Plica Syndrome / Patello-Femoral Syndrome?

Discussion in 'Road Cycling' started by Alan Jeddeloh, Mar 9, 2003.

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  1. I've been bothered by a soreness in my left knee since mid November. It came on suddenly, and at
    first I though I had just strained a tendon. It petty much limited my riding until the first of the
    year. At that point I got back into intermittent commuting and weekend rides of 15-20 miles.

    The soreness started coming back and I went to the doctor a few weeks ago. The doctor examined the
    knee, concluded there was nothing structurally wrong, other than chronic inflammation or tendonitis.
    He put me on a prescription NSAID for a week and told me to stay off the bike for that time to give
    it a chance to get thoroughly quieted down. After I again rode to work, did a brief run for lunch,
    and rode home -- 18 miles net for the day. My knee again acted up coming home, becoming downright
    painful pulling the last hill.

    I returned to the doctor the next day, different Doctor* again examined the knee and concluded there
    was nothing structurally wrong, gave me some Celebrex samples and a referral to a PT.

    I saw the PT the following day, who made her own evaluation (nothing structurally wrong with the
    knee) BUT: my kneecaps are sitting to the outside a bit. Her supposition was that I either have
    Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome, where
    the medial Plica** is inflamed. For both she gave me a set of stretching exercises (Hamstrings,
    Quads, Iliotibular band, plus a stretch for the kneecap itself. She also assigned me to get another
    bike fitting.

    I did the fitting, then tried a ride. At about 8 miles my knee served notice that if I didn't stop
    soon it was going to make my life miserable. I reported my status to the PT the next day. This time
    she deep-massaged the knee in the area of the medial Plica and found a nice big bump. I came home
    with some more exercises and stretches.

    I spent some time on the web researching Patello-Femoral Syndrome and Plica Syndrome. Between the PT
    visit and various web sites, it seems like the Plica is the most likely culprit. The depressing news
    is that it looks like the "conservative" course of treatment runs 6-12 weeks and only works in about
    40-50% of cases. During that time you have to give up the aggravating activities (cycling, in this
    case). The next option appears to be arthroscopic surgery to remove the Plica.

    Has anybody had experiences with Plica Syndrome? How did it turn out? How long did it take you to
    get back on the bike.
    --
    Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in life
    are death and taxes" didn't do the laundry in a family with children!

    * Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of spare
    tissue on the synovial sac.
     
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  2. S. Anderson

    S. Anderson Guest

    I'm not a doctor and I'm not there, but here's a tidbit for you to consider. I know that if you're
    predominantly a distance rider, you can develop an imbalance in your quad muscles to the point that
    the outer quads overpower the inner muscles and you end up pulling the kneecap to the outside of its
    track. The person I know that had this problem had weight-lifting exercises prescribed that would
    strengthen the inner quads, much like a sprinter would
    do. This alleviated the problem and it has never recurred, AFAIK. Anyway, if they're pulling you
    off the bike anyway, you might want to do some squats designed to work the inner thighs and you
    might have some relief from that.

    Cheers,

    Scott..
    --
    Scott Anderson

    "Alan Jeddeloh" <[email protected]> wrote in message
    news:BA90E7DB.1AD2%[email protected]...
    > I've been bothered by a soreness in my left knee since mid November. It
    came
    > on suddenly, and at first I though I had just strained a tendon. It petty much limited my riding
    > until the first of the year. At that point I got
    back
    > into intermittent commuting and weekend rides of 15-20 miles.
    >
    > The soreness started coming back and I went to the doctor a few weeks ago. The doctor examined the
    > knee, concluded there was nothing structurally wrong, other than chronic inflammation or
    > tendonitis. He put me on a prescription NSAID for a week and told me to stay off the bike for that
    time
    > to give it a chance to get thoroughly quieted down. After I again rode to work, did a brief run
    > for lunch, and rode home -- 18 miles net for the
    day.
    > My knee again acted up coming home, becoming downright painful pulling the last hill.
    >
    > I returned to the doctor the next day, different Doctor* again examined
    the
    > knee and concluded there was nothing structurally wrong, gave me some Celebrex samples and a
    > referral to a PT.
    >
    > I saw the PT the following day, who made her own evaluation (nothing structurally wrong with the
    > knee) BUT: my kneecaps are sitting to the outside a bit. Her supposition was that I either have
    > Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome,
    > where the medial Plica** is inflamed. For both she gave me a set of stretching exercises
    > (Hamstrings, Quads, Iliotibular band, plus a
    stretch
    > for the kneecap itself. She also assigned me to get another bike fitting.
    >
    > I did the fitting, then tried a ride. At about 8 miles my knee served
    notice
    > that if I didn't stop soon it was going to make my life miserable. I reported my status to the PT
    > the next day. This time she deep-massaged the knee in the area of the medial Plica and found a
    > nice big bump. I came
    home
    > with some more exercises and stretches.
    >
    > I spent some time on the web researching Patello-Femoral Syndrome and
    Plica
    > Syndrome. Between the PT visit and various web sites, it seems like the Plica is the most likely
    > culprit. The depressing news is that it looks
    like
    > the "conservative" course of treatment runs 6-12 weeks and only works in about 40-50% of cases.
    > During that time you have to give up the
    aggravating
    > activities (cycling, in this case). The next option appears to be arthroscopic surgery to remove
    > the Plica.
    >
    > Has anybody had experiences with Plica Syndrome? How did it turn out? How long did it take you to
    > get back on the bike.
    > --
    > Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in
    > life are death and
    taxes"
    > didn't do the laundry in a family with children!
    >
    > * Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of spare
    > tissue on the synovial sac.
     
  3. Dave Cook

    Dave Cook Guest

    Soccer players have a similar problem to the imbalance you describe. They will often use "pre-wrap"
    just below the knee which puts slight pressure low on the patella keeping it in its track. There is
    also a device - a kind of strap - sorry, I forget the name - that accomplishes the same thing. Maybe
    Alan could run this past the therapist. It also makes a big difference if the therapist is a
    cyclist. Good luck Alan. "S. Anderson" <[email protected]> wrote in message
    news:[email protected]...
    > I'm not a doctor and I'm not there, but here's a tidbit for you to
    consider.
    > I know that if you're predominantly a distance rider, you can develop an imbalance in your quad
    > muscles to the point that the outer quads overpower the inner muscles and you end up pulling the
    > kneecap to the outside of its track. The person I know that had this problem had weight-lifting
    exercises
    > prescribed that would strengthen the inner quads, much like a sprinter
    would
    > do. This alleviated the problem and it has never recurred, AFAIK.
    Anyway,
    > if they're pulling you off the bike anyway, you might want to do some
    squats
    > designed to work the inner thighs and you might have some relief from
    that.
    >
    > Cheers,
    >
    > Scott..
    > --
    > Scott Anderson
    >
    >
    > "Alan Jeddeloh" <[email protected]> wrote in message
    > news:BA90E7DB.1AD2%[email protected]...
    > > I've been bothered by a soreness in my left knee since mid November. It
    > came
    > > on suddenly, and at first I though I had just strained a tendon. It
    petty
    > > much limited my riding until the first of the year. At that point I got
    > back
    > > into intermittent commuting and weekend rides of 15-20 miles.
    > >
    > > The soreness started coming back and I went to the doctor a few weeks
    ago.
    > > The doctor examined the knee, concluded there was nothing structurally wrong, other than chronic
    > > inflammation or tendonitis. He put me on a prescription NSAID for a week and told me to stay off
    > > the bike for that
    > time
    > > to give it a chance to get thoroughly quieted down. After I again rode
    to
    > > work, did a brief run for lunch, and rode home -- 18 miles net for the
    > day.
    > > My knee again acted up coming home, becoming downright painful pulling
    the
    > > last hill.
    > >
    > > I returned to the doctor the next day, different Doctor* again examined
    > the
    > > knee and concluded there was nothing structurally wrong, gave me some Celebrex samples and a
    > > referral to a PT.
    > >
    > > I saw the PT the following day, who made her own evaluation (nothing structurally wrong with the
    > > knee) BUT: my kneecaps are sitting to the outside a bit. Her supposition was that I either have
    > > Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome,
    > > where the medial Plica** is inflamed. For both she gave me a
    set
    > > of stretching exercises (Hamstrings, Quads, Iliotibular band, plus a
    > stretch
    > > for the kneecap itself. She also assigned me to get another bike
    fitting.
    > >
    > > I did the fitting, then tried a ride. At about 8 miles my knee served
    > notice
    > > that if I didn't stop soon it was going to make my life miserable. I reported my status to the
    > > PT the next day. This time she deep-massaged
    the
    > > knee in the area of the medial Plica and found a nice big bump. I came
    > home
    > > with some more exercises and stretches.
    > >
    > > I spent some time on the web researching Patello-Femoral Syndrome and
    > Plica
    > > Syndrome. Between the PT visit and various web sites, it seems like the Plica is the most likely
    > > culprit. The depressing news is that it looks
    > like
    > > the "conservative" course of treatment runs 6-12 weeks and only works in about 40-50% of cases.
    > > During that time you have to give up the
    > aggravating
    > > activities (cycling, in this case). The next option appears to be arthroscopic surgery to remove
    > > the Plica.
    > >
    > > Has anybody had experiences with Plica Syndrome? How did it turn out?
    How
    > > long did it take you to get back on the bike.
    > > --
    > > Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in
    > > life are death and
    > taxes"
    > > didn't do the laundry in a family with children!
    > >
    > > * Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of spare
    > > tissue on the synovial
    sac.
    >
     
  4. JFYL

    JFYL New Member

    Joined:
    Jul 24, 2003
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    :cool:
     
  5. JFYL

    JFYL New Member

    Joined:
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    Messages:
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  6. Joe

    Joe Guest

    JFYL wrote:
    >
    > Alan Jeddeloh wrote:
    > > I've been bothered by a soreness in my left knee since mid November. It came on suddenly, and
    > > at first I though I had just strained a tendon. It petty much limited my riding until the
    > > first of the year. At that point I got back into intermittent commuting and weekend rides of
    > > 15-20 miles. The soreness started coming back and I went to the doctor a few weeks ago. The
    > > doctor examined the knee, concluded there was nothing structurally wrong, other than chronic
    > > inflammation or tendonitis. He put me on a prescription NSAID for a week and told me to stay
    > > off the bike for that time to give it a chance to get thoroughly quieted down. After I again
    > > rode to work, did a brief run for lunch, and rode home -- 18 miles net for the day. My knee
    > > again acted up coming home, becoming downright painful pulling the last hill. I returned to
    > > the doctor the next day, different Doctor* again examined the knee and concluded there was
    > > nothing structurally wrong, gave me some Celebrex samples and a referral to a PT. I saw the PT
    > > the following day, who made her own evaluation (nothing structurally wrong with the knee) BUT:
    > > my kneecaps are sitting to the outside a bit. Her supposition was that I either have
    > > Patello-Femoral Syndrome (Patella not tracking properly causing irritation, or Plica Syndrome,
    > > where the medial Plica** is inflamed. For both she gave me a set of stretching exercises
    > > (Hamstrings, Quads, Iliotibular band, plus a stretch for the kneecap itself. She also assigned
    > > me to get another bike fitting. I did the fitting, then tried a ride. At about 8 miles my knee
    > > served notice that if I didn't stop soon it was going to make my life miserable. I reported my
    > > status to the PT the next day. This time she deep-massaged the knee in the area of the medial
    > > Plica and found a nice big bump. I came home with some more exercises and stretches. I spent
    > > some time on the web researching Patello-Femoral Syndrome and Plica Syndrome. Between the PT
    > > visit and various web sites, it seems like the Plica is the most likely culprit. The
    > > depressing news is that it looks like the "conservative" course of treatment runs 6-12 weeks
    > > and only works in about 40-50% of cases. During that time you have to give up the aggravating
    > > activities (cycling, in this case). The next option appears to be arthroscopic surgery to
    > > remove the Plica. Has anybody had experiences with Plica Syndrome? How did it turn out? How
    > > long did it take you to get back on the bike.
    > > --
    > > Alan Jeddeloh "ajeddelo at easystreet dot com" The person who said "The only things certain in
    > > life are death and taxes" didn't do the laundry in a family with children!
    > > * Same practice, I usually get the doctor on call. ** The Medial Plica is simply a fold of
    > > spare tissue on the synovial sac.
    >
    > :cool:
    >

    Alan,

    Your original post rolled off, but your problem sounds exactly like mine. I had some bad tendinitis
    about a year ago, but after allowing about 6 months of recovery, I tried riding again but after many
    months of trying to ride, irritating my knee, letting it heal (rinse, repeat), I find I can hardly
    go a mile without my knee bothering. I had an MRI and the doc says it's medial plica syndrome. I'm
    currently receiving ultrasound and electro-massage therapy, and if this doesn't work, it's surgery.
    Supposedly recovery is fairly good with this type of surgery, from what I've read.

    If you want to correspond and compare our situations/progress, let me know.
    ---
    NOTE: fake address. real address is mtber2 at comcast dot net

    > --
    > >--------------------------<
    > Posted via cyclingforums.com http://www.cyclingforums.com
     
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