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Author Topic: London (UK) based PFPS Rehab Center/ Physio??  (Read 1326 times)

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Offline react2resist

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London (UK) based PFPS Rehab Center/ Physio??
« on: August 10, 2021, 12:26:42 PM »
Hello all,

29 year old who has been struggling with chronic PFPS for about 10 months. More  about my issue here: https://www.kneeguru.co.uk/KNEEtalk/index.php?topic=79051.0

I'm wondering if anyone can suggest a physio/ rehab place that can treat PFPS. So far I have not had much luck. As lots of people say to me, my condition could likely be helped by following the process that Dr Scott Dye in San Francisco advises.

Can anyone advise of a similar Dr/Physio in London UK?
« Last Edit: August 20, 2021, 11:31:00 AM by vickster »

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #1 on: August 10, 2021, 01:05:57 PM »
You could try Claire Robertson at Wimbledon Clinics (Parkside hospital). A physio but more a diagnostician, but recognised for her knowledge around PFS

https://clairepatella.com/

Nick Wirth is also a really good physio, this is his clinic (Sutton/Woking). Extremely experienced and knowledgeable

https://msophysio.com/msk-physiotherapy/?gclid=CjwKCAjwx8iIBhBwEiwA2quaqylKHkBY8gGQwfkOSuYJURFigYyMp6bwYvRkLjI_6mJvaDW-hQa7nRoCiAQQAvD_BwE


Both private, Nick covered by private insurance, Claire self pay only (around £200 for initial assessment)

Depends what you’re looking for. Presumably you’ve tried knee specialists before? Don’t know of any doctors, but you could try a sports physician (not a surgeon if there’s nothing damaged to fix)

You can try the forum specialist database too, just filter on physio / non surgeon options

https://www.kneeguru.co.uk/KNEEnotes/specialists


« Last Edit: August 10, 2021, 01:12:01 PM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #2 on: August 11, 2021, 05:06:28 PM »
You could try Claire Robertson at Wimbledon Clinics (Parkside hospital). A physio but more a diagnostician, but recognised for her knowledge around PFS

https://clairepatella.com/

Nick Wirth is also a really good physio, this is his clinic (Sutton/Woking). Extremely experienced and knowledgeable

https://msophysio.com/msk-physiotherapy/?gclid=CjwKCAjwx8iIBhBwEiwA2quaqylKHkBY8gGQwfkOSuYJURFigYyMp6bwYvRkLjI_6mJvaDW-hQa7nRoCiAQQAvD_BwE


Both private, Nick covered by private insurance, Claire self pay only (around £200 for initial assessment)

Depends what you’re looking for. Presumably you’ve tried knee specialists before? Don’t know of any doctors, but you could try a sports physician (not a surgeon if there’s nothing damaged to fix)

You can try the forum specialist database too, just filter on physio / non surgeon options

https://www.kneeguru.co.uk/KNEEnotes/specialists


THanks Vickster! Will have a look at both and see what makes sense

Offline SuspectDevice

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #3 on: August 17, 2021, 10:23:00 PM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #4 on: August 18, 2021, 04:14:42 PM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.

Problem I'm having is getting a clear idea of what my 'envelope of function' is. When even walking leads to pain, bloody hard to know what limits to work in.

The Celebrex did seem to do wonders last week and I'm carrying on taking one a day (checking blood pressure weekly) but the pain does seem to have crept back. I use a TENS machine to help with the pain in the afternoon/evening as I don't want to take anything other than the celebrex.

As I am office based I think the office chair may be causing my knees to flare up.

It's  pretty much my 12 month anniversary of having this chronic pain and I still feel like I'm banging my head into a brick wall trying to find a way out.

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #5 on: August 18, 2021, 06:41:10 PM »
Can you work (at least part of the time with your legs up and straight (eg sofa/bed).
Also look at the adjustability of your chair, at the possibility of a standing desk etc. Your employer should support you in this, so talk to manager/HR/occupational health.
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline SuspectDevice

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #6 on: August 18, 2021, 09:58:11 PM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.

Problem I'm having is getting a clear idea of what my 'envelope of function' is. When even walking leads to pain, bloody hard to know what limits to work in.

The Celebrex did seem to do wonders last week and I'm carrying on taking one a day (checking blood pressure weekly) but the pain does seem to have crept back. I use a TENS machine to help with the pain in the afternoon/evening as I don't want to take anything other than the celebrex.

As I am office based I think the office chair may be causing my knees to flare up.

It's  pretty much my 12 month anniversary of having this chronic pain and I still feel like I'm banging my head into a brick wall trying to find a way out.

