Patellofermoal Pain Syndrome

oh, and when i do foam roll or use PVC pipe, i can “awaken” the various “pulling” sensations around my knee, around the quad tendons and so on…

poor running form,

  • old sneakers,
  • lordosis
  • strength training
    = one very BIG MISTAKE… my knees took the grunt on this one!

I wouldn’t necessarily say that there is a static or dynamic q-angle, but I think I know what you are trying to describe. If your knees are going into valgus (knock knee’d) when you run, squat, etc, your hip external rotators are weak and/or internal rotators are short and/or stiff. Also, you may lack mobility in your feet/ankles causing over-pronation at the foot, adding to the valgus position. Tons of issues that may be present, especially since you self admit to increased lordosis, poor strength training, etc, so as already recommended, seek out a practitioner to evaluate you.

I suffered through PTFS for a good 2 years before I finally resolved it. It felt like someone was hammering a spike through my kneecap every step I would take up and down the stairs. It just plain sucks.

So what worked for me?
Well, at the time, I was ironically working at a physical therapy clinic…I sucked their brains dry for info and none of it helped. Maybe that’s no surprise to some.
What did work:

  1. Get lean and stay lean. An extra 20 lbs of bodyfat amounts to 20fold that at the PTF joint. You will have much greater success of that badboy sitting in the patellar groove if you’re a bit lighter.
  2. Flexibility is important…quads, ITB, hamstrings, hip flx, etc. However, this always seemed to be a “secondary cause” in my opinion.
  3. Posterior chain strengthening. Hamstrings, glutes, etc. Compound movements only. Deadlifts, olympic lifts (to some degree)…help the muscles fire synchronously. For the quad-dominant types, which is the majority.
  4. No leg extension please.
  5. I would cut out running…especially hills.
  6. In my experience, VMO strengthening out the ass does nothing. Makes no sense…what everyday/functional movement requires the VMO to fire independently all by its little lonesome?

Ok bro. Hope that helps. Good luck.

Ok, so here’s an update:

I have been stretching and rolling my lower body with a piece of PVC pipe daily----at least 3-6 times per day. I perform various hip flexor stretches along with all of my other lower body stretches frequently, too. I have discontinued all dyanmic knee flexion/extension exercises (or at least the ones that bother my knees), and I’ve replaced them with static ones. I’ve had two appointments for ROLFING (a form of deep myofascial release) and it has been PHENOMENAL! My posture has already changed, and my coworker made a comment without knowing my history! (He thought I lost weight, but in actuality, my pelvis sits differently at the base of my spine, so I don’t look pregnant anymore). I highly recommend this form of active release therapy----it is pricey, but worth every penny! The Rolfer was also very familiar with musculoskeletal and sports-related injuries, so I was a pig in honey-shit on his table!

PMac — thanks for the tips.

Levelheaded — I’ve changed my running stride. As I ease myself back into running, I’ve experimented with mid-foot running. I used to be a heel-striker and an overstrider. This modification to my running gait has permitted me to run as far as 1.5 miles pain free! I also attempt to step below my hip, as opposed to far in front of my body. The Rolfing has also really helped free my hips and glutes/hams so that I can now get that proper hip extension.

MC — I read your article “Cool Nervous System Tricks”. I tried some of those things, and I pass all tests. Then again, I think the article is geared toward strength training. The work I’m doing now is NO WHERE near what I used to do for strength or hypertrophy. So I guess I’m not sure when I’m supposed to do the tests… ?

Thanks everyone! This advice is invaluable!

Deathbyviolet,
i’m kinda surprised that you say you “passed all the tests” in the article.
There’s no “pass” or “fail” - they’re just assessments to see if changes that you make help you perform better, or, in the case of the balance test - to see if you’re too fatigued to do your next rep/set.

Likewise, a set of drills were suggested above as alternatives to your pvc pipe (whoever invented that really has a lot to answer for).

how’d that go?

best
mc