Fixing medial patella (knee) pain in a cyclist | Feat. Tim Keeley | No.111 | Physio REHAB

[@Matt-qu3pg]

Thanks for the help, gonna try these out for a couple months

[@physiorehab]

No problem 👍

[@MiguelAugusto1982]

Exercises timestamps: - 3:03 Clams (instructions 4:34); - 3:40 Abductions ( instructions 6:02 ); - 7:34 Step Downs for control / One Legged Squats ; - 9:34 Ball Squat for actual strength laterally ; Intro, Diagnosis and Explanations before.

[@Faded_0022]

Here I am. Same pain, same weakness. Thanks, great video Mb

[@physiorehab]

Hope the exercises help you!

[@ddangerousddave]

Great video! While he seemed to have poor control of the hip in single leg stance likely due to weakness, would this cause knee valgus on the bike since the pelvis is stabilized on the saddle? Would you consider looking at bike fit issues in this case?

[@physiorehab]

He has done a full bike fit twice. Doesn't matter if he is sitting or standing, the weakness in the hip will still mean he will internally rotate. The hip muscles have dual function with knee control: pelvic stability and hip rotation

[@cathyhorvitz5248]

Wow Tim! One of your best videos ever!! I'm going to apply this to all of my running niggles!! Thank you so much for putting this information out there!!!

[@physiorehab]

Thanks!

[@gawa62]

Great video Tim.Im suffering from the same problem when I cycle with my right knee drifting inwards.Just wondering if this cyclist did make a full recovery? Many thanks

[@AnjaLSL]

Thank you this is gonna save me pain, time and money 🙂👍 Great information. Thanks again 🌸

[@physiorehab]

Hope you go well!

[@guywelch656]

This is the best video on youtube

[@physiorehab]

Haha many thanks 🙏

[@pina7352]

I used to have my right knee pain whenever I rode my bike too. The pain disappeared since I have been doing three of your exercises. But what I have now is a new problem; left ankle pain! Any suggestions of exercise to fix that Tim? Thanks a lots for your great videos xxx

[@esa4141]

Thank You from this video. Been strugling exaclty this issue and also lost my hope of painfree biking. Having massive glutes doesnt mean they fire up correctly, as lessons learned

[@physiorehab]

Hope you’re back on the bike all ok soon!

[@esa4141]

@@physiorehab thanks. Im back on bike and able to ride long distances with no pain after activation and streght trainings. Had medial pain.

[@mickwebiphone]

How long did it take before you were cycling with no knee pain?

[@esa4141]

@@mickwebiphone approx month. It was weird as the pain went away after ride and nothing else made pain than biking.

[@epramatarov]

This is exactly the knee pain I’m experiencing, and to make it worst, as I am new to cycling I thought your knees should be pointing inwards, which is exactly what the problem is. Thanks for the helpful video.

[@physiorehab]

Glad you got it sorted!

[@sebseb118]

I have had patellofemoral pain since my acl surgery 4 years ago, without knowing what it was until lately. I have been advised to do gluteus activation but without knowing precisely how to do that. Now with this video it is a little bit more clear. I will give it a try and see if there is any improvements. In my case the knee feels sensitive for a few minutes after prolonged cyclism

[@physiorehab]

Hope this exercise helps you!

[@sebseb118]

@@physiorehab Thanks, I've been doing clamps , pelvic drops on a stepper, side line abduction and lateral planks for a few days . My pain while walking stairs is gone , I'm hoping to move on to weight bearing exercises soon, like single leg squats .

[@12Ceej12]

Fantastic video guys. Great selection of exercises and extremely well presented. Subscribed!

[@physiorehab]

Thanks!

[@wisemant11]

Really good stuff. Thanks for sharing, Tim.

[@TheGinger1]

100% agree that we need to be looking at the hip to solve many medial cycling knee issues. The knee is often the victim of poor hip or ankle mechanics. However, just because he’s clipped in doesn’t mean that it should be ignored. If the cleat is poorly positioned and forcing the foot to sit out of alignment, the knee can then flair up (but then I’m sure you’ve ticked that box as you’re damn good at what you do).

