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Runners knee/PFPS

 
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tommy060289




Joined: 08 Aug 2012
Posts: 433

PostPosted: Mon Nov 19, 2018 9:08 am    Post subject: Runners knee/PFPS Reply with quote

Hi everyone,

had a pretty crappy year with injuries this year moving from one injury to the next but my right knee has most consistently been the source of my misery. After initially suffering with a bit of hamstring tendinopathy earlier in the year, the right knee behaved itself for about 4 weeks before I picked up a fairly standard case of 'runners knee' aka Patella femoral pain syndrome. This started back in later May/early June and 6 months on it is still plaguing me.

I've seen 4 different physios regarding this who have all offered different solutions but unfortunately none have really fixed anything. I've been through the standard run of the mill 'tight quads/tight hamstrings/strengthen your hips/strengthen your glutes' but don't think this is the issue. I've addressed these, done all the banded side leg lifts, single leg squats, stretching, increased internal rotation of the tibia and still nothing.

I also was offered a slightly more plausible explanation of a lack of terminal knee extension in the bad knee as I have a slight leg length discrepancy of around 12 mm measured in the tibia. This results in the cartelidge on the back of the knee not being full stimulated so then lacks full nutrient replenishment so I have been working on tibial internal rotation to match the left leg which I have improved but don't feel like im really getting anywhere with the right knee in terms of being able to muscularly contract the knee in to extension when sat on the floor for example. The PT can manually extend the knee and I can push my knee back in to extension but when the PT super-extends the knee it feels stiffer to pull back past zero degree so I don't think there is physical stopper in the knee as to preventing extension beyond 0, but whats actually making it stiff im not sure.

Not really sure what im asking for on here but just wondering if anyone has any experience or advice as to what could be the root cause. I've rested, ran through, strengthened an stretched. Been taking glucosamine tablets for about 60 days now, tried switching to cycling which doesn't make things any better (so maybe there's a compression element in there or maybe that's just me thinking about it too much). I have no history of acute knee damage or surgery. running is about the only time the knee doesn't hurt but after it feels sore but its not really well correlated. I ran parkrun this weekend and going up two stairs at a time 6 hour later felt like someone put a drill in my knee cap but then ran the Conwy half slowly with my OH and knee isn't as painful that or next day though can still 'feel' m knee as if its a bit full or something though no signs of swelling. Equally, I don't think theres a particularly strong correlation between how hard I run and the knee problem post run but maybe a slightly minor one:(

Again, don't expect a fix from here but feel im running out of treatment options here so any input would be appreciated!

Cheers,

Tom
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explorerJC




Joined: 20 Oct 2005
Posts: 15880
Location: Farthingstone

PostPosted: Mon Nov 19, 2018 10:21 am    Post subject: Reply with quote

send me short videos of you running at mixed paces - side on (both sides) and front and back...
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tommy060289




Joined: 08 Aug 2012
Posts: 433

PostPosted: Mon Nov 19, 2018 10:45 am    Post subject: Reply with quote

thanks JC. Ill drop you a PM
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Pedro Peru




Joined: 19 Apr 2010
Posts: 1016
Location: Leeds

PostPosted: Mon Nov 19, 2018 11:28 am    Post subject: Reply with quote

Is the pain in the short or the long leg?

Did any of the things you tried affect the pain at all?
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tommy060289




Joined: 08 Aug 2012
Posts: 433

PostPosted: Mon Nov 19, 2018 12:02 pm    Post subject: Reply with quote

The longer leg
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Pedro Peru




Joined: 19 Apr 2010
Posts: 1016
Location: Leeds

PostPosted: Mon Nov 19, 2018 1:23 pm    Post subject: Reply with quote

makes sense. Did any of the physio try a heel lift? 12mm isn't an insignifican t difference.
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tommy060289




Joined: 08 Aug 2012
Posts: 433

PostPosted: Mon Nov 19, 2018 2:18 pm    Post subject: Reply with quote

Yes one of the physios did recommend that. I previously had a 6 mm insert in for my shoes over the last couple of years but over time these seem to have slowly crept out of the shoes and realised it was a short coming.

I promptly inserted them back and ended up with an injury to my left ankle which I tied to maybe jumping straight to a 6 mm insert so took them back out. I've now started to build up again using a 3 mm initially and then ill go back to 6 mm shortly and hopefully will work out better this time.

I have read a few solutions saying use an insert of half the difference (so 6 mm) which would put me within the 'less than 10 mm your body is ok with' I have read. Do you have any additional input/thought on this PP?
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Pedro Peru




Joined: 19 Apr 2010
Posts: 1016
Location: Leeds

PostPosted: Mon Nov 19, 2018 2:56 pm    Post subject: Reply with quote

tommy060289 wrote:
Yes one of the physios did recommend that. I previously had a 6 mm insert in for my shoes over the last couple of years but over time these seem to have slowly crept out of the shoes and realised it was a short coming.

I promptly inserted them back and ended up with an injury to my left ankle which I tied to maybe jumping straight to a 6 mm insert so took them back out. I've now started to build up again using a 3 mm initially and then ill go back to 6 mm shortly and hopefully will work out better this time.

I have read a few solutions saying use an insert of half the difference (so 6 mm) which would put me within the 'less than 10 mm your body is ok with' I have read. Do you have any additional input/thought on this PP?

I don't like inserts particularly but would start with either a 3mm or 4mm lift if using them. PFP can be really dificult to resolve and is easiest when the person has a clear deficit effecting gait. It sounds like you've been through the usual strengthening work. Did you also do motor control work? Did they watch you run at all?
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tommy060289




Joined: 08 Aug 2012
Posts: 433

PostPosted: Mon Nov 19, 2018 4:10 pm    Post subject: Reply with quote

Iíve used some control movements such as banded single leg squat (starting with using other leg to assist balance) and then on to step down keeping knee straight and then on to single leg squat.

Iím no ballerina by any stretch so donít look like a text book squat but I can do x10 with decent control and then repeat and Iím pretty symmetrical across both legs for strength. The physios Iíd probably give the most credit to tested side leg abduction, etc and felt had acceptable strength/symmetry.

I havenít had any gait analysis done since the injury but itís a good shout. Itís strange that during running there is no pain but most pain is a while after running going up/down stairs.
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Pedro Peru




Joined: 19 Apr 2010
Posts: 1016
Location: Leeds

PostPosted: Mon Nov 19, 2018 4:36 pm    Post subject: Reply with quote

Sounds like you have done lots of good strength work but possibly less on the control side of this. x10 single leg squats is impressive but how you are doing them is as important IMHO. It maybe that some work challenging your ability to hold your self upright on one leg and other movements might be beneficial as well as someone (our very own ejc) having a look at your running.
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