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Patella-femoral syndrom and speedplay float(22 posts)

Patella-femoral syndrom and speedplay floatWoof the dog
Dec 12, 2001 12:30 PM
Hi all,

Finally went to see a doc about the R. knee problem I had on and off throughout the year. Here are the conclusions: when I walk, I don't use that big inside muscle (forgot whats it called, starts with a v) that pushes the patella outside/into the femur groove as much as I should, so my leg snaps back into place. Pain and discomfort are caused by the patella rubbing against an inside lower bump of the femur because even though that muscle is developed due to cycling it lacks in lets call it "lengthening ability." She felt the rubbing in my r. knee. I also twist my feet out when i walk, like you would when clicking out. I ride speedplays, love the pedal, but I am starting to wonder if that has any effect upon the knee problem I have. I am not sure what role does this foot twisting plays in my situation, but would I be better off getting a more restricted float pedal? Anyone who has a clue what I speak a/ please advise.

Thanx.

woof.
re: Patella-femoral syndrom and speedplay floatmorey
Dec 12, 2001 12:35 PM
The muscle is called the Vastus lateralis, the speedplays are not the problem. I have the problem with my right leg, which has some deterioration of the vastus due to tha auto accident. One solution is leg extensions with a light weight, toes facing out. Do high reps 15-20. Do them fairly slow.
Morey, clarification?Jon
Dec 12, 2001 12:43 PM
Morey,

He's describing an "inside" muscle which would be the vastus medialis, but functionally
talking about the vastus lateralis with respect to its action on patellar tracking. Maybe one
had better inquire a little more about what's what? Just checking.
Morey, clarification?morey
Dec 12, 2001 12:52 PM
It could be the vastus medialis, however the same advice would apply. Unless he asks, we can only guess. It is one of the vastus group, that we know. Speedplay pedals have really helped me.
Conflicting infobrider
Dec 12, 2001 1:05 PM
Seems there's some conflicting information here. Originally was described a problem with "lengthening ability" of one of the muscles of the vastus group. Morey, you describe a problem with the v. Lateralis, but describe a strengthening exercise for the v. Madialis, then say it would be the same for the v. Lateralis. What gives here? I'm thinking that there's a scar tissue problem here that might be best addressed by ART treatment. Doesn't sound like a strength imbalance to me. Any thoughts?
Conflicting infoWoof the dog
Dec 12, 2001 1:52 PM
Just called her, its vastus obliqus (sp?) or in other words, VMO. and I don't think i have any scar tissue. Whats ART treatment?

Thanx a bunch

suffering Woofie.
Conflicting infobrider
Dec 13, 2001 8:35 AM
ART is Active Release Therapy, a fairly new (to the mainstream) chiropractic treatment that gets results FAST. If you can find an ART practitionaer in your area, they're good as gold.
re: Patella-femoral syndrom and speedplay floatnothatgullible
Dec 12, 2001 1:05 PM
I was diagnosed with the same problem that you have and I was on speedplays. I found a good sale on Time Equipe pedals and decided to give them a try. Guess what, the knee felt a hundred times better, I guess the more stable platform maybe combined with less float might have had something to do with it. The only problem was that I developed ITBS on my right knee. Oh well I guess you can't have it all. But if I were you I would give the Time pedals a try, if you look around you can get them for less than $125. Good Luck with that knee. Knee problems stink.
re:I wonder if anbody uses two different pedals. nmdzrider
Dec 12, 2001 1:52 PM
re:I wonder if anbody uses two different pedals. nmnothatgullible
Dec 12, 2001 3:19 PM
As far as using two different pedals, I've thought about it many times. My left knee prefers the Time pedals and the knee with ITBS prefers speedplays.

