Monday, August 11, 2008

Patellar Femoral Syndrome

I have gotten a professional diagnosis! Pam (aka McKenzie) was right on with her comment, thanks. Last Thursday I had my call with coach (Scott) and told him the dramatic version of my failing knee. He hesitated little before he called it PFS. The good news is this will heal and even more good news is it most likely will turn itself around before Teton's. PFS is a common knee ailment among runners and bikers. I know mine is a result of biking on TOP of my training for Teton's. I also believe running for many hours on bad blisters just drove it home.

The plan: Extremely aggressive VMO stimulation! That means diligent exercises and some as many times a day as I can handle it.

1. Sitting with my back against a wall with my legs straight out in front, place a small ball between the legs in the middle of the quad, squeeze abductors then contract quads...tapping the VMO to make sure it knows you mean IT! This is to be done all day long and even while walking and standing I am supposed to think about contracting this muscle.
2. Pulley attached mini squat for eccentric loading. A strap around the leg just below the knee while the other end of the strap or cable is attached to the a post or if it's a cable it's attached to a weight stack. Step back to create tension then squat focusing on the eccentric phase of the load...when you straighten the leg but do not hyper extend the knee. Do this 3X20-30-40 or whatever I can do.
3. Run at a 5-7% incline on the treadmill. Start very slow, think small steps, knee lift, quick paw-back, do this until I get a zinger in the knee then finish the workout on the elliptical machine.
4. A bunch of exercises for the glute medius to prevent deterioration and to help keep the knee driving forward not diving inward.
5. Ice like a freak.

That is the plan and of course I hit it hard. When I started this on Thursday my VMO would barely respond. It looked atrophied and very week. My run lasted 1 mile on the incline before I got a zinger. Apparently the sharp pain I experience is due to the lack of muscle contraction and the kneecap jams over into a bad spot. By Saturday morning things were looking better; I barely had any swelling or pain while walking. This was so cool and I was able to run 1.5 miles. My VMO was quivering during the rehab. which is good news because at least it's waking up.....hello!

Saturday night I arrived in Utah late and had already planned to meet a few people on the Wasatch course. They needed aid and I would join them to the finish of their run which meant I would run 15 miles. The long drive to the meeting point was a quiet one as I debated whether to give it a go or not. When we arrived I gave the knee a test spin and it was definitely better but not great. I spent another 45 minutes debating with myself and Bill. I cried, I paced, I relaxed, I fought the urge, I gave in to the was exhausting emotionally over a simple run which is sort of pathetic. Logically I knew it would be best to skip the rugged hilly run and continue my rehab but part of me wanted to test it, push it, get over the fear of using it but in the end logic won. Deborah completely understood and encouraged me to NOT run.

This morning I had an appointment with a physical therapist. Scott recommended I see one to be sure I am doing all the exercises right and maybe add some hands on feedback. Bill found me a great one here in Park City. This is a good place to be with a knee injury because of all the skiing, knees are a speciality. I was excited to get someone to poke and prod at my knee and make sure I was doing all I can to heal it quick.

Before my appointment I headed down to the gym for my routine and workout. I got all set up and was able to run 3 miles!!!! Big day for me. :) I probably could have run further but felt very mild pain so I jumped.....I mean dismounted slowly and got on the elliptical for the rest of my workout. I got me heart rate pumped today for over 1 hour. I spent another hour doing weights and the rehab. stuff then it was off the see the doc.

The PT poked, prodded, slid, pushed, thumped and jostled my knee cap and all surrounding areas. She smiled and said, "Your going to be fine"! She said my three days of rehab. was spot on and my knee is almost mended. She put me through a battery of tests, workouts, ultra sound, stretches and ice. She recommended I come back Wed. and Fri. but by then I should be good to go. She said some of the same things Scott said, like;

1. Doing nothing is the worst thing you can do.
2. AGGRESSIVE VMO stimulation is way to rid yourself of this and resume training.
3. You will be fine for your race.

I am still not banking on Teton's but I am optimistic. When I can run anything on trail, up and down I will feel better. I think that day is nearing. Until then I am getting my cardio and tempo stuff done in a creative fashion. I am running/walking uphill (3.5 miles) at AT then having Bill drive me back down and then repeating. I am on the elliptical doing strides. I think I can stay in shape but without the long descents I feel nervous that my legs will not hold. Maybe all this strength training will be good stuff. One thing is for VMO will be strong. :)


  1. Great news!
    I did have to lookup VMO though: vastus medialis obliquus. For others like me:

  2. Awesome Ronda! You will come out of this stronger for sure and with a happy knee! Get clips before you hop back on that bike! ;)

  3. Positive thinking coupled with a bunch of rehab and patience...really, Ronda, when did things not happen for you last time? :) Looking forward to see you at Tetons!

  4. Here's to a quick recovery! I agree -- clips aren't so bad.

  5. I've been out of pocket, so I totally missed it that you hurt your knee! So glad to hear you have it under control.

    Can't wait to hear about Tetons. Looks like an awesome race!

  6. Ronda,

    Great news about your knee!@! Surf was pumping today. Overhead and 100 degrees in the city. Good day. for marathon PR going well.

    Keep driving with that intensity you maintain so well. You are almost there. :] K

  7. I have had a similiar problem for 4 years and your analysis and exercises have worked the best. Only time will tell. I'll keep ya updated. Thanks for caring and sharing.