VMO rehab..success ?

Shades

Hi,

i've got a vmo muscle( inner quad) that is weak/wasted/inhibited, causing a slight lateral tilt of the patellar resulting in a bit of inflammation around the knee cap. Consequently i'm limited in how much cycling I can do.Basically it's patellofemoral syndrome.

I've been trying to sort the problem out for 1-2 years. My approach is to get the inflammation down and to try and build up the vmo with physio; however, I'm not making much progress.

Anyone ever had this problem and successfully cured it?
Any vmo excercises out there that actually work? How long should it take?

Cheers,P

SportDoc

Another thought on PFPS. Short easy read.http://www.chiroweb.com/archives/24/11/05.html

afroboy

Do you still have a weak vmo? I used to think that all my pain in my right knee was just vmo weakness. I would work the hell out of my right knee with lunges, squats, leg exensions (last 20 degrees only so as not to put extra pressure under the patella). It ended up i was working my knee so hard i was getting patellar and quad tendonitis and no longer PFS. The resolution of the PFS only took about 4 weeks after i got the inflammation down. There are also many other factors like internal foot pronation, tight ITB, weak hip flexors, tight hamstrings and calves, leg length difference. Pedals with extra float can help some people, as can a shortening of crank length to decrease the pressure on the patella at top-dead-centre of the revolution. Either way, nothing gets betrer til it is completely rested and you start again when the inflammation has gone down. Goodluck with it mate, if you want any more info, just message me

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(Awaiting delivery!) 2007 Giant TCR Alliance 2, 105, Campag Vento wheelset

2zanzibar

Good article, does anyone know of any simple hip flexor and iliopsoas exercises?

Gluteal strengthening excercises having been very helpfull for me. Still have a tight ITB though.

afroboy

Hi Mate. Check out this link:
http://www.exrx.net/Lists/Directory.html
I use exrx for all my exercise requirements. It is a great page and has animated examples for all exercises, so you should find some flexor exercises to suit you

I am currently doing eccentric exercises for my patella and Quad tendon which is just fantastic. Interestingly, i too have to do some glut strengthing as my right side (also the side with the bung knee) is weak. As for the old ITB, they are such a pain when they get tight! I have had 2 ITB rubs from a physiotherapist, and was deeply bruised both times so i do my best to keep that baby all stretched so i dont need a rub LOL.
While on the ITB, check out this page:
http://www.exrx.net/Muscles/TensorFasciaeLatae.html
I used to have a VERY tight TFL which connects to the ITB. I was taught stretches for that muscle, and i had great relief from ITB pain

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(Awaiting delivery!) 2007 Giant TCR Alliance 2, 105, Campag Vento wheelset

2zanzibar

Thanks for the links afroboy, thats a great website!

xbgs351

Thanks a lot for that link. I have had pfps for about 19 months now. I have see a number of sports doctors, physios a podiatrist and I have even had a surgeon do a scraping of the patellar. The results have been disapointing with continual knee pain. I had been riding between 0 to 80 km per week as doing no riding made them far worse and this sort of volume didn't aggrave them excessively.

I read the link two weeks ago and realised that my hips had been in the described position for about 2 years after I hurt a disc at work. Over the last two weeks I have been stretching the relevent muscles at every spare opportunity and my hips are now in a much better position. My knee pain is the least it has been for a long time and I can actually sleep on my stomach which is something I haven't been able to do for a long time due to the pressure on the patellar.

Last week I managed to ride 105km which is the most I have ridden in a bloody long time and this week I have ridden 145km. I hope the improvement will be long term and at this stage it feels like it will be.

kennf

I struggled with PTFS for about 6 months earlier this year, to the point where just sitting at a desk would make my knee ache. Saw a very good ortho who simply said I was misaligned (SI joint). Agressive streatching of the hip flexors, IT band and glutes did wonders. Also, doing one-legged squats with my back against a swiss ball on a wall has helped stabilize the knee (and works the hell out of the VMO, although VMO weakness wasn't really what was screwing me up).

Shades

Thanks for all these suggestions. Well two years into it i've still not solved my PFS problem. I can relate to the symptoms & frustrations listed in your posts all too well.

