# PFS (runner's knee), 8 months down, super bummed



## jeanox (Dec 22, 2014)

Been lurking awhile, sad that this is my first post, but I'm going a bit crazy, so here I go... /*Begin Venting*/

In march 2014 I was crazy excited to train to bike up one of my favorite mountains. I started training early in the season. I haven't had a car in like...5 years and uphill/downhill street riding is part of my norm. I ride trails on the weekends and early mornings on some weekdays. In addition, I was doing some light running and squat workouts. 

Anyway. Long story short is, I had pain under my kneecaps when I was resting, thought that it was a sign of be being whiny, so I pushed harder, which made it worse. Both knees had the same thing going. I don't have insurance, so I had to go by Dr. Google and some friends, but runner's knee seems to fit my symptoms. I did nothing, rested, elevated, iced, compressed, all that stuff. I did that for a couple weeks. Then weeks turned into months. It hurt to walk across my apartment, it hurt to sit, it hurt to freaking lay down.

I'd read this stuff that would say "oh, you have runner's knee? Try riding a bike!" and I'd smack my forehead. There are 2 things that make my knee freak out instantly, that's anything resembling a pedaling motion and squats. 

It's been 8 months. I'm going crazy. I didn't realize how much of myself was wrapped up in riding/hiking/spelunking, but dammit, being immobile is really wearing me down psychologically. I can't even get freaking groceries because I don't have a car. I haven't needed one until all this. I was watching a show yesterday and one of the characters knelt down and was doing something while talking, and I realized that someone crouching down on the ground seems superhuman to me at this point. It drives me insane. A year ago I was doing higher level canyoneering, some pretty technical spelunking trips, and riding further/higher than I ever have. 

And here I am. If I walk half a mile on a flat road to the store, I'll be paying for it for days. 

*sigh*

My uncle is a PT with an emphasis in Sports stuff. He's trying to help me out, but I don't have money, so visits are infrequent. All the exercises he's told me to do make it hurt more, or leave me feeling the same. I'm foam rolling 3 times a day, strengthening medial quads, stretching IT band, and trying to avoid any kind of stressful activity. When I get back to riding, I know I'm going to do a lot of things different, but for now, I just want to use stairs again. Or, you know, not have to ice my knees for months on end. 

:madman::madman::madman:

There. ***** fest over. The psychological impact of sports injury is not what I expected. I don't think I've ever really been depressed until all this hit. My plan going forward is to proceed with strengthening exercises, introducing them slowly and carefully. Keep with the foam rolling. Nothing, I mean NOTHING has notably improved things for me yet. All I can do is keep trying different things in a measured/patient way until something clicks. Here's hoping it doesn't take 8 more months.


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## mantrain (May 23, 2013)

Sounds like you have several issues, not the least of which are your knees. Pain while resting is certainly not typical of most muscle-skeletal injuries. Are there positions you can get your knee into that will make it feel better? Has your PT uncle been able to shed any light in the issue?

Also, why in the world do you not have health insurance? We have this thing called _Affordable Care Act_, for better or worse. You can go online and apply for health insurance, and if you make no money, the gov't pays; At least that's how it works in CA. Pretty sure that exists in UT also, since it's federal.

I could say more about things I picked up on about your overall situation, but it would be going beyond the scope of mountain biking threads, and into the realm of life coaching... You might look into that though.....


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## jeanox (Dec 22, 2014)

According to the feds, I qualify for Medicaid. By qualifying for that, I am automatically disqualified for subsidized options and the matter is handled directly to the state. Utah chose not to expand it's medicaid. You basically only get it if you're pregnant or have dependents, neither of which I have or am planning to have. So the feds give me a big thumbs up, and utah gives me a big **** you, and there's nothing to be done for it, other than filling out forms to waive the mandatory fee due to my state being stupid. 

Basically tons of people who were uninsured before the ACA still are, only now they have to pay fees for care they don't receive.

Pain while resting is a classic sign of runner's knee because the pain is delayed. My uncle has confirmed that I have it (I can feel it tracking improperly and he's confirmed it in both knees). Part of what really sucks about it is that while I'm moving or exercising, I feel almost no pain. It is afterward that the pain comes (usually within 12 hours of the activity). It makes it difficult to track exactly what triggers the pain when the cause/effect has this delay on it. 

Another sign of runner's knee that I experience is Theater Sign (which basically means that if you sit in a chair for extended periods, pain is triggered due to stress placed on the joint, pressing the patella into the femur). This one sucks because I work with computers, so sitting is kind of a thing. I've modified my desk so my legs can be fully extended, which helps a bit, but isn't a final solution. I also get up ever 2 hours to foam roll and stretch. 

