Bilateral Patella Femoral Syndrome for 6 months with no end in sight when do you consider surgery?

by Liesel
(Los gatos, CA)

I hiked every day (worked as a park ranger) this summer and developed very severe patella femoral syndrome. I have a high pain threshold(I pushed through pain this summer unfortunately and created this)...but this is something else.


I have been in 3 months of physical therapy including stretching, leg raises, hip strengthening. I am a very fit 42 yo female and athletics are an extremely important part of my life (I was a competitive cyclist, and recreational body builder before this summer...my vmo is plenty strong, but my flexibility was bad).

Orthotics have helped (I definitley had feet problems and pain that I previously just attributed to my footwear and now know it was my arches) , exercises have helped, but I am still constantly in pain (depending on what I do).

I do my exercises and stretching everyday because I want to get better so badly... but nothing seems to help. I just tried to do some partial (less then 70 degree) wall sits last week and my knees exploded in pain for several days after that and this is the trend.

I can do very little lower body exercise without my knees being in pain (I have resorted to rowing machine upper body only, weight lifting, and swimming without flip turns..this is the same person that was riding 200 miles in a day last year).

When do you consider surgery? I am baffled why this won't back down. I do have previous history of ITB syndrome in R knee, but no other specfic knee trauma or surgeries.

side note: I first developed the start of this in the spring along with patella tendonitis by overtraining and my orthopedist told me to do exercises and stretching. He said it was OK to go hiking all summer. I called him mid summer in severe pain and asked if I should quit hiking. He said just take 4-7 days off and continue. I specifically asked him several times if what I was doing could cause permanent damage....he said NO...this sure seems permanent to me. (Time to get a new orthopedist?) I finally did quit a week early because the pain was so intense and I was limping after all my longer hikes(at that point it did not matter what the orthopedist said).

Comments for Bilateral Patella Femoral Syndrome for 6 months with no end in sight when do you consider surgery?

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Dec 10, 2008
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surgery?
by: Bart - SII

Hip strengthening, specifically of the abductors and external rotators is the key to treating PFS. It doesn't matter how strong your vmo is - it doesn't control where your femur goes and that is the primary problem with PFS.

If your previous rehab was hip and core based - meaning the majority of the exercises focused on your hip strength and balance, then surgery may be your next option. If it wasn't hip based, but maybe had a couple of exercises like side leg lifts and the hip machine, then a hip strengthening program may help and I would recommend looking at it before surgery.

There are some examples of hip strengthening exercises on the site under the rehab section. And the Patella Femoral Solutions program is a hip/core based program designed specifically for patella femoral syndrome. It is what I have used with all of my PFS patients.

Bart

Mar 27, 2009
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Rest for PFS
by: Anonymous

From everything I have read activity is the worst thing for it. You have to rest for an extended period, which could be several months. Your knees are severely overloaded and can't take it. REST REST REST!!!!!!!! Ice may also help.

May 13, 2009
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Resting...
by: Liesel

I had bilateral surgery and that help things a bit, but I think I could have avoided the surgery. My MRI's did not show too much damage, but my knees were not improving, however, in hindsight, I would have waited much longer for the surgery. I think what help most about the surgery is that it forced me off of my feet...and caused me to have to rest...really rest. The Physical Therapist I saw this fall had me cycling on a stationary bike (with no resistance), but I think that it was causing more irritation. I have been icing and take NSAIDS since last summer. It's May and my knees are flared up again despite the surgery. I can't walk around the block without pain right now. I tried cortisone injection in one knee and that did not do anything. I will try your program and see if it is better (it has to be) then what my PT had for me. I'm not ready for new knees yet! Thanks.

Sep 30, 2009
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Not all things work
by: Anonymous

I currently have been diagnosed with this condition and I can assure you that if over a year of rest dosen't help. I have seen three different physio's and two different surgens and they all have come back telling me that any type of exercise or surgery could potentially couse more harm. So in my case what could you do?

Oct 03, 2009
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living with the problem
by: Anonymous

ive also have had this problem for many years i was a competitive cross country skier and then got bilateral and had to quit. i did physical therapy for 3 yrs and then decided to get surgery. After surgery i still had a lot of pain in my knee, my knee still swells and have tremendous pain still. ive talked to all my doctors and they all tell me the same thing, basically they cant do anything about it, take Tylenol. it sucks but now sense ive been having my problem for years ive just basically have learned to dealt with the pain. and just ignore it i still cant do physical activities without my knee bothering me. this condition sucks!

Oct 23, 2009
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I have the same problem
by: Doug

I have had patella tendonitis ever since I played College football. It got so bad after my final season that I had both knees cut on at the same time, hoping to make it to a tryout in Seattle. Unfortunately, it got worse and I went back under the knife for two more surgeries. It helped a bit, but over time (last 25 years) it has gotten far worse! I too am extremely active and do everything the PT's told me to do and more. I just can't seem to get rid of this issue. I am very fit (under 10% BF)and have good leg strength. Is there some other option to help with this syndrome? Help I am desperate and don't want to hear from anyone who says, just don't do the things that make it hurt! Does this new prolo-therapy work?

Thanks
dwright1958@live.com

Oct 23, 2009
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bilateral patella femoral
by: Anonymous

I currently have bilateral patella femoral and that is because i do a lot of sports. I have had it for 3 years and they are getting much worse over time. I suggest you go to physio therapy before it gets worse

Oct 26, 2009
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surgury
by: Keri from arkansas

I have pFS in my right knee and it is getting worse and worse. I work with 15 two yr olds and my knee has made me fall twice at work. When is surg an option
my email is sweetangel_71655@yahoo.com I would love some advice

Dec 02, 2009
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DONT DO SURGERY!
by: MAILE

I HAVE BEEN DEALING WITH THIS PROBLEM FOR OVER A YEAR AND A HALF NOW. I HAD SURGERY EARLY OCT 09' AND IT SEEMS TO HAVE MADE THE PAIN WORSE. ALL THE DOCTORS TELL ME THE SAME THING TO KEEP UP WITH MY PHYSICAL THERAPY BUT I PRETTY MUCH LEAVE PT EVERYTIME IN HORRIBLE PAIN. NOTHING I HAVE TRIED HELP. I HAVE HAD INJECTIONS AS WELL AND THEY DIDNT DO ANYTHING. MY KNEE HAS LESS RANGE OF MOTION NOW AND IT HURTS ALL THE TIME. I AM IN THE MILITARY SO I AM SCARED THAT I WILL NOT BE ABLE TO CONTINUE BECAUSE OF THIS ISSUE. IS THERE ANYTHING ELSE OUTTHERE THAT I AM MISSING THAT COULD HELP WITH THIS STUPID KNEE ISSUE??? EMAIL @ mailemayers@yahoo.com ANY ADVICE WOULD BE GREAT!

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