I get knee pain usually 3 hrs into a road ride. Initally I feel a sort of tugging or tightness at the very top of the calf (maybe the gastrocnemious). At this stage it's not too painful, but if I continue to cycle for 10-20 minutes it then quickly escalates into very severe knee pain on the lateral side of the knee. The knee becomes red and swollen and i cannot continue cycling. In fact, I can barely walk. If I stand up in the saddle the pain lessens somewhat. But I cannot lower my body weight on that leg at all . Climbing & descending stairs is too painful for 10 hrs or so. And yet, 24-48 hrs later im almost pain-free and can cycle again (although im not doing that as rountine).

In general, I'm always getting the "cinema-sign" symptom of an aching knee-cap after prolonged sitting or driving. I've also noticed that the vmo on the problem leg, although still of a fair size, is weaker and doesn't fire as strongly as the other vmo muscle. MRI scan showed a slightly lateral tilt of my patellar. Im still limited in the amount of cycling I can do. I did do one 80 mile road-ride this summer and got away with it. I used to do a ride like that at least once a week.

Some conclusions i've made:
* The ball and squat excercise recommended by kennf, which i've started doing recently, seems to be improving things slightly.
* McConnell taping of the knee seems to help a little too.
* I stretch and stretch and am now the most flexible man in Britain. Probably for that reason I don't find stretching to help any further. But my calves are still tight I reckon.
* I find mountain biking to be easier on the knees, probably due to the lower gears and the lower rpms on the descents.
* Resting definitely makes the knee pain worse.
* Tried all the excercises and I still cannot get my problem vmo to function correctly i.e fire and flex like the normal vmo.
* The cinema sign symptom seems to be a good indicator of the severity of the PFS, which seems to vary over time but never go.
* Some physios are excellent. Some are a total waste of space. If you see one make sure they're a sports physio who actually does some sport.

Navigator

I know its been a while that you have had this item posted, however you have described my issue to the tee. My problem is exactly the same and I'm in my third season with it. Did you manage to improve your condition and how?

I'm really hoping you fixed it

raspy87

Hopefully by now you've sorted the problem out. If not i found a pretty simple but effective VMO work out...not sure if it was posted (if it is sorry for the repeat). I was having right knee pain and a PT friend of mine suggested this work out. take a coffee can, lay on your back on the floor, place the coffee can under the affected knee, and continually tighten your quads lifting your heel slightly off the ground. try doing about 50 of them twice a day... in the morning and at night before bed. if 50 is too much/little gauge appropriately. don't exceed 100 per set starts to become ineffective.

if the pain continues, you may want to seek medical attention. could possibly be something such as the beginning of rheumatoid arthritis or possibly lyme disease. (hopefully not, would not wish it on my worst enemy )

hope you figure it all out
Cheers
Andrew

Navigator

Thanks so much for your response. Its really appreciated. I've not sorted it out yet fully but I am seeing a Sports Massage guy who is really good and has helped me tremendously. It seems that he can only take me so far though and i'm keen to work harder for a fix. I am in the process of buying my dream bike, so want to be able to enjoy it this season.
Does it matter what kind of coffee can...Starbucks or Second Cup(Canadian Coffee Shop)?

raspy87

Not sure if that was supposed to be a joke lol. But should have about a 4 inch diameter and be able to fully support the knee (be as wide or wider than your knee) the can should be laying on it's side (so you can roll it) just to clare things up. I hope you understand this hahaha if not get back to me and i'll try to be a bit more clear.

Good luck
Andrew

Shades

hi,

i'm the OP.

yes my knee has improved, but it has taken a long time -2 years!

Looking back at my original post I wrote: "i've got a vmo muscle( inner quad) that is weak/wasted/inhibited, causing a slight lateral tilt of the patellar resulting in a bit of inflammation around the knee cap".
Actually I think that I got it the wrong way round. I had inflammation, maybe tendontis, that eventually caused a weak vmo and then patellar maltracking. Inflammation around the knee will inhibit the VMO muscle, which can then in turn lead to patellar maltracking problems. Because the inflammation was stopping the vmo from working efficiently, excercises were pointless. So the way forward was to reduce the inflammation, and then sort the vmo muscle.

The key for me was getting some ultrasound on the knee which helped the swelling go down. It was only after the swelling went that the vmo excercises started to work, letting me build up the VMO muscle again.

I'm not convinced its totally better ( it feels weird going up and down stairs) but I now regularly do 3-4 hour rides over hilly terrain. I'm also back training for time trials.

My advice - if you have any knee problems be very cautious with your cycling. Get some good physio and cycle cautiously. I just carried on and lost 2 quality cycling years.

caused