The imbalance is chronic at this point, the real question is why. Muscle imbalance seems to be the go-to first guess on this, but I've been working my VMO for a few months with no real change (usually, the VMO is weak and the other quads strong, which pull the patella out of it's groove laterally). The thing with the knee, according to my uncle, is that when problems arise in it, they are usually a result of problems elsewhere (hips, ankles, or both). It makes it a real mess to try and figure out just what combinations of things are contributing because there are so many factors playing into it. Flat feet, ankle injuries, q-angle, IT band tightness, hamstring tightness, quad muscle imbalance, etc. 

My frustration comes from the pain delay. Makes it hard to track what sets it off. The delay also makes it so I have to methodically test out potential exercises one by one, because if I try 5 exercises one day, then the next I have horrible pain, I have no idea which of the 5 triggered the episode. So recovery is slow. Inflammation is basically always present. After 8 months of this, some days I lose my composure (like today). 

Before all this, I had no idea how much of myself was wrapped up in biking/spelunking/canyoneering. Losing the ability to move and even walk to the store is humiliating and incredibly discouraging. I've focused for 8 months just on the ability to do mild activities without triggering pain. For the last few years, I've been working freelance but freelance isn't cutting it with this. I need health care. I'm applying for jobs with companies to open up my options. This lifestyle worked for me when I was free to bike all over creation, but now I'm just a prisoner. Unless you've been down for 8+ months with something like this, you probably won't understand at all.


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## Ridnparadise (Dec 14, 2007)

Don't take this the wrong way, because it is a professional opinion. If everyone went into all the possibilities of what is not right with their body, most would implode mentally. I agree you need to chill or get some emotional support that does not come in kilobytes.

However, start with this: 
You have a history going back 8 months
You were very fit and doing lots of riding and from what you said there was no injury
You have tried all sorts of physical therapies and the only thing happening is more pain
You say there is inflammation
You have resting pain which is NOT typical of PFS
PFS is not a diagnosis, only a syndrome that describes anterior knee pain
Theatre sign is more typical with plica syndrome and that is not what you have

So a fit person develops pain bilaterally and it is associated with inflammation and aggravated by things that have not and should not cause it. Forget alignment issues etc - they are irrelevant because you have not been able to do the activity you think caused it. Riding did not cause this.

You need a formal medical assessment. Bilateral arthralgia or arthritis suggests a primary rheumatology or infectious diseases diagnosis, including things like rheumatoid or psoriatic arthritis, mosquito or tick-born infection. Do not exclude STI's. 

Where were you 8-10 months ago and is it possible your emotional issues are because you are sick and not just sore....

Sorry you are not well, but do not expect me or anyone else on this forum to fix you. You need a formal medical assessment. Look after yourself now and don't wait for it to all get worse as your finances really fail.


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## jeanox (Dec 22, 2014)

"Sorry you are not well, but do not expect me or anyone else on this forum to fix you."

Never had that expectation. I just needed a place to vent and perhaps gain some more perspective. I want to hear what others have gone through if they've had similar symptoms. There's only so much I can do on my own and I exhausted that a long time ago. I'm not a doctor and I don't expect random people from the internet to wave a magic wand to fix my issues. I just want some perspective, so I appreciate replies, particularly from people who've directly dealt with this. 

In the end, I have no idea what really has caused this. Could have been a lot of things. What I really care about is how to go from here. I'm lining things up as much as I can to get professional help. In the mean time, I am trying to be proactive by rolling, stretching, and trying different things on my own. 

Despite my uncle's assessment and the piles of articles I've read on this, I'm totally willing to admit what I have could be something else. Especially when treatment has only made a mild difference. I kinda don't care what it's called, but I want to get back to normal. I want to train again. My riding is how I get around town 100%. It's how I visit people, how I get to work when I'm not freelancing, how I go to the store, how I escape when I ride in the mountains. It's very isolating to lose mobility that suddenly and not have it return. I don't have a car and cannot afford one, so my isolation and inability to do basic things without calling in favors is very upsetting. You may not like or understand my feelings, but they are legitimate. This also happened at a time where I'm taking a lot of chances professionally and, in shortsightedness, didn't factor an injury like this into my plans financially. My options for treatment are few. I'm having to change where/how I work in my day job just to fix this. I'm willing to change basically anything right now in order to get better. 

So yeah. Pain under my kneecap, inflammation of my knee ligaments, and pain that follows activity (not during activity). Painless crunching when I bend my knees. Anti-inflammatories help somewhat, as does icing and compression. That describes me. Whatever you call it, I have it, I want to work on it. I want to be responsible for this and treat it as much as I can on my end, even if that isn't enough, I have to feel like I'm doing something. Until I get a job with benefits, I must handle this myself as best I can. If anyone has felt these symptoms or has had a similar injury, I'd like to hear your story.

