Physical therapist for knee in Boston

[quansoo]

A month or so ago the outside of my knee started getting sore while riding. I'd been thinking about switching pedal systems, and after my knee problem started, I did (not because I thought the problem was related to the pedals but just because I wanted new pedals). I then went to an enormously knowledgeable senior guy at Wheelworks for a cleat fitting. I also went a full fitting while we were at it, as I thought maybe I needed a longer stem. The fitter noted my leg length discrepancy and shimmed my shoe. We also made some other adjustments. Unfortunately, my knee problem persisted. It would get sore after a few miles and then after a few weeks it just sort of stayed sore all the time, even when off the bike. I think either 1) I injured the thing and then aggravated it by riding a bunch before it was fully healed, 2) something's wrong with my technique, and/or 3) there is some further tweak to be made to the cleat and shoe.

A few days ago I went to see an ace Mass General knee doctor, who said I've got iliotibial band tendinitis and told me to stay off the bike and go to physical therapy. He mentioned that there are PTs who specialize in various parts of the body, and I should have then asked him whether he could recommend one who focuses on knees but forgot to. I'm going to call his office on Monday to ask that question but figured I'd also ask here. There used to be a guy on the North Shore, Pete Smith, who is a PT and also a cycling coach, but I can't seem to track him down.

If anyone can recommend a PT who specializes in knees in the Boston area, or knows how I can find Pete Smith or a guy like him, I'd appreaciate it. It's been very frustrating not to be able to ride, and I want to get this thing fixed as quick as I can.

Thanks in advance.

[Bruce K]

I think Pete is in the Hamilton-Wenham area north of Boston.

I also think he is a member of ECV so you might try posting something on the club website (if you can actually register without being a member).

I'll post something to our 4C's e-mail list and try to get you more info.

BK

[Derailer]

If anyone knows of anyone like this in Chicago, please let me know. I have a very similar problem as the OP.

[Bruce K]

PM sent re: Pete's e-mail.

BK

[RkyMtn]

I have been recovering from this issue (if it is this). The sad thing is, there is very little knowledge on this, so the real problem is still a mystery. However, I did come across a PT who also had this and did extensive research.

After much searching, he ran into a doctor in Europe who determined that the IT Band is not the problem. The pain, according to his research, is a fat pad under the IT Band that becomes irritated and is the pain source. The typical cause, and it seems to be the case for myself, is a spike in activity. I had been riding 2 times a week during the winter and early spring, riding 20-30 miles each time. Then, on a very nice day, I did a 45 mile ride and got the symptoms near the end. The fat pad theory seems to hold some water as the doctor who speculated this has done a number of surgeries, removing the fat pad, and has 30 out of 31 success rate in his clients. So, something to consider. Also, anatomy shows that the IT band is not a band, but is attached all along the femur, which rules out irritation from snapping over the end of the femur bone. It is just sad to see so many people suffer from this and no one really investigating this,... except for a professional in Europe.

I also notice when I get this problem, it usually comes from riding AFTER a rest stop. I had the issue start to come on today, after stopping for lunch. I stopped, and did some stretching in my Hamstring, IT band, calf and Solus(sp?). Then rode again and all was well.

The PT also noted that when the ITBS comes on, it typically happens when you run or pedal slowly, as the problem seems to come on when the leg is bent around 30 degrees. One client of his is a hardcore runner and said every time he would run gently (slowly), the ITBS would kick in. Then, one time, he started by walking to warm up and then running near full steam and no ITBS! Good news!!!

Given the run fast theory, I have also changed my riding style. I used to be a power pedaler, with a 80-90 cadence. Now I am 93-107, and seems to keep the ITBS at bay.

As for recovery, I have heard of people resting for a week to several months. I rested 1.5 weeks and it reoccurred. I then was off for a month, and then started riding only 4 miles for the first week and then adding miles as the weeks went by. I am back to my normal 20-30 mile rides now, after 2 months of recovery riding.

The things I did to help this problem was 1.5 months off the bike, stretching hard, icing the ITBand at the knee around the source of the soreness, and taking vitamin I (Ibuprophin - 400mg 1 hour before riding, and 400mg after riding and 400mg the next morning.)

Here is the article I got most of this from:

http://saveyourself.ca/tutorials/iliotibial-band-syndrome.php

Cheers to you all!!!

Eric

[Ti Designs]

I have been recovering from this issue (if it is this). The sad thing is, there is very little knowledge on this, so the real problem is still a mystery.

The sad thing is that fitters know forces and movement based on bike fit, PTs and doctors know injury based on forces and movement, and somehow the two groups never talk - why is that?

He's talking ITB tendonitis, where is the source of irritation? Your guess at the point of irritation may be right, but the reason is probably a lateral movement across the fat pad, which to me says alignment problem. How your joints track under force and how they track without much force are two different paths. None of this the PT is ever going to see.

Quansoo, do yourself a favor. Go to a bike shop that has some sort of video capture fitting station and get some video from the front of you turning a small gear and of you pushing a harder gear. Then, when you go to the PT you'll at least have some indication of where the problem started. This may help with a cure off the bike, but once you get back on it's back to the same problem. I guess you need a fitter who understands injuries from both sides...

I do have a PT I trust to send my racers to. Having been a roommate of one of the best racers in the area (with some of the worst knees), he understands cycling, cycling injuries and rehab. I'm not posting his name on any internet forums.

[RkyMtn]

Anyone else out here dealing with ITBS and having success managing it, I'd really appreciate your input on what you are doing to successfully deal with it.

Thanks,

Eric