Boston Cycling Orthopod for Knees

[cbjesseeNH]

I'm looking for a Boston Orthopod knowledable in cycling kneee injuries. Or a good PT who can diagnose and treat problems.

My knees are acting up - the right PF ligament is popping in and out of track with a snapping sound. It just started happening last week and it pops when I'm just walking around. It pops when I stand on the bike, unless I try to rotate my hip in when rising up. I'm wearing a double Cho-Pat strap to try and keep it stable. Ibuprufin and ice help. I have orthotics and cleat/bike fit from Fit Werx in VT - good folks.

I was told 25 years ago (I'm 49 now) that I have antiverted hip joints (pigeon-toed from the hips) and will experience tracking problems. If it's a muscular imbalance, I need to find out which muscles to focus on. I understand most have tight IT Band and hamstring issues with weaker VMO quads, which pulls the kneecap outward, but I'd like to know for sure so I make things better rather than worse with exercises and stretching.

 

[Billsworld]

Brian Mckean @ Healthpoint in Waltham. Celtics Doc. ........... Eddie Lacert (spelling??) Celtics trainer is at the same location.

 

[rdr0912]

Brian Mckean @ Healthpoint in Waltham. Celtics Doc. ........... Eddie Lacert (spelling??) Celtics trainer is at the same location.

First off, not to be an ass, but if you are refering to the celtics STRENGTH trainer that's one thing, if you are refering to their ATHLETIC TRAINER, that's another story. The ATHLETIC trainer may be able to help you out (sorry force of habit since I'm an athletic trainer myself).

Back to the point of the post...If you have Diagnosed anteverted hips, and they are actually to the point of being diagnosed, most likely you will have at least a little pain regardless. Especially since you are 49, your body has more or less adapted to your anatomical ways and tried to make up for it. Cycling obviously won't help that. Take it for what it is worth, but if you were my athlete, I would have you work on general quad strengthening (regular leg ext and VMO strengthening as you are already doing it sounds like among other exercises). Further, I would have you start to work your hip internal and external rotators. This will help to stabilize and possibly bring your hip back into the "normal" position and therefor change the angle that the rest of your leg is at. Sometimes you have to look above the problem to correct it.
As far as treatments go, you hit the nail on the head with some NSAIDS (advil, motrin, aleve...whatever works for you) and ice. Cutting down on the activities that agravate your symptoms wouldn't hurt either until you get this under control with the strengthening exercises previously mentioned.

That's just some free advice. you can take it or leave it, just thought I'd put my two sense it. Hope it helped

 

[cbjesseeNH]

I try to learn a bit from others' experiences and advice, so much appreciated.

What do you find good to target rotators and VMO? I'm trying leg extensions and leg presses with my legs a bit externally rotated, but don't want to strain my medial knee structures. Hiking downhill, I've gotten pez anserine bursitis from stepping with too much external rotation, so I try to keep them rotated in more now when hiking.

What do you think of those Nautilus/Cybex-type hip adductor/abductor machines?

 

[Billsworld]

Ed is the "Athletic Trainer" and is a PT . I have been through an ACL replacement, a Lateral release(for a similar pain problem) , a bicept reattatchment and a few other minor scopes for sports injuries. All with Arnie Scheller and Brian Mckean at New England Babtist, with follow up with Ed. For the bicept tear and repair they let me do my own PT and was cleared for unrestricted lifting after 3 mos. Some way of increasing VMO strength does sound right for you, but most of the PT guys are steering people away from leg extensions these days. Best of luck

 

[rdr0912]

The machines are good, actually squatting is best in most cases. When you squat you have to use many more muscles to balance and stabilize yourself that you do not use with a machine. That being said, if you are doing 3 sets move your toes each set (i.e. first set toes SLIGHTLY pointed towards each other, 2nd set toes straight, third set toes SLIGHTLY pointed away from each other). With each of those sets, make sure your knees go straight forward and not in and out (respectively) with the direction of your toes aka your knees should always stay about shoulder width apart.
For the ABd and ADd machines, they aren't bad especially since we don't use those muscles on a regular basis. Keep in mind that too much work on ADD. may increase the likelyhood of IT band syndrome if you don't stretch regularly...as long as you stretch well, you should be good.
Hip internal rotators (IR) and external rotators (ER) are tough. If you can get an exercise band like theraband or something, you can use that. This may get confusing so bear with me...cut two lengths and make a loop about 12" diameter. Get some kind of ball to place between your knees while sitting. Hold the ball (you don't need to squeeze) with your knees and put one length around your ankles. While holding the ball with your knees, move your ankles away from each other (you should feel resistance of band)...do 3 sets of 10 reps. This is for the internal rotators.
FOr the external rotators, place both lengths on legs of a table or something that is anchored down well. Place an ankle in each loop. While holding the ball while sitting again, move both ankles TOWARDS each other until they touch. You will have to play around with how far apart the anchors are as to your leg length, flexibility, and band length. When you start this exercise, the bands should pull your ankles out slightly so there is resistance for the entire motion.
You may be able to pick up some of this exercise bands in a sporting good store like Dicks, but I haven't looked since I can use it at work.
VMO= while sitting and watching TV, put a pillow or two under your heel. Squeeze your quad so you are pushing the back of your knee agains the cusions of your couch. Do 30 ever time a commercial comes on and you should be good.
Everyone is different so you may have to tweak the sets and reps accordingly and build from there.
Hope it helps

 

[rdr0912]

Ed is the "Athletic Trainer" and is a PT...Some way of increasing VMO strength does sound right for you, but most of the PT guys are steering people away from leg extensions these days. Best of luck

No need for the quotations...it is a real profession. Many people in the professional ranks think that PT and ATC (certified athletic trainer) is the way to go...personally I think that is a waste of time and in a way contradicts each other, but that is another argument for another type of forum.
Anyway, leg extentions are not always the best exercise depending on the pathology. Related to my last comment of the difference between PT and ATC...PTs are not always as concerned with the FUNCTIONAL rehabilitation for an athlete. Usually they are interested in the return to activity. This is not saying they ALWAYS do not do this. Some do, some don't. I would hope that clinicians in the professional setting are doing this. This is why I think it is a waste to have both the PT and ATC. This is a huge debate that has been going on and usually each respective party thinks they are better than the other. Each is better than the other in their own setting in my opinion. No need to bash each other like a bunch of politicians.
Ok sorry for that last small rant, I will stop now and try to stay on track...

 

[Billsworld]

No problem. Most of my experience has been from the patient side of things as well as 20 years of powerlifting and bodybuilding. (none of that makes me qualified to dispense injury prevention advice) As far as the patella femeral pain goes , they gave me tons of ITB stretching and some painfull massage. The VMO strengthening was mainly very controlled steps up with some blasted little device that told me when the vmo was firing right. This was mostly post op. I have recently found that riding rollers on my track bike with no resistance is a great way to get miles in with no little stress on the legs. Try it for 20 minutes with tights on before you venture out to train. Then ice and sretch at the end.........OOPs I gave advice

 

[cbjesseeNH]

I was shown a good exercise for isolating the VMO (medial quad). Prop the thigh up on a foam roll, add a 5lb ankle weight, rotate out from the hip, flex the toes back, and contract the VMO isometrcally with leg straight out. One can feel the VMO attackment to the patella at 4 o'clock and tell whether it's fully contracted by a light poke with the fingers - good "biofeedback".

Ten x 10sec on each side and I really felt it later. I guess they need the extra attention.