Concerning the ART treatment, I had it done for my ITBS and it didn't do a thing for me. It cost me $140 for the first visit of an hour and $70 for and extra two visits of a half and hour. I think is has a lot to do with the experience of the person performing the treatment. The chiropractor I went to was certified in the treatment but I guess didn't have enough experience with it or simply the treatment is not the miracle they claim it to be. Right now I'm having myofascial release treatments that cost me $40 an hour and it has made a big difference. So be careful out there, there are a lot of promises in this world made by a lot of people but when it comes time to deliver, it seems that a lot of them falter.
my story -- Morey & others, please commentharper
Dec 12, 2001 2:29 PM
I have been diagnosed with the same problem.

Ortho sent me to the therapist. Therapist, after examination, believes that my quads are too tight (not flexible) and are thus causing too much stress on my tendon, causing aggravation. I'm on a treatment program of ultrasound, followed by intense stretching of the quad and hamstring, followed by ice massages. Also instructed to do some light quad strength work. The exercise I was given wasn't what I expected. I was told to lay on my back, turn my toes out, and lift the leg for a count and back down. I thought I'd be banging weights around.

I've been in therapy for one week. The knees feel good after therapy, but develop soreness afterwards, probably from all the stretching.

Does the "too tight" analysis sound correct to anyone? Or am I being given bad advice?
my story -- Morey & others, please commentmorey
Dec 12, 2001 2:39 PM
The Vastus obliques is towards the oblique muscle ( which is outer or side of the abdomen, love handles), however all the vastus muscles are in the inner thigh. Pointing toes outward would greatly improve the tension here. This is generally a very weak area, do not need alot of weight, probably just your leg weight would do. The "too tight" diagnosis would also be a factor. Can be either or or both.
vastus medialis obliquus or vmoRaiderMike
Dec 12, 2001 2:55 PM
I just had surgery to reconstruct a torn ACL, my vmo has deteriorated to nothin which lets my outside quad muscle which is the vastus lateralis something or another pull my kneecap towards the outside of my knee when I walk and it misses its groove and locks momentarily. I do straight leg lifts with 15lbs of ankle weights I lift my leg 12" hold it for a 5 count and repeat as many times as you can x 4 sets. when I do these I turn my foot out to the outside of my leg which isolates the VMO. 1 leg squats work well too. I doubt in your case it is a weak vmo as much as it is an overdeveloped vastus lateralis muscle which most cyclists have. If you have one of those neoprene supports with a hole in it for your patella wear it with the hole slightly off center towards the inside of your leg this helps the vmo keep the kneecap in its groove. It almost eliminates the sticking on my knee.
re: Patella-femoral syndrom and speedplay floatChen2
Dec 12, 2001 4:17 PM
It's what I have and my knees like Speedplays. Poor petellar alignment, vastis medialis (sp?) underdeveloped relative to the vastis lateralis. The kneecap is pulled to the outside and there is excessive pressure between the kneecap and the lateral condyle of the femur. Now that I'm 58 almost all of the cartilage is gone in that cantact area. I've had five surgeries to correct the problem. These have included retinacular releases, the petella is cut loose from the vastis lateralis, chondroplasti, the cartilage is shaved smooth, and tibial tubercle transfers, the tibia tubercle where the petellar ligament attaches to the tibia is cut off, moved medially and screwed back down. These sound like extreme measures to correct sore knees, but they have helped quite a bit and my legs don't have a strange appearance except one screw head left a bulge below the skin. After surgery I was on a stationary bike in 5 days and back on the real thing in 2 weeks. Five weeks after surgery I did the Backroads Wine Country tour, Napa Valley, Sonora Valley, Russian River Valley, and all of the hills between the vallies.
I'm not recommending surgery to anyone, but it can be, in some cases, the best alternative. And if I had done it earlier in my life I would have more cartilage in my knees now. This year I rode more than 2000 miles including 2 time trials and 2 centuries. My knees feel better on Speedplay X1's than on SPD's.
-Al
stretchgtx
Dec 12, 2001 4:18 PM
I don't know all all the medical jargon, but I've had knee problems off and on for years (used to run and play soccer), most recently something like what you describe. I couldn't solve it by changing my setup or even by backing off on the riding. I talked to some PTs and friends with knee problems, and someone turned me on to the Wharton's stretch method, which is being used by some Olympic level runners and swimmers. In the Wharton's book, it states that cycling can create overly tigh quads, which will compress the kneecap against the joint. That described my problem pretty much exactly (with no fancy lingo). After a few weeks of using the stretching method (which is much different than conventional stretching), I feel 100% better, much more flexible and less injury prone in general. Good luck.

