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Hello guys,

I recently developed a patellofemoral syndrome probably due to 3 causes:
- saddle too front forward and too low
- too much power too often on the indoor trainer
- overuse (I'm at 4500 km in Zwift since last November)

With my PT and according to the pain points when massaging, we believe that the VMO was the root cause because it was extremely sore. It took a full 2 weeks to get it back to life. I also eased up on training during these 2 weeks. Daily massages and re-positioning of the saddle allowed me to get back to Zwift.

Now the problem...

My PT gave me 6 stretching exercices. Two of them directly or indirectly pull on the MCL and Pes Anserine.

Even going extremely gentle, and making sure that all my muscles are warm, after these stretches, I feel pain in the MCL and Pes Anserine area for 1 to 2 days.

On the other hand, I also feel (somewhat... really not sure on this one) that these exercices are beneficial after the 1 to 2 days heal.

Should I keep going? Did you ever experience this?

Thanks!

8 comments

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madcarew [786 posts] 6 months ago
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Really, ask your PT. What someone else has experienced with MCL / pes anserine inflammation may differe wildly to what you experience. A cycling specific PT may be helpful. I had chased a glute 'injury' for about a year with various specialists, and eventually when going for a bike fitting with a cycling specific PT (works with NZ olympic squad) and he diagnosed a likely hip issue which required surgery to fix, and fixed the apparent glute issue. The PT was cycling specific which made a huge difference to the way he approached the problem.

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zzk [56 posts] 6 months ago
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I'm struggling to make sense of your and your PT's logic. 

Problem saddle too low and fore = solution raise saddle and move aft

Too much power= not the problem, just bad position

Overuse = could be a problem if unaccustomed, but if not could just be position

 

VMO can give rise to PF syndrome, but may simply be effected by bad position

Save yourself a lot of money and temporarily cut volume and regulartiy of intensity. Get that bike fit sorted and move on. Incidentally get out on the road. Static trainers no matter how smart and technologically advanced do not reproduce real cycling and tend to load up the patellofemoral joint due to the continual resistance throughout the pedal stroke. Similar to riding a long climb or beasting a headwind.

 

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VeloUSA [267 posts] 6 months ago
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Not all PT's know everything about the body, especially the kees. Those who don't may give poor advice. Call around and find a PT who specializes in knee therapy or one who is an avid cyclist. A visit to an orthopedist is possible, or if you have inflamation then an rheumatologist may be consulted to get down to the root cause.

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Xcessiv [1 post] 6 months ago
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Thanks guys. After reading a lot about the topic, I believe I overstretched my hamstrings which connect to the medial side of the knee. I still need to find out what caused the apparent patellofemoral syndrome prior to the hamstring overstrech. I still believe the main cause is the saddle being too far forward, combined with overuse. 2 months ago, I considerably brought it forward because my bibs were slightly rubbing on the seat post. I was worried of damaging them. Big mistake...

@madcarew: very good point, and it is quite funny that you mention the hip because I believe I also have hip flexor issues.

@zzk: also good point regarding indoor training. That's where I've developped most of my injuries.

@VeloUSA: very hard to find in this area, but I'll give it a shot.

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CXR94Di2 [2192 posts] 6 months ago
1 like
zzk wrote:

I'm struggling to make sense of your and your PT's logic. 

Problem saddle too low and fore = solution raise saddle and move aft

Too much power= not the problem, just bad position

Overuse = could be a problem if unaccustomed, but if not could just be position

 

VMO can give rise to PF syndrome, but may simply be effected by bad position

Save yourself a lot of money and temporarily cut volume and regulartiy of intensity. Get that bike fit sorted and move on. Incidentally get out on the road. Static trainers no matter how smart and technologically advanced do not reproduce real cycling and tend to load up the patellofemoral joint due to the continual resistance throughout the pedal stroke. Similar to riding a long climb or beasting a headwind.

 

The point about indoor trainers is not correct. Smart trainers offer variable resistance, just like riding outside. if you ride in the wrong gear and grind whether outdoors or indoors then you will strain your legs joints

Avatar
CXR94Di2 [2192 posts] 6 months ago
1 like
zzk wrote:

I'm struggling to make sense of your and your PT's logic. 

Problem saddle too low and fore = solution raise saddle and move aft

Too much power= not the problem, just bad position

Overuse = could be a problem if unaccustomed, but if not could just be position

 

VMO can give rise to PF syndrome, but may simply be effected by bad position

Save yourself a lot of money and temporarily cut volume and regulartiy of intensity. Get that bike fit sorted and move on. Incidentally get out on the road. Static trainers no matter how smart and technologically advanced do not reproduce real cycling and tend to load up the patellofemoral joint due to the continual resistance throughout the pedal stroke. Similar to riding a long climb or beasting a headwind.

 

The point about indoor trainers is not correct. Smart trainers offer variable resistance, just like riding outside. if you ride in the wrong gear and grind whether outdoors or indoors then you will strain your legs joints

Avatar
peted76 [1142 posts] 6 months ago
2 likes

@Xcessive

You sound like the sort of person who likes detail. A fresh, professional bike (and cleat) fit should be a priority for you IMO. It'll be worth every penny to you in the long run.

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Daveyraveygravey [611 posts] 6 months ago
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How do you do that much riding indoors?!  Bloody hell!

Anecdotal story from my experience, different but similar to what you are saying I think.  I did a charity ride round Goodwood racetrack a few years ago.  It was a great experience, there was a large bunch of people going really hard.  I joined in, did my share on the front (I was one of the 4 or 5 that went on the front, unlike the other 20 or so but that's another story) but after a few laps I was aware of growing discomfort in my pelvic region, which wasn't getting better.  Next time round I pulled into the pits and leant up against one of the garage walls, I was locked into positon on the drops and could not get out of this position.  I eventually lurched onto the grass and more or less fell off the bike and lay on my back for 10 minutes, gradually moving my legs and back.

I think I had been so focussed on the effort, and pushed myself so hard, I got this cramp, I can't think of any other way to describe it.  I've never had it before or since, but am wary now of whenever I put a big effort in to move around on the bike.

I rarely bother doing any stretches at all, I don't seem to benefit from them. I will warm up gently for 10 minutes on almost every ride, and try to finish a ride with a cooling down period, but sometimes the moment carries you away.