patellafemural syndrome training/exercises?

[AbsolutStoli]

so i decided to go to an ortho while im still insured and see what the issues with my knees are. they only bother me after a full day of strain and exercise, like a day of skiing, so seeing as ski season is coming up i wanted to check it out.

the doc told me i have patellafemural syndrome. basically, my patella is mistracking. this causes pain and discomfort. but he said its common. im doing physical therapy now (had 1 session, 2nd is today), but wanted to throw the question on here also just because you guys are a wealth of knowledge and i want a training routine that would get me ready for the season too.

basically, my question is, what exercises should i do and what i should avoid, to strengthen my thighs evenly and get the patella tracking correctly? and what exercises would also be good to build strength for skiing, obviously.

i currently row for an hour for cardio. im changing it up starting this week with just rowing for 40 minutes and doing the bike as my "cool down" for 20 mins. what else should i be doing as a targetted strenthening exercise? any specific lifts?

i think more importantly is what shouldn't i do? the last thing i want is for the condition to get worse. you know?

btw, i did search for patellafemural and for patella, but all i got was ACL related threads. the doc said my acl was great, its just the inner thigh is weaker than the outer.

thanks guys!

[Fuzz]

I have the same issue after my ACL recon. In my case, it's the VMO that's still too weak to pull the patella correctly to the inside.

According to my PT, it's very hard to isolate just the VMO to work on it. Doing quad work will help -- but unfortunately, the patellafemoral pain prevents a real quad workout (e.g. one-legged squats).

Two things help me a lot -- taping, or using a brace that pushes the patella slightly over to the side -- with either, I can do deep squats without pain. I just got the Shields brace (by Hely Weber) which includes a little horseshoe-shaped piece that allows you to push the patella to the side (i.e. in the right track). Then I can do one-legged squats to build up the VMO, so that the patella can eventually track normally on its own.

[GoNads]

You're going to want to strengthen your VMO, Vastus mediollus or however you spell that one, and your gleuteus medius. This can be achieved my lots of single leg lowers, and squats off a stool, make sure your hips are square and you aren't dipping or cheating, keep your core taught.

For your gleuts its a little harder to explain, you should try to get a physio to show you these, but you can do clamshells, lie on your side and bend both knees, heels under your bum, and open the top leg like a clam.

Also, you can lie back facing the wall, leg straight and slightly behind your body, raise that leg up and down the wall.

All in all you probably need a trainer or physio to make sure you're doing these correctly, make sure you stretch your illio-tibial band, and your hamstrings/quads out REALLY well. I still have to tape BOTH my knees for PFS everytime I ski, play soccer, hockey or weight lift.

[AbsolutStoli]

thanks guys. im doing physical therapy now, and theyre showing me some strengthening exercises that im definitely going to be doing. im asymptomatic, no pain on a day to day basis, this is more like preventative care before it got out of hand.

i was just a little concerned that my current exercise routine may be counterproductive. but it doesnt sound like it is.

the ortho said that if he doesnt see improvements by my second visit, he might be putting me in some braces. but no need to waste $$ if i dont need them, right?

[amyzilla]

I'm having the same issues (still)

Another exercise you can try is to sit on something and rest your heel on something that's just a little lower than what you're sitting on, so your knee is at like a 10-15 degree bend. Pick your heel up and use your quads to push your leg as straight as you can, and do like 15 reps. My therapist explained that it forces the kneecap to travel in the correct motion.

Also, when you're biking, watch your bad leg to make sure that the knee isn't dipping to the inside.

[Vinman]

sme good suggstions in here. There are many causes of patello-femoral syndrome.

Some of the more common ones I see
tight hamstring.........stretch the hammys
leg lenght difference..........orthodics
fallen arch on one side...orthodics
weak quads....strait leg raises, short arc quad extensions, leg press, squats
weak glutes........lots of balance work
weak core.............lost of fit ball and yoga/pilates medicine balls etc...
tight quads.............stretch
tight patellar retinaculum......patallar mobilizations


many others too specific to mention and would depend on your physical exam.

[oftpiste]

I was diagnosed with the same thing. Did some PT and nothing worked until they taught me how to stretch. Incredibly simple, painless, and my knees have been largely pain-free ever since (3 years maybe?)

[char]

Backwards sprints.

I got diagnosed with this when I was playing soccer in high school. Coach had us start doing backwards sprints and BAM! no more knee issues.

I still get some pain from time to time, but if I do some backwards sprints and wear a brace for a day it goes away.

[stompinlines]

This place is Vinman's world.
Listen to the man.

[yentna]

A bit late to post, but...

I've got the same problems, in both knees. Stretching the IT band turned out to be crucial. And, strengthening my hips. The knees still bother me but it's much more tolerable. I also tape my kneecaps in place and wear compression braces when doing impact or weighted workouts.

Best hip strengthener: exercise band around the ankles, squat and walk sideways, being sure to keep in the semi-squated position.