of cranks--all should be looked at by people who know.
     
  4. dsdelis

    dsdelis New Member

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    HI Mike,

    I know how frustated you are. I am now on month 15 with patellar tendonitis. But good news, it does get better. It just takes a very long time. I bet you are now in the very early stages of healing. I think stretching is very important. The tension on that tendon needs to be released. A PT gave me some very helpful advice. He said to stretch the quads very lightly before you get out of bed and take your first steps in the morning. Be careful though, your muscles are cold from sleeping. Avoid any excercises that flex your knees more than 30 degrees. I think sometimes PT is a little too aggressive with injuries as tempermental as this. I am told that collagen synthesis does not begin until 100 days after the injury. Tendonitis is a breakdown of collagen within your tendon.

    You must be dilligent about stretching and I think you should try to get back on your bike ASAP, even if it just for a few minutes every other day. Six months ago I was able to ride for 5 minutes, now my longest ride has been 1.5 hours at low/med effort.

    This injury is very discouraging. But it can be beat. I would not consider surgery for a moment. I had/have a very bad case of this and I think I am almost through it. It has been a long road just to get where I am now.

    One last thing. Be careful not to favor your good leg. I have developed a slight case of ITB tendonitis in my good leg from always weighting it. Let me know if I have been of help.

    Hang in there and you will beat this -Dean
     
  5. DocK

    DocK New Member

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    Sorry to hear about your problems. It sounds like you have jumpers knee, or patellar tendinopathy (histological studies have shown very little evidence of tendinitis). You may have a build-up of fibrosis due to injury and previous therapy. The sports doc is likely to be a waste of time due to his specialty is probably surgery. Find either a physiotherapist or sports chiropractor who performs soft-tissue mobilization, whether it be a manual technique such as active release technique or Trigenics Myoneural Medicne, or graston/ASTYM/SASTM-all techniques utilizing instrumentation. Most of the aforementioned techniques have websites you can check out. You should also have someone look at your leg lengths as this could be a contributing factor and alignment may be needed. Good Luck!!
     
  6. djg21

    djg21 New Member

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    I'm not a doctor, but IME the only way to resolve any tendonitis injury is to rest it, and desist from engaging in the motions that cause it while the inflammation subsides.

    I developed a really bad tendonotis in a shoulder, which I actually attributed to using a computer mouse at work ("Mouse Shoulder" is pretty common it seems!), and by overdoing it in the weightroom as I was rehabing from an ACL revisoion surgery. I was miserable on my bike, and could barely hold the handlebar with my right arm.

    I worked with my PT on the shoulder, icing like crazy and stretching. I also stopped using a mouse, and instead used the touchpad on my laptop. I also stopped doing any exercises that aggravated the shoulder. After two months, the tendonitis was entirely gone.

    Perhaps you may wish to put the bike aside for a few months and swim to upkeep your fitness. After the injury is healed, stary again, but AFTER you've had your bike fit and cleat alignment checked. In addition, if you have feet problems, like a flat foot, or a pronation issue, have a custom insole made for your cycling shoe. Custom insoles ofgen resolve a lot of knee, hip and lower back issued by simplu placing the feet in a neutral, correct position while you are pedaling. Here's a link http://www.d2customfootwear.D2 charges $150 for custom insoles specifically designed for cycling shoes.

    Good luck.
     
  7. kaian

    kaian New Member

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    Have you ever heard of active release technique (ART)? It's soft tissue work that is supposed to be helpful for tendinitis, injuries, etc. I am having my chiropractor who is certified in doing ART use it on my neck and shoulders where I have developed an overuse injury from cycling. So far it is working great. I feel a lot more loose and have less pain. You might want to look into it and give it a shot.

    I had tendinitis in my right knee about 2 years ago. Physical therapy worked great for me, but I've noticed that I have to stretch regularly and do exercises (weight or other) that keep the quads strong. The PT I went to used ultrasound treatment, stretches and exercises using therapy bands and weight machines. I had to avoid activities that put strain on me knee for at least a good 4-6 weeks. Most PTs will tell you to back off and then when they feel you are ready, will tell you to start back with activity very slowly.
     
  8. Jhikers

    Jhikers New Member

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    Mate, I haven't posted a reply in months - but your situation sounds so frustrating. I went through some decent knee pain back in Jan 2002, I'd ridden 80km on dead road in the big chain ring and for the following week I struggled to stand up for long periods.

    Since then, I've never experienced it again - I found an awesome physio, and sensational chiropractor and haven't looked back.

    From the sound of things, your quads are way, WAY too tight. Stretching them will help lengthen them a little, but what you really need is some deep tissue massage to loosen the belly of the muscle - this will hurt, but will lengthen the muscle much more, and relieve the pain around the joint immensely. For this you need to see a good physiotherapist, they should use their elbow to get right in and loosen it up.

    Another factor may be that some of your bones are out of place - this will put stress on the muscles, so visits to a chiropractor would help put your bones back in place so that then massage would become much more effective.

    Checkout:
    http://www.cyclingforums.com/t86579-.html

    If the inflammation around your knee disappears - the exercise I would recommend to release your quad a bit would be:

    1) Get a stick, like a regular broom handle, or cricket stump and lie it on the ground.

    2) Now, kneel on the stick - both knees at the same time. Support yourself with your arms if it hurts too much. Your knee should be at a right angle (90deg), the stick positioned right under your knee cap digging into the tendon. Stay there as long as you can, rock slightly from side to side and find the parts that hurt - I reckon the 'inside' will kill. But keep doing it - you've gotta loosen it up. This is great to do on the lounge room floor while watching tv. Do it in the morning, and at night.

    Keep stretching the quads too... stretch and massage.

    Before you do anything, you have to loosen the muscle - get blood in and lengthen it. Resting it will not achieve this. Stay off the NSAIDs. Strengthening the muscles should come later - strengthening now may just cause them to tighten further. Just focus on relieving the pain first by loosening the muscles.

    Hope this helps
     
  9. Don Shipp

    Don Shipp New Member

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    Don't stretch before exercise. When you are riding again, improve your flexibility by stretching after, when body tissues are warmed up.
     
  10. Kaizen

    Kaizen New Member

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    Hey Mike, I have the exact same issues with my knee, however it has been only 11 weeks. They're calling my issue Chondromalacia Patella (softeneing of the articular cartilage). I'm going for an MRI on next week. You have done a lot of homework and I am very interested to find out how your rehab is going... please share.

    Kaizen
     
  11. Mike_Rides_Red

    Mike_Rides_Red New Member

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    Thanks for all the replies. Sorry I haven’t posted for awhile.

    My knees have gotten much better in the past month. The sports medicine doctor I saw had a lot of experience with cyclist knee problems. He said I had patella femoral syndrome, not tendonitis. The reasons he thought I had started getting knee trouble was:

    1. Lack of stretching (quads, IT band, calves, hamstrings). Before I had this problem I stretched very little and had never even heard of the IT band stretch. Stretching your IT band is very important in cycling to keep it from getting too tight and causing a problem.

    2. I was training hard almost everyday when I should have mixed up my training with lighter, easy rides, and cross training.

    3. My seat height was low. When the seat is too low the knee has to bend more at the top of the stroke. This puts more stress on the patella/cartilage. Forget about setting your bike to the Lemond fitting theory (your inseam length X .883 = seat height). This sets your seat too short. A proper fit is about 15 degrees of knee flexion at the bottom of the pedal stroke with the heel in riding position. My Doctor professionally fitted my bike and my insurance paid for it! He raised my seat about an 1.5” and set the for/aft position all the way back.

    4. I had a muscle tightness/imbalance. A common reason for patella femoral syndrome is that the outer/IT band side of the quads overpowers the inner side/VMO. My VMO was too small and my IT band was too tight. This makes the patella not track correctly creating a problem. To fix this problem the Doctor advised me to get a foam roller, regularly stretch my IT band, and get a electric muscle stimulator for my VMO. The foam roller really stretches out the IT band/outer leg muscles. http://www.runningtimes.com/issues/04may/IT Band photos foam roller 2.jpg

    The VMO stabilizes knee tracking so it is important to have a strong VMO. I had tried VMO strengthening exercises in the past and none had seemed to greatly work out the VMO. The VMO is a hard muscle to isolate a contraction and that is why a muscle stimulator is so helpful. It strongly contracts the VMO and you can do it watching TV. Within 1 week my VMO was visually larger. My insurance covered the cost of mine which was about $150. Another good way to work out the VMO is stand-up pedaling.

    The Doctor recommended that I get my knee moving instead of resting it. I started doing short periods of swimming, Precor, light resistance on the trainer, etc. My knees improved greatly just within 2 weeks of light exercise, stretching IT band, and VMO strengthening. The inflammation has disappeared and my knees are much better. I can walk, jog, and ride again! My knees still arn't at 100% but hopefully they will get back to full stength soon. I have found that the cho-pat dual knee straps are very helpful when running.

    Unfortunately I broke my collar bone last week dirt biking so I’m out of doing anything fun for 6-8 weeks. At least my knees are better!

    My advice for those of you having knee problems is get a diagnosis/recovery plan from a sports medicine doctor who regularly deals with cyclist knee problems. The orthopedic surgeon and the physical therapists I went to in the beginning deal mostly with old people and not sports injuries. I believe that if I knew exactly what I had and what to do to correct my problem in the beginning I would not of had this drawn out knee problem.
     
  12. Dondare

    Dondare New Member

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    We need to get your doctor posting on this site. It sounds like he's worth his weight in somethingorother.
     
  13. wiredued

    wiredued New Member

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    17 years old seems a little young for arthritis you might want to examine things you eat everyday. For instance are you a coffee drinker or tea drinker do you drink hard water or do you consume to much protein. All these and more can have an effect on bones, joints and tendons. I had similar problems with my knees at 21 and avoided cardio for a long time because of it (not a good solution). You might find the solution to your problem mousing around at this sight.

    http://www.acu-cell.com/crcu.html
     
  14. Kaizen

    Kaizen New Member

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    Thanks for sharing Mike. Please keep us posted. What state do you live? I may want to go to your doctor.
     
  15. Mike_Rides_Red

    Mike_Rides_Red New Member

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    I live in Northern California.
     
  16. Jay eS Iye

    Jay eS Iye New Member

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    great information. I have also been diagnosed with PFS by a school doctor who is also a cyclist. I got mine from not doing much training (longest ride being 16 miles) and then I went and did a 73 mile ride in the Ride for the Roses and my knees were very over stressed. Didn't make it better than I have had to do some 4-6 mile runs for the Army after that and I kept hurting it worse. So over the winter break I'm going to do no running and work on the elipticals and on my bike. I'm also going to work out my legs to strengthen those muscles to help stop future injury. And now reading this I"m going to really concentrate on stretching out my legs b/c I have always had really tight legs. Thanks for the advice and hopefully mine too will get better
     
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