Yes I know.  I was the same.  And I'm not sure anyone else can tell you where your envelope is either.  It was years of trial and error for me to work it out, and then some exercises which I'm sure were suspect, but seemed to go ok.  I had pain that did not improve hardly at all for maybe 4-5 years, until I got on the Celebrex for 5-6 months, then gradually started to emerge from Hell.

How long have you been on Celebrex?  It was months for me before I got to a stage where I could feel confident I could do some harder exercise....and then I probably went a bit too hard with things like Sissy Squats.  With trial & error however, I found some exercises that were better - deadlifts, kettlebell swings, crab walk with band around ankles.

Walking also hurt me for years (though my knees basically hurt all my waking hours anyway), but I persisted with my slow flat 15-20min walks most mornings.  And my swimming with ankles strapped & pull buoy helped keep some aerobic fitness & sanity.

The TENS machine was also a Godsend for me.  45mins many evenings with legs up on the couch.

I too am office based and as Vickster says, I put a box under my desk so could sit with legs straight.  I could not really sit with knees bent anywhere.

It's a bloody hard long road, but you can beat it.  The fact that have an idea of what it is likely to be early (i.e. synovitis) puts you years ahead of me.
« Last Edit: August 18, 2021, 10:00:03 PM by SuspectDevice »
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #7 on: August 19, 2021, 10:38:49 AM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.

Problem I'm having is getting a clear idea of what my 'envelope of function' is. When even walking leads to pain, bloody hard to know what limits to work in.

The Celebrex did seem to do wonders last week and I'm carrying on taking one a day (checking blood pressure weekly) but the pain does seem to have crept back. I use a TENS machine to help with the pain in the afternoon/evening as I don't want to take anything other than the celebrex.

As I am office based I think the office chair may be causing my knees to flare up.

It's  pretty much my 12 month anniversary of having this chronic pain and I still feel like I'm banging my head into a brick wall trying to find a way out.

Yes I know.  I was the same.  And I'm not sure anyone else can tell you where your envelope is either.  It was years of trial and error for me to work it out, and then some exercises which I'm sure were suspect, but seemed to go ok.  I had pain that did not improve hardly at all for maybe 4-5 years, until I got on the Celebrex for 5-6 months, then gradually started to emerge from Hell.

How long have you been on Celebrex?  It was months for me before I got to a stage where I could feel confident I could do some harder exercise....and then I probably went a bit too hard with things like Sissy Squats.  With trial & error however, I found some exercises that were better - deadlifts, kettlebell swings, crab walk with band around ankles.

Walking also hurt me for years (though my knees basically hurt all my waking hours anyway), but I persisted with my slow flat 15-20min walks most mornings.  And my swimming with ankles strapped & pull buoy helped keep some aerobic fitness & sanity.

The TENS machine was also a Godsend for me.  45mins many evenings with legs up on the couch.

I too am office based and as Vickster says, I put a box under my desk so could sit with legs straight.  I could not really sit with knees bent anywhere.

It's a bloody hard long road, but you can beat it.  The fact that have an idea of what it is likely to be early (i.e. synovitis) puts you years ahead of me.



Thank you both Vickster and SuspectDevice. It is strange how reassuring it is to have people willing to give their experiences and advise. It does help when I'm feeling like there's nothing I can do.

Regarding Celebrex - I've only been taking it two weeks. I think after this prescription I will switch from 200mg to 2x100mg throughout the day. It has by far given the best results. Naproxen and Ibuprofen are a waste of time.

Regarding exercises - I think everyone in the gym must think I'm wondering round like a lost puppy haha. I used to walk in with purpose and hit the solid routine, but now I'm just trying the different machines to see what can offer muscle fatigue without bringing on a lot of pain.

Regarding the desk - I have got a block under my desk now to try and keep them straight. I also have a timer to go for regular small walks and have started standing as well

One question which I've asked physios and never get a straight answer to:

Should I exercise and push through the knee pain in order to strengthen? Or is that a complete waste of  time and I should address the pain first?

Obviously I don't mean thrashing my legs with squats and running. But gentle strengthening that still flares the knees up.


Online vickster

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #8 on: August 19, 2021, 01:45:47 PM »
Have you tried proper physio led hydrotherapy, rather than trying to strengthen with weights?
Works for me. Once you have a programme, you can just go to pool on own.
Whereabouts in London are you actually based? I can only suggest places SW, not much use if you’re in North East!
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #9 on: August 20, 2021, 08:59:30 AM »
Have you tried proper physio led hydrotherapy, rather than trying to strengthen with weights?
Works for me. Once you have a programme, you can just go to pool on own.
Whereabouts in London are you actually based? I can only suggest places SW, not much use if you’re in North East!

