Advice for Patella Femoral Syndrome

Hey guys, I was doing some deadlifting last week when I began to have a sharp pain in my right knee. I knew something was wrong and decided to take it easy after that. I saw my doctor, and he said I have patella-femoral syndrome. Which is a common injury to people involved with sports. For those of you not familiar, it is an irritation of the undersurface of the kneecap. And it rubs against the femur.

My doctor prescribed some Anaprox and told me to ice it and take it easy. I also asked a friend of mine (who is a physical therapist) what he thought. He also suggested taking the pain reliver and icing it. He also said I could squat and do my normal lifts as long as it doesn’t hurt.

Unfortunately, bending down to pick up a weight makes my knee hurt. So he suggested doing some leg extensions with higher reps with my feet pointed out.

My question is how many of you have had this (or have this) and how have you trained around it. And what is your advice to get back to lifting heavy again?

Thanks a lot!

In terms of diet, the thing that has helped me over the last 6 months is large doses of vitamin c, coupled with judicious rest periods and alternate exercises until functionality was restored. Vitamin c isn’t just a great antioxidant; it is essential for the repair and rebuilding of damaged tissue. Vit c and calcium are necessary ingredients that form the base for all connective tissue in the body, for example. Add a little protein in the mix, you get collagen, a little more calcium, you get cartilage, even more calcium + magensium/phosphorus, you get bone. Anti-inflamms don’t necessarily help and can cause gastro-intestinal problems. If they work for you and you tolerate them well, great, but don’t be surprised if they don’t do much.

greg, thanks for the advice. I will definitely increase my vitamin C consumption. I do pretty good on calcium and protein, so that should help.

I’ve noticed the anti-inflammatory doesn’t seem to do a whole lot for the pain. It always aches. Luckily, it hasn’t caused any gastro-intestinal problems or other side affects.

I’ll go easy for now. I just want to get back to squatting and doing some snatches and cleans! It sucks to have a knee injury!

welcome to the unhappy club, I have been working on rehabing a Patellar tracking problem for over 6 months now and let me say it is a very slow process, for me anyway. When it started i began to have pain in my right knee while squatting, and soon after began to have pain with anymovement that recquired by to bend the knee by more than 50-60 degrees. My problem seems to stem from weaknees in the vastus medialus and a tight iliotibial band.

First thing to do would be to get a referral from your doc to send you to a PT or an orthopedist, they will be able to evaluate what is going on with the knee, MDs tend to act like they know everything, but are more trained to treat kids with colds and sick old people than they are trained to diagnose knee problems.
First try to reduce inflammation, you are on the correct path by icing and taking NSAIDs-Ibuprofen is my poison of choice, swelling on the knee presents a vicious cirlce for people with a tracking problem, often the tracking problem can be brought on by a weakness of the vastus medialus compared to the vastus lateralis, the medialus is very sensitive to swelling of the knee and as little as 10-20 ml of swelling can cause inhibition of the medialus, because the medialus is not firing the patella pulls to the outside and grinds awkwardly through the femoral notch, this causes even more swelling which in turn inhibits the medialus, many people with PFS show muscle wasting of the medialus. If you see a PT they can show you exercises that can help to rebuild the medialus. These isometric exercises often utilize some sort of biofeedback so the patient can tell how hard they are flexing the muscle. I don’t believe you can totally isolate the medialus since the four parts of the quad are activated by the same spinal nerve, but for some reason or other the exercises seem to help.
After swelling has gone down you can probably resume more traditional strenght training exercises. Be sure to warm up and stretch out prior to traing.
Patellar Femoral Syndrome can be brought on by a number of factors including, but not limited to: tight lateral retinaculum, flat feet, tight iliotibial band, Increased Q angle, and Patella alta.

It is important for you to be properly diagnosed by either a n orthepedist or PT so you can find out what your particular problems are and you can get on the road to recovery.

My PT has worked with hundreds of cases of PFS and says no two cases are alike, some patients recover quicly, some take longer, the pain varies from patient to patient, etc.
Go see a specialist and best of luck to you

cyguy, thanks for the info. Yes, I have been icing my new each day (2-3 times) and taking the anti-inflammatory. Luckily, the pain isn’t sharp and unbearable. But it is a constant, nagging pain that does hurt more during certain activities.

I’ll be going back to see my MD in a few weeks. I’ll have him refer me to the Orthopedist then. He wanted to give me some time to go easy and use the medication.

I’ll be trying to keep my quads strong with unilateral leg extensions. When I see an Orthopedist, I’ll ask them about exercises as well. In the meantime, I can still work my hamstrings, so I’ll give them and my calves some extra attention.

I hope that I can recover quickly. Hearing about your six months of rehab is a little depressing. I really don’t want to be out of commission that long! Hopefully I won’t have to be.

Good luck to you and thanks again for the information.

well my input is that it is likely a tight ITB, which seems to be the most common problem. Nearly all of us have ITB’s that are tight if you are athletic (it is simply neglected). But when i had it it was as simple as tight hams. I have chronically tight hams so my hams and vastus lateralis were acting as a pully system (as the have virtually the same insertion point)and moving my patella to the lateral side of my knee. I was able to correct the problem in it’s early stages and stretching actually saved me. I jsut used a stretching repetoire that really isolated my hams and the PFS slowly went away. Hope that this helps and you recover as well as i did. Otherwise definately see a sports medecine doctor.

first of all, leg extensions are probably the worst exercise for PFS or tracking problems. believe me. see a sports med specialist and a good PT, and don’t wait till it gets worse. My left knee is F@*#ed, not to mention the 2 inches of atrophy on my left quad. I’ve had 2 surgeries, cortizone shots and I am on celebrex - which seems to work good for swelling. what the other guys said about tightness of the illiotibial band and other muscle imbalances is usually the cause, so get a good stretching program and do it every day for a start. be careful with the full squats and deadlifts till you get everything stretched out. if you have pain under the patella doing anything, stop doing it for right now. the pain is usually a sign that your patella is scraping the cartilage underneath. leg presses with your feet fairly high and wall squats are usually a good way to keep some tension on your quad to prevent atrophy and pain, while you correct your problem. any more specific questions, let me know.

Sorry to hear about your injuries, Im a bodywork practitioner that deals with alot of sports related injuries. I would suggest you go to a massage therapist or bodywork practitioner in your area that is qualified in sports massage. It’s an expensive way of treatment. Good luck!

I will definitely do a lot more stretching to help correct the problem.

As for leg extensions, I didn’t know they would be so bad. So I’ll back off on them as well. I will definitely get a referral to a specialist and have some exercises recommended.

In the meantime, I’m still icing it and taking my Anaprox. I haven’t done any squatting, sprinting, deadlifting or power cleans due to the pain. It doesn’t take much to aggravate it.

So I will concentrate on stretching and working my hams and calves until I can get my knee in good shape.

Thanks again for the advice. This really sucks! I was just beginning a maximal strength phase and now I can’t do any heavy leg work! DAYUM!