Patellofemoral pain syndrome or something else?

Mike S · 08-21-2008, 02:11 AM

Since my right knee never seems to give me a break, I am back once again with a description of my latest problem.

Pain is in the right knee only (exact point of pain shown below).

Pain is produced with deep bending (past 90 degrees) or 90 degree bending + manual pressure (as shown below).

Bonus questions: What is causing it? Muscle imbalance? My vmo is pretty well developed, which I understand is usually the muscular reason for it. Overall tightness? Trigger points in my glutes?

Do any modalities provide instant relief? I've never understood whether after foam rolling/massage to a trigger point, one should feel immediate relief in the area where the pain "refers to" Ive rolled my it bands a good 10 times per side for 2-3 times, but it doesnt provide any noticeable relief to the knee pain.

Thanks!

UConnJulie · 08-21-2008, 07:52 AM

Could be a plica.

Sorry, don't remember your specifics ... have you seen a physician for this?

Mike S · 08-22-2008, 09:15 PM

yes, multiple. and ive heard every single possible explanation (it feels like it at least) I remember the plica being mentioned recently, specifically that it wasn't the plica (but my trust for drs advice is rapidly diminishing).

Causes for my pain that Ive heard so far:

weakness: weak adductors

flexibility: tight hip flexors, tight quads, tight hamstrings, tight it band, tight calves

Anterior pelivc tilt: tight hip flexors, psoas

flat feet - this is the most recent one, and both my pt and ortho mentioned that I should get some arch supports/orthotics. my left foot is more flat than my right, yet my knee pain is in the right knee. doesnt seem like flat feet would be the cuase

tried some arch supports and didnt like them, nor did they provide instant relief for my knee pain

UConnJulie · 08-23-2008, 06:55 PM

Any trigger points in your quads? Rectus area about 1/2 way 1/3 way down? (ie mid to upper mid thigh)

Mike S · 08-23-2008, 11:06 PM

yes, all over, and i tried foam rolling them, and have gotten a few massages there with no noticeable difference

UConnJulie · 08-24-2008, 07:52 PM

Trigger points will take consistent work to reduce, you won 't get an immediate effect ... get a lacrosse ball and roll it on them with your hands while you sit with your legs out in front of you.

Stretch your quads afterward.

BUT, something is causing the quads to be overworked. My guess is glutes that aren't working properly.

ts.vassilev · 08-25-2008, 07:01 AM

Quote:

Originally Posted by UConnJulie

My guess is glutes that aren't working properly.

My guess also. I can't be wrong when I'm copying Julie

Mike S · 08-25-2008, 08:48 AM

would anterior pelvic tilt cause the glutes to not function properly?

UConnJulie · 08-25-2008, 02:01 PM

They often go hand in hand ... which came first though, the chicken or the egg? Hard to say if lazy glutes contributes to APT or if APT causes the glutes to shut down.

Mike S · 08-25-2008, 06:17 PM

what role do flat feet play in this? I've been considering whether to suck it up and start wearing arch supports, but I dont know if they will do anything, and don't want to "depend" on them if there is another way to treat the excessive pronation.

From something I read, it seems like anterior pelvic tilt can cause/exacerbate flat feet? Does that make sense?

UConnJulie · 08-25-2008, 07:17 PM

Could be ... the best way to tell ... try arch supports and if they help, great, if not, oh well.

If you need glasses, is wearing them creating a dependency?

How flat are we talking?

APT and overpronation go hand in hand ... they are both symptoms of the body not resisting gravity well.

ts.vassilev · 08-26-2008, 05:44 AM

Julie, I've often heard of lacrosseball rolling of the plantar fascia suggested for flat feet. WHats your take on that? Also - curling of the toes, like if you're trying to pick up an object from the ground using your toes, or curling a bed sheet?

UConnJulie · 08-26-2008, 07:34 AM

I roll my feet every morning, but I have high arches. I'm sure it would feel good no matter what.

The foot usually can benefit from strengthening/stabilization exercises ... the best one is not curling your toes, but rather drawing the ball of your foot back toward your heel --with LOW effort. This activates the deep intrinsic muscles in the foot which help support the arch and stabilize the mid-tarsal joints.

ts.vassilev · 08-26-2008, 07:53 AM

Quote:

Originally Posted by UConnJulie

The foot usually can benefit from strengthening/stabilization exercises ... the best one is not curling your toes, but rather drawing the ball of your foot back toward your heel --with LOW effort. This activates the deep intrinsic muscles in the foot which help support the arch and stabilize the mid-tarsal joints.

I figured this one on my own a couple of months back - I positioned my foot as if I have a higher than my actual arch and tried touching the ground with the ball of my foot. First couple of times I had an almost cramping feeling, but later it became comfortable. One foot is better then the other thogh.

I get a similar feeling doing standing BB calf rises when I'm trying to push off the ball of my foot(versus what's natural).