I have not tried hydrotherapy. the few times i've been in a pool in the last few months have lead to my knees aching like crazy. But I'd give  it a try. I am based in Camden unfortunately so little bit far from deep SW

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #10 on: August 20, 2021, 09:17:24 AM »
Probably yes, but the place I go to is a 10 min Uber ride from Morden at the end of the northern line so could be an option if nothing closer :)

There are hydrotherapy facilities more centrally
Eg https://www.central-health.com/chelsea-physiotherapy-clinic/

https://www.thelondonclinic.co.uk/medical-services/physiotherapy-and-aquatic-therapy/aquatic-therapy

Or try other private hospitals perhaps, although may be more expensive
« Last Edit: August 20, 2021, 11:51:52 AM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline SuspectDevice

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #11 on: August 20, 2021, 10:25:28 PM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.

Problem I'm having is getting a clear idea of what my 'envelope of function' is. When even walking leads to pain, bloody hard to know what limits to work in.

The Celebrex did seem to do wonders last week and I'm carrying on taking one a day (checking blood pressure weekly) but the pain does seem to have crept back. I use a TENS machine to help with the pain in the afternoon/evening as I don't want to take anything other than the celebrex.

As I am office based I think the office chair may be causing my knees to flare up.

It's  pretty much my 12 month anniversary of having this chronic pain and I still feel like I'm banging my head into a brick wall trying to find a way out.

Yes I know.  I was the same.  And I'm not sure anyone else can tell you where your envelope is either.  It was years of trial and error for me to work it out, and then some exercises which I'm sure were suspect, but seemed to go ok.  I had pain that did not improve hardly at all for maybe 4-5 years, until I got on the Celebrex for 5-6 months, then gradually started to emerge from Hell.

How long have you been on Celebrex?  It was months for me before I got to a stage where I could feel confident I could do some harder exercise....and then I probably went a bit too hard with things like Sissy Squats.  With trial & error however, I found some exercises that were better - deadlifts, kettlebell swings, crab walk with band around ankles.

Walking also hurt me for years (though my knees basically hurt all my waking hours anyway), but I persisted with my slow flat 15-20min walks most mornings.  And my swimming with ankles strapped & pull buoy helped keep some aerobic fitness & sanity.

The TENS machine was also a Godsend for me.  45mins many evenings with legs up on the couch.

I too am office based and as Vickster says, I put a box under my desk so could sit with legs straight.  I could not really sit with knees bent anywhere.

It's a bloody hard long road, but you can beat it.  The fact that have an idea of what it is likely to be early (i.e. synovitis) puts you years ahead of me.



Thank you both Vickster and SuspectDevice. It is strange how reassuring it is to have people willing to give their experiences and advise. It does help when I'm feeling like there's nothing I can do.

Regarding Celebrex - I've only been taking it two weeks. I think after this prescription I will switch from 200mg to 2x100mg throughout the day. It has by far given the best results. Naproxen and Ibuprofen are a waste of time.

Regarding exercises - I think everyone in the gym must think I'm wondering round like a lost puppy haha. I used to walk in with purpose and hit the solid routine, but now I'm just trying the different machines to see what can offer muscle fatigue without bringing on a lot of pain.

Regarding the desk - I have got a block under my desk now to try and keep them straight. I also have a timer to go for regular small walks and have started standing as well

One question which I've asked physios and never get a straight answer to:

Should I exercise and push through the knee pain in order to strengthen? Or is that a complete waste of  time and I should address the pain first?

Obviously I don't mean thrashing my legs with squats and running. But gentle strengthening that still flares the knees up.

2 weeks on Celebrex is nothing.  Give it a few months.

Yes Ibuprofen was useless for me too.  Can't recall if I tried Naproxen.  I did try something called Moxicam?  which was not much use.

Should you push through the pain?  All my research & experience says definitely not if what you have is what I had (synovitis).  But having said that, after maybe 2 months on Celebrex I did start pushing through the pain somewhat with Sissy Squats etc.  However, strangely I found the first few reps were bad, then it improved somewhat.  And it did hot give me flare-ups for days after, maybe only a bit the next day which I figured I could cope with.  Again, the trial and error thing.