http://www.amazon.com/exec/obidos/ASIN/0812926234
re: Patella-femoral syndrom and speedplay floatsprockets2
Dec 12, 2001 4:24 PM
You don't seem to indicate if the cycling is the direct cause-like it begins to hurt while you are on the bike or immediately after-or if it becomes prominent at some other time. If it happens during a ride, that is one thing, but if it just sort of begins randomly, comes and goes, that is quite another.

In either event, I like the earlier ideas of leg exercises and stretching, to bring the muscles and connective tissue into better balance, but dang, man, work on your walking gait, it isn't a fixed thing. Also, note the term syndrome. It is somewhat non-specific, excepting that it pertains to the kneecap and the femur. Many of us have had knee pain which would roughly fit under the P-F Syndrome heading-mine did, and it had different causes. You could have a few things happening at once. Both walking and riding could be giving you a hard time. But again, you didn't specify the onset specifics.

To finally answer your question, I would think that a less forgiving pedal would be the wrong direction to go. You make a knee and leg behave by working on their interaction directly not by locking down the ankle and swinging from there.
re: Patella-femoral syndrom and speedplay floatrocky
Dec 13, 2001 7:09 AM
I've dealt with the same issue for years and I've seen many doctors/therapists/quacks to no avail. The only thing that ever worked was time off the bike coupled with stretching/ice/ibuprofen. Once a year or so my knee problems would pop up again. This spring I paid out of pocket to see Andy Pruitt in Boulder. He was the first person to completely understand my situation from a cyclist's point of view. His diagnosis was simple - most cycling shoes are not designed very well and because of this most people are susceptible to knee pain. The platform is too flat and when pressure is applied (pedaling), the knee has a tendency to collapse inwards which will eventually cause aggravation. You can read a good explanation of this on specialized's website in regards to their "varus wedge". The solution was a couple of little wedges, "big meats", under my cleats. The wedges change the angle of your leg (moves it outwards) and put the ankle, knee and hip into alignment. After a little rest, so the inflamation would go away, my knee was fine. His belief is that if your motions are biomechanically correct, you will not have to rely on adapting to the problem. BTW, He did help design the specialized body geometry shoes, but he never tried to sell them on me.
If you can, try to see a specialist who rides bikes. They will understand. If not, try a pair of specialized shoes.
good luck
john
re: Patella-femoral syndrom and speedplay floatmorey
Dec 13, 2001 7:27 AM
After going over my anatomy books:
Vastus Lateralis Oblique - VLO
Vastus Medialis Oblique - VMO
These are the two Vastus muscles which are attached at the hip and inserted at the knee.
The vastus lateralis tends to do most of the work, therefore the medialis if injured can regress quite rapidly which allows for misalignment of the knee. Leg Extensions, Leg Curls and stretching with light weight would probably help. Toes facing out!
re: Patella-femoral syndrom and speedplay floatzac
Dec 13, 2001 9:57 AM
i second the motion to use time pedals.

i used the x-2s and immediately developed severe pain in my right knee. moving the cleat to the outside of the shoe (i.e., the foot is closer to the crank and more centered over the pedal) helped considerably.

the main problem i've found with the speedplays is that the spindle cannot be centered under the ball of the foot - in my case (with sidi mega g-4s) the pedal is too close to the toes. this means that i can't get the proper leverage especially when standing.

calls to both speedplay ("it's simple - get another pair of shoes") and sidi ("we've never heard of this problem before.") were frustatingly no help at all.

