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For a few years now I have had patella-formal pain syndrome in my right knee. I have been to the doctors and received physiotherapy but this does not seem to have had any positive impact on my knees despite doing the exercises regularly. One thing I was told would improve my knee is cycling - I sold my car a few months ago and bought a bike instead. My right knee hasn't got any better, but my left knee has got a whole lot worse.

It's embarrasing but I actually cannot sit down or stand up without a lot of support, and I have to lower/raise myself using my arms. The pain in both knees are very different though...

Right knee

  • Hurts if doing a single legged squat with foot planted
  • Grinds and crunches regularly
  • Incredible pain when sat for long periods - it needs to be stretched and extended
  • Pain whilst going between sitting/standing positions

Left knee

  • Hurts if doing a single legged squat with heel raised
  • Sharp inner pain - no clicking, grinding or crunching
  • Feels fine after sitting for long periods
  • Pain whilst going between sitting/standing positions

Here's the thing I really don't get though - I cycle to work and back 5 times a week, I play badminton 3 times a week, and I play football (soccer) 2 or 3 times a week - and apart from the opening couple of minutes, whilst doing these things I feel absolutely no pain at all, and indeed both during and afterwards my knees feel a lot better.

The physio has told me that with the knee problems I have, doing exercise (playing football/badminton) shouldn't hurt it at all, and in fact may help strengthen it, especially the cycling. But after 3+ years of having these troubles now with no improvement I am starting to wonder if I should start taking it easier?

Any thoughts or suggestions would be very welcome, thank you!

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    You speak of one-legged squats. Can you do regular (air) squats? Can you add weight? I had a similar condition which got better once I started squatting 30+kg. It was suggested to me that the additional muscle tissue stabilizes my knee better now, while the workouts also led to increased blood flow. If you try this, see if it hurts after working out, not during as it always does with me. Once I'm done though, it's all better.
    – user8119
    May 12 '14 at 15:17
  • Thank you for the reply, sorry when I say "squats" I mean bending my leg slowly and minimally, which is the same when I have both feet planted - I can maybe do a 45 degree squat but that would be pushing it. I certainly couldn't do a squat to get my to chair level and back up again. I will try to do it though and use supports where possible whilst starting out. Push through the pain barrier as like yourself I don't really have much (if any) pain afterwards.
    – Nick
    May 12 '14 at 15:27
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    Do you know where exactly these pains are felt? Couple examples are behind the knee cap (in which case it would be a coating depletion), inside the knee (ACL, MCL or fluid issues) or on the sides (meniscus issues)? The baffling and scary thing is that you're active. The only thing that hints to me would be something to do with the lubrication of the knee; which would have something to do with blood flow. More details if you have, please.
    – iGbanam
    May 13 '14 at 18:24
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    This question and answer may be of some help to you. Also, check your bike set up and technique when you cycle. Good luck.
    – BackInShapeBuddy
    May 13 '14 at 22:12
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    Hey @VictorySaber, I've tried all sorts, had scans etc but unfortunately nothing has helped. I still regularly play football, badminton etc and mostly without pain. A telling point for me was we recently went on a trip to the US, we walked ~15 miles a day for a week in SF and I had zero pain. We walked ~10 miles a day in Vegas for just a few days, and I think due to the constant stairs on the overpass my knees were destroyed. I was in agony every single evening. I think stairs are the biggest cause of my knee pain.
    – Nick
    Feb 9 '16 at 12:01
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What you're going through sounds similar to an experience that I had. I was a college athlete, I played basketball and tennis every day of the week and lifted multiple times a week. I had very bad pain in both of my knees and it was due to tendonitis above and below the knee cap. I was treated for this but the pain consisted. I finally went in and got my feet checked out. The doctor found that I was folding inward slightly on my left foot and so this was misaligning my entire lower torso. This was due to the constant change in direction on the basketball court and tennis court, much like what you do when you play soccer or tennis. I received inserts for my shoes and the pain has decreased significantly. I would suggest going and getting your feet checked out because the solution may be as simple as getting inserts.

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  • Thank you! Just to clarify, who checked your feet? A doctor, physio, a sports store worker? Glad that your knees are better now though!
    – Nick
    Jun 16 '14 at 8:45
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    No problem! I visited a podiatrist. They took a mold of my feet and then sent the mold off and I received inserts for my shoes about a week later.
    – Guy Hendrickson
    Jun 17 '14 at 15:16

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