Trying to get back to cycling was my biggest problem.  After a few months on Celebrex, my knees could cope better with heavy loads/short time (e.g. weights) far better than lighter loads/long time (e.g. cycling, running).  That was not Richard Bedards experience, but it was mine.  I needed to use weights/strength work to build (not so much quads) but more glutes/core/hammies/balancing muscles before my knees would tolerate cycling again.  Before the knee crap started, I used to ride 4-6x/week up to 200kms/week, including really hard 100km time trails.  These days, 40kms (1.5-2hrs max) is my limit, but that's OK.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #12 on: August 25, 2021, 10:43:54 AM »
I followed the Dr Dye protocol without seeing anyone other than my local doctor, just figured it out from Dye's online videos/papers.

I took a summary of all I'd been through, what others had said, what I'd tried, what Dr Dye suggests (long term anti-inflams & staying within your envelope of function, then gradually, very carefully expanding it) to my Dr and he agreed it was worth a try.  And it worked (though not in a simple linear way - still many ups and downs).

He was concerned about the anti-inflams, but we did liver & kidney function tests along the way and all good.

There is also a woman who works with Doug Kelsey in the US.  They both follow Dye-type protocols and she was offering online consultations.  Can't recall her name though, you might be able to track her down on the internet.

My main issue with all this is that there is no clear recipe.  The Dr Dye approach is a philosophy to follow which definitely works, but within that, everyone is different so there is much trial and error to work out what you can do not to exceed your envelope.  The anti-inflams for me however were the key to making progress.  From there, my own experimentation with different excercises could proceed.

Recently, I feel taking collagen powder every morning is also helping me improve further.

Problem I'm having is getting a clear idea of what my 'envelope of function' is. When even walking leads to pain, bloody hard to know what limits to work in.

The Celebrex did seem to do wonders last week and I'm carrying on taking one a day (checking blood pressure weekly) but the pain does seem to have crept back. I use a TENS machine to help with the pain in the afternoon/evening as I don't want to take anything other than the celebrex.

As I am office based I think the office chair may be causing my knees to flare up.

It's  pretty much my 12 month anniversary of having this chronic pain and I still feel like I'm banging my head into a brick wall trying to find a way out.

Yes I know.  I was the same.  And I'm not sure anyone else can tell you where your envelope is either.  It was years of trial and error for me to work it out, and then some exercises which I'm sure were suspect, but seemed to go ok.  I had pain that did not improve hardly at all for maybe 4-5 years, until I got on the Celebrex for 5-6 months, then gradually started to emerge from Hell.

How long have you been on Celebrex?  It was months for me before I got to a stage where I could feel confident I could do some harder exercise....and then I probably went a bit too hard with things like Sissy Squats.  With trial & error however, I found some exercises that were better - deadlifts, kettlebell swings, crab walk with band around ankles.

Walking also hurt me for years (though my knees basically hurt all my waking hours anyway), but I persisted with my slow flat 15-20min walks most mornings.  And my swimming with ankles strapped & pull buoy helped keep some aerobic fitness & sanity.

The TENS machine was also a Godsend for me.  45mins many evenings with legs up on the couch.

I too am office based and as Vickster says, I put a box under my desk so could sit with legs straight.  I could not really sit with knees bent anywhere.

It's a bloody hard long road, but you can beat it.  The fact that have an idea of what it is likely to be early (i.e. synovitis) puts you years ahead of me.



Thank you both Vickster and SuspectDevice. It is strange how reassuring it is to have people willing to give their experiences and advise. It does help when I'm feeling like there's nothing I can do.

Regarding Celebrex - I've only been taking it two weeks. I think after this prescription I will switch from 200mg to 2x100mg throughout the day. It has by far given the best results. Naproxen and Ibuprofen are a waste of time.

Regarding exercises - I think everyone in the gym must think I'm wondering round like a lost puppy haha. I used to walk in with purpose and hit the solid routine, but now I'm just trying the different machines to see what can offer muscle fatigue without bringing on a lot of pain.

Regarding the desk - I have got a block under my desk now to try and keep them straight. I also have a timer to go for regular small walks and have started standing as well

One question which I've asked physios and never get a straight answer to:

Should I exercise and push through the knee pain in order to strengthen? Or is that a complete waste of  time and I should address the pain first?

Obviously I don't mean thrashing my legs with squats and running. But gentle strengthening that still flares the knees up.

2 weeks on Celebrex is nothing.  Give it a few months.

Yes Ibuprofen was useless for me too.  Can't recall if I tried Naproxen.  I did try something called Moxicam?  which was not much use.