i got a pair of time equipe pros and the problems pretty much went away. there is still about 10 degrees of float in the time pedals but the platform configuration puts the ball of the foot on or in front of the spindle. my knees (tendonitis for the last 25 years) are pretty happy. and i can stand and crank on these guys. like some of the review on this website indicate, you really feel locked in. a downside is the weight compared to the speedplays. when i look at performance on the bike, however, there is no comparison - ergonomics are still far more important than a few ounces.

i would also concur with rocky(john) - most bike shoes are not properly designed. if you look at the actual shape of the foot outline (determined by the last, or mold, the shoe is made over) it barely resembles your actual foot. it's possible that if your shoe is not comfortable, you may be overcompensating in your knee joint, but that's an idea.

i also agree with the others - biking is very muscle specific - and a muscle imbalance can cause real problems in your joints. i recommend rowing as an alternative training outlet. most gyms have the concept 2 ergometers (don't use those silly gas shock things). you will get all the strength and aerobic training you need and more. try to find a rower to show you how to row properly (if not you might develop other problems).

good luck
alighnment, shoes and crosstraining + pedal strokeWoof the dog
Dec 13, 2001 12:49 PM
I got this knee pain when I was using spd's and regular (shimano) shoes. I had really tight hamstrings as well, but I started stretching so they are only a tiny bit tight. Last winter, I purchased speedplays and specialized body geometry shoes that are supposed to align the leg, and I think they do the job well. I was able to get the speedplay cleat far back enough, and I even have some extra space, i think. The problem didn't go away or change to a better (the discomfort would come and go), so I know that in terms of my technique and ergonomics on the bike I am doing everything fine. Well, I can't be 100 % sure, but I already did what I can for my knees and the problem didn't go away. The problem I am experiencing probably comes from not having any cross training, not even a gym usually. Last year I barely even walked (just biked everywhere), which probably caused my leg to snap back quick while walking without the vmo used to pushing the patella into the groove quick enough - thats how I get the pain. I feel that my knees like it better with speedplays because the float is not restrictive. I will ask my doctor about this kicking out foot thing first thing on monday. She is going to show me all the exercises I need to do, but I am certainly open to your suggestions. I will check with her about rowing and the morey suggestion. Hope it will go away. I noticed that when my town bike broke and I had to walk a lot, my knee felt better. I think that is because I cause my vmo to work correctly and walk right, so the cartilage on femur doesn't get aggravated. I also tried a little strap that holds up the patella and it helped, but I don't wanna wear it - it sucks. Thank you all for your suggestions. All were read and taken into consideration.

Woof the grade A honey producing bee.

P.S. Would there be any biomechanical problem arising from twisting a foot out a tiny bit on the upstroke? Its kind of natural to make sure there is enough space between the heel and the chainstay, but I could work on having my leg pointing dead straight throughout the stroke. Or it wouldn't matter? Thanx.
alighnment, shoes and crosstraining + pedal strokeWoof the dog
Dec 13, 2001 12:52 PM
in the P.S. part: i mean my FOOT pointing straight, not a leg.
alighnment, shoes and crosstraining + pedal strokezac
Dec 14, 2001 6:30 AM
i've seen people riding with one foot parallel to the bike and the other toe'd in, literally, about 35 degrees. everyone is different. i find myself toeing in slightly and not to avoid the crank arms. maybe it's a comfort thing.

i think that, like the walking gait, the riding position and biomechanics for each person, in the end, are entirely individual.

i don't know your age but i'm 44 and wish that i had cross-trained more in my early 20's instead of being so singularly sport concentrated. i know of many world champion rowers who have, for reasons of injury or other, been forced to do other exercises they would have never considered before thinking that their rowing conditioning would deteriorate. in fact, the opposite occured: they would come back to perform better than they thought possible.

i highly recommend finding other activities to do(e.g.,walking is fine and speed walking requires a great aerobic system)even if they don't seem related to biking (e.g., swimming).

best of luck