[@physiorehab]

Yep - he had already been to a pro fitter and had all the cycle set up done. Tick )

[@alanxxx8736]

Thanks for making this video , having suffered from vmo and medial knee problems for some time these exercises have finally got me back on the bike again , would you recommend any other exercises as a progressing from these , kind regards.

[@physiorehab]

That’s great - have a look at my knee programs at physiorehab.com

[@alanxxx8736]

Execellent , can't thank you enough for making this video 👍

[@cynk956]

I've occasionally have had this problem throughout the years when cycling. Now that I'm older, the pain is more debilitating. I'm an OT and my instinct is telling me to look more functionally which is what OTs do. I'm thinking that my underlying problem is that of leg-length discrepancy which then causes the internal rotation. To me, the guy looks a little tight on his whole left side, but hard to tell in this video. I've had great success with my patients because I look and think about the body as a whole and the functionality of movement. I really like the exercises recommended but I think they are more like band aids. What really needs to be worked on is loosening up/stretching the whole left side including the trunk. For example, the first thing I notice is the side-lying position. I would put something under the guy's right hip like a pillow or slight wedge to slightly give more lengthening to the left side while doing this exercise. It wouldn't have to be much but think about the nice stretch that would give to the left hip by pushing up on the right hip. Of course, it looks so bad that the guy is propped up on his right arm but that's probably just the situation at the moment. But it does make it clearer about how just a little bit of discrepancy in one side can throw off the whole body. I can't tell what the cause is: Is it the hip not in perfect alignment or is it leg length or does the guy just tend to bear weight on his left. OTs also look at accommodtions. I would experiment with raising up the left pedal. Maybe just an 1/8" might do the trick. As Tim said, this probably has been an issue for a while but just didn't rear its ugly head until now. I would also recommend checking out raising the surface of the pedal a bit for long-term maintenance since this guy is looking for long rides. As for myself, I raised the sole of my shoe a tad with just a little more height medially to compensate for the twisting, and voila! No more pain when riding. Sorry for rambling but I love figuring out what the underlying problems are and looking at the whole picture, not just exercises for specific areas! If you need a therapist, get one that is a hardcore detective! One that asks a lot of questions about your daily routines, posture, activities, how do you position your body when you sleep, etc. Of course, I'm biased and would say go to an OT versus a PT. LOL Good luck, everyone!

[@marketingsam]

Great video. I have the same issue. How many sets and reps per exercise? Also when would you suggest introducing leg press/barbell squats?

[@physiorehab]

Samuel Jefferies sets 3-4. Reps 10-12. Weighted exercise once you have mastered this and symptoms are better

[@samueljefferies640]

@@physiorehab thanks so much, pain now gone but not properly tested on bike yet. Did the exercises yesterday, found the single leg squat against gym ball one a little awkward. Surprised how much my glutes hurt during the clams. Also I purchased a DIY laser level so my girlfriend can check my knee tracking when on the rollers. If I was still in Aus I'd visit you for sure.

[@kendoclem]

Hi Tim could I ask would you recommend the same exercises/strength work for pain on the outer side of knee?

[@physiorehab]

Yes you could try that as it maybe the same problem in the hip

[@kendoclem]

@@physiorehab thank you for the reply Tim will give it a go :-)

[@finnbruton7274]

Great video! Is there a term for this problem? I get this but also when I run too or climb stairs. :(

[@physiorehab]

Patellofemoral pain

[@oliverangelil7781]

I have this. I don't think a diagnosis was mentioned - does Sebastian have Patella Femoral Pain Syndrome?

[@aarontewelde3577]

I had the exact issue from a combination of running and cycling. Focusing on preventing my knee from collapsing to the inside seemed to have an almost instant effect. My knee went from slight sharp pain to almost no pain at all

[@aarontewelde3577]

I think it's time to incorporate some hip stabilization exercises into my routine

[@physiorehab]

Yep sounds like the right thing to do!

