Patellofemoral Pain

[i_like_sun]

Hey guys, 

Thought I'd post in here, as I'm sort of running out of ideas on how to attack this damn patellofemoral pain.

I'm a snowboard alpinist, and specialize in steep, technical lines. Been doing it coming on 20 years. I also did research in exercise physiology in grad school, so I know my training and orthopedics extremely well. 

 

I've bumped into a brick wall though, and need some feedback....

 

Back in late January I was doing some snowboard training, working on "brink of destruction" heelside carving. This is a key skill for us shredders, as the heelside turn on big exposed faces is critical. It takes a moderately deep squat, and puts your lower extremity under tremendous load. I noticed a sharp "TWING" in my left knee on a couple turns, so I backed off. No pain after, and was shredding pain free for several weeks after.

 

Fast forward to late February, and I did a regular zone 2 / 3 trail run. It was a mid day "lunch lap", and so I kept it mellow and short. Just 5 miles and 1,400 vertical over 1 hour. I've done this run over a hundred times.

 

The next day I had quite a bit of pain in both patellas. This is totally new for me, as I've been one of the lucky ones who HASN'T blown his knee out. 

 

Rested a couple days, then was out on the splitboard and the pain got A LOT worse.

 

Its been coming on 3 months, and I keep finding myself in these "rest / rehab until minimal pain, then test the waters" cycles. 

 

In this time I've developed a new crepitus (crackling sound) in my left kneecap, and I can't seem to get away with even mellow spins on the mountain bike or "walk / jog" exercise without it getting pissed off and feeling like I'm doing more permanent damage. Its also completely stopped my splitboarding dead in the skintrack, and even mellow climbing is off limits because I can't walk downhill without it becoming very painful. 

 

I'm extremely well educated in patellofemoral tracking, hip & knee mechanics, proper footwear for pronation etc...

 

I don't think my problem is a mal-alignment issue so much as it is a tissue overload injury. I also know that chondromalacia on its own is not a "strong" statistical predictor for anterior knee pain, as much of the asymptomatic population has some degree of cartilage wear / tear. So the pain has to be coming (probably) from an overload of the subchondral bone or synovium. It feels like bone pain though...

 

My question for any other athletes, PT's or athletic trainers on here, is what is your guy's / gal's experience with the prognosis for moderately severe patellofemoral pain syndrome? And what strategies have helped you or your patients / clients? Lastly, what kind of timeline have you all experienced with this damn problem? 

 

For reference I'm 35 years old, so I'm not made of plastic anymore, but still at my peak physical powers and still full of angst to get rad in the mountains! 

 

Its a damn frustrating injury. I feel that my fitness has been peaking this year higher than any previous year. I had a Liberty Ridge climb planned, and several other super fun and interesting steep snowboard objectives in line for this spring that are now as far as I can tell, totally fucked by this injury. I'm concerned now that this damn knee pain may severely hamper my mountaineering career, if not has the potential to end it completely. 

 

I mean, shit man, I survived a rollover car crash that broke my back and blew out a disc, and this knee pain scares me more than THAT injury did! 

 

Thanks so much for any insight / guidance guys!! 

[JasonG]

Sorry for the obvious, but have you talked to a good ortho about it? 

[Rad]

I second @JasonG. You could also try a sports med doc. Some combination of physical exam and imaging may reveal your issue, which is the first step in coming up with a solution.  Good luck!