*edit* Oh, also, I'm giving IK Tape a go just to see if taping my knee has any effect. That's not gonna fix things, I'm sure, but if it stabilizes things, it may enable me to do some exercises without as much pain following which may aid recovery. Here's hoping.


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## mantrain (May 23, 2013)

sounds like chondromalacia patella. 
Just wouldn't that expect it on both knees.


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## danorano (Nov 14, 2012)

You should definitely see an orthopedic doctor. Tell them that you don't have insurance and that you need a payment plan. They'll give you the non-insurance rate for an office visit. Can you get the money from your parents? Trying to diagnose by reading all the different possibilities is really hard since injuries in specific parts of the body often have very similar symptoms.


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## drinkwat (Mar 17, 2008)

Bumping this thread. I am having similar issues, the only difference being that my knees don't hurt when I'm resting. For the past year of so I've always had a minor knee pain (generally below the kneecap) after rides. Over winter I built up a single speed and then a two months ago went out a rode my SS 4 times during over the course of one week. A day or so later I was walking up stairs and bang, intense knee pain. Figured I had just over done it on the bike and decided to just rest my knees for a week and then work on building up my leg muscles. Went to the gym ran for a mile and did some leg work and the next day I could hardly walk. My knees have felt seriously wonky ever since (tracking issues, popping/grinding, instability, dull to sharp pain mainly around the kneecap, etc.). I've been RICEing my knees for the past month and not exercising. The only strain my knees get now days is the occasional walk to campus and infrequently up and down stairs (which hurts). I have an ortho appointment for next week so hopefully I get some help, but man does this stuff suck. I really thought my knees would have healed by now. All I want to do is get my knees back to normal. I'm in agreement with the OP about the mental side of things being the worst. Really does bring on the depression.


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## Natedogz (Apr 4, 2008)

Ridnparadise said:


> Don't take this the wrong way, because it is a professional opinion. If everyone went into all the possibilities of what is not right with their body, most would implode mentally. I agree you need to chill or get some emotional support that does not come in kilobytes.
> 
> However, start with this:
> You have a history going back 8 months
> ...


Great info.

@OP, how's this going? Did you get to see good doctor yet? I've had tendonitis in both my elbows (bilateral epicondylitis) on and off for almost 30years...sucks but with help of good chiropractor/kinesiologist, massage therapy, stretching, light exercise with weights, some yoga, lots of walking and biking, better nutrition I am much better in recent years, but I have to be careful not to overdo certain types of exercise.

On the affordable health care act side, a long-time friend almost died back around 1997 after an offroad 4x4 accident and while he made good income, he had little savings except a house and Medicaid and MediCal wanted to **** him. They saved his life, but imo due to their own negligence also made him disabled for life. :/

This guy (Allan Willette) really helped me lots with my tennis elbow, I have no association with him or his site, just trying to help others. He can be little repetitive and I'm not 100% in agreement with him, he makes the most sense about it than anything or person that I've read or spoken with about tendonitis.
Tossing The Tendonitis Myth ? Why Tennis Elbow Is NOT Inflammatory

Whatever you do, don't give up. I wore tennis elbow braces for years and felt like a wimp and a freak, people always asking what's that on my arm when referring to the braces. I've had to wear them a few times since initial problems, when I've pushed myself to hard to soon.  There were so many things that I was simply incapable of that I should have been able to do....I know your depression...it makes me sad just remembering all that I've been through with this injury. Best of luck, please keep us updated and heal quickly. 

EDIT: @Drinkwat, same goes for you, heal quickly and keep us updated.


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## Bail_Monkey (May 8, 2007)

A few things worked for me, so they may not work for everyone as each injury is a little different. Especially when your talking about knees, with ligaments and tendons, bone, muscle...

Left knee hurting, right knee is OK. Climbing quickly with not enough cadence... I first advise to keep a higher cadence when climbing, basically spin faster.

To relieve inflammation, try ginger. In a blender, add about an inch and a half of raw ginger, fruit juice and squeeze one whole lemon. Blend and drink on the days you workout. I have been drinking this at least 4 times a week if not more. There is sweetness from the juice, tartness from the lemon and spicyness from the ginger actually tastes pretty good. If you like it a bit sweeter add agave, a banana. You can make it green w/spinach or kale. My knee soreness has subsided. I'm going to try to add fresh turmeric as it also reduces inflammation.

I also have an ace bandage wrapped around and below my kneecap to keep my patella tendon down. If the patella tendon lifts and your kneecap is not centered, it can cause pain. Your quad can pull your kneecap towards the outside causing problems... The ace bandage is reusable, there are people who tape up their knees, but it wastes tape... 

Good luck.


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