[@christywerst470]

Thank you for making this video! I have this problem too. Can I still cycle or should I do these exercises for a while first? I noticed I can ride shorter distances with little to no pain as long as I keep a higher cadence.

[@physiorehab]

If no pain you can keep riding. Keep up the exercises all the way through

[@johnlee9791]

I have this same exact issue and was prescribed a knee brace with brace on the lateral side. Should I be wearing the brace on the medial side as to prevent my kneecap from moving inwards?

[@physiorehab]

No the knee cap usually moves outwards not inwards

[@julieburgevin2601]

Great, it's what I need! Any suggestions for knowing whether or not I'm activating Glute Med if I don't have someone tapping and getting my brain to feel it? Just make sure there's the burn?

[@physiorehab]

You should feel it high up on the glute - near the rim of the pelvis

[@ojdatang]

How long did it take him to heal? And did he fully recover?

[@physiorehab]

Yes he is cycling fine no problems. Only 6 weeks to get back

[@scottscale1]

@@physiorehab 6 weeks without bike too, just these exercises? I am having the same problems, thanfully i found this video and i start tomorrow with these exercises, but i dont know if i should do some cycling too.... till the pain? thanks

[@physiorehab]

@JB R type if it’s not painful to ride

[@sroshanwar4100]

My patella is mistracking medially as per my physiotherapist. But my issue is still unresolved. Can I try these exercises?

[@physiorehab]

If they don’t hurt yep!

[@Nivej8180]

How often would you recommend working on strengthening the weak leg/knee? Every day? Every other?

[@patches1396]

Prob lightly everyday with rest days n stretchin

[@aprstudio7115]

This is exactly what im suffering from right now

[@physiorehab]

Try the exercises!

[@thepatternforms859]

i got on the bike and rode 90 miles in 3 days....had zero pain on the bike but when i tried to go run i discovered sharp stabbing pain in the front of both knees coming from under the patella on both knees...now i am totally unable to run at all...pain is worse when going down hill....how did this happen? nothing is helping to fix it...wth

[@physiorehab]

Probably the 90 miles in 3 days….

[@thepatternforms859]

@@physiorehab I run 50mi / week the 90 miles bike is nothing

[@physiorehab]

@@thepatternforms859 well it’s definitely a load component so you need to look at the cause, load vs biomechanical faults vs muscle deficits. Best get that professionally assessed if you are wanting to do those sorts of kms!

[@thepatternforms859]

@@physiorehab I ended up taking a Thera gun and massaging the heck out of the quad muscles on both sides and focused above the knee as well… my quads once loosened up I went out to run and noticed pain 60-70% better… did it again the next day and pain almost entirely gone… I think what happened is that a massive bike session as my first session on a bike caused quads to strengthen and change structure especially the VM which then screwed up my patellar tracking and control giving me a sort of pseudo petellar femoral pain syndrome… all I needed to do is loosen up the quads and massage them a lot

[@sudhanshu9326]

Same thing happened with me I sprained my ankle and after 1 mouth rest when I get back to playing I had knee pain . During my rest I was walking with that unstable ankle do you think that is the reason I got knee injury?

[@physiorehab]

sudhanshu marbade quite possibly!

[@sudhanshu9326]

@@physiorehab I have watched your seminar on patella femoral syndrome I think I have that problem .how much time it will take me to go back on Court?

[@physiorehab]

sudhanshu marbade pretty hard to answer that question without assessing you and your history sorry

[@ancientdiscoverys]

What about medial knee clicking without pain ?

[@physiorehab]

Same drill - work on hip strengthening

[@mirzakulenovic9655]

What if you have this pain, but the spot has varicose veins as well? I’ve had a prior ACL tear.

[@physiorehab]

Not sure that it would be a problem

[@vaughny7258]

how often do we do this? plz. i think this is what i need pt said i got distraction but i get pain right where you said. i started standing on hurt leg and notice it wobbles and other one doesnt

[@ojdatang]

Is this like medial plica syndrome?

[@physiorehab]

Not quite