Should you push through the pain?  All my research & experience says definitely not if what you have is what I had (synovitis).  But having said that, after maybe 2 months on Celebrex I did start pushing through the pain somewhat with Sissy Squats etc.  However, strangely I found the first few reps were bad, then it improved somewhat.  And it did hot give me flare-ups for days after, maybe only a bit the next day which I figured I could cope with.  Again, the trial and error thing.

Trying to get back to cycling was my biggest problem.  After a few months on Celebrex, my knees could cope better with heavy loads/short time (e.g. weights) far better than lighter loads/long time (e.g. cycling, running).  That was not Richard Bedards experience, but it was mine.  I needed to use weights/strength work to build (not so much quads) but more glutes/core/hammies/balancing muscles before my knees would tolerate cycling again.  Before the knee crap started, I used to ride 4-6x/week up to 200kms/week, including really hard 100km time trails.  These days, 40kms (1.5-2hrs max) is my limit, but that's OK.


Hi Suspect Device,

So for that 2 months before you were able to do sissy squats, kettle bells etc, did you just walk? Or did you compliment it with anything else?

Offline SuspectDevice

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Re: London (UK) based PFPS Rehab Center/ Phyiso??
« Reply #13 on: August 26, 2021, 11:41:34 AM »


Hi Suspect Device,

So for that 2 months before you were able to do sissy squats, kettle bells etc, did you just walk? Or did you compliment it with anything else?

I just walked & did my swimming with no kicking.  Maybe some upper body & core strength work from memory?

My synovial inflammation was so chronic & my knees so fragile, it took a fair while before the Celebrex started to have a real controlling impact.

The biochemical changes that happen in your knees with what I call 'true PFPS' (i.e. loss of tissue homeostasis = cytokines & other inflammatory chemicals going ballistic, not the VMO weakness/patella mal-tracking bunkum that most physios are fixated on) is a real beast to get on top of.  But you definitely can get on top of it with patience & careful experimentation.
L Medial menisectomy 2012
PFPS both knees 2012-2017
Pre-CRPS diagnosed 2014 (I think this was crap)
2017 - 90+% cured via Dr Dye's research
2018 - MTB crash, busted collarbone & ribs - easy compared to knees!
2021 - ride 3x/week, swim 2x/week, gym 2x/week, short runs 2x/week, back to short races

Offline kneegeek2020

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #14 on: September 07, 2021, 12:01:09 PM »
I just want to give my two cents to this thread.  I've read a lot about the "envelope of function".  In theory this makes sense- in someone who hasn't had surgery or developed brain AMI.  A brain that doesn't activate the quad results in a quad that cannot be built. 

Atrophy--->pain---> more atrophy--->muscle amnesia (brain AMI)

The quad is the shock absorber for the knee.  The absence of it (think atrophy) means every step sends the impact into the knee joint.  This is the reason that "building the quad" results in a reduction in pain- more muscle mass equals less pain.  The absolute best exercise (lowest shear, lowest impact) is the terminal knee extension w/ exercise bands.

Unfortunately, strength training will not grow the muscle in some people.  When pain is prolonged, the brain forgets how to fire the quad.  These are pathways that have developed from the time you learn to walk.  Once forgotten- how does one remember?

Muscles grow via two mechanisms. They are as follows.

•   Metabolic Stress
•   Micro Tears

My advice for people who haven't had their quad atrophied (shrunken) for too long.

Ice the knee for 20 minutes before performing strength training
Ice the knee after strength training

The safest exercises are:
Terminal knee extension w/ bands (get on youtube)
The elliptical (bike riding is toxic for someone w/ patellar issues)


« Last Edit: September 10, 2021, 10:51:16 AM by kneegeek2020 »

Online vickster

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #15 on: September 07, 2021, 01:20:31 PM »
What’s AMI?

This is a forum for laypeople rather than medics or scientists, so it would be helpful to adjust your post accordingly (explain in full any abbreviations and acronyms, things like this sentence ‘ Corticospinal reflexes translating acetylcholine NTs via neuronal transmission into the cerebral cortex which then sends Nts via alpha/beta transmission which blocks the quad…’
and so on)

Thanks :)
« Last Edit: September 07, 2021, 01:23:39 PM by vickster »
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline kneegeek2020

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #16 on: September 07, 2021, 01:53:13 PM »
AMI is quad atrophy. A condition that occurs to anyone who has a serious knee injury or surgery. 

Online vickster

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #17 on: September 07, 2021, 03:38:10 PM »
Ah ok, I’ve actually been pretty lucky in that regard despite a number of surgeries. Calf rather wasted though!
What does AMI actually stand for?
Came off bike onto concrete 9/9/09 (lat meniscus, lat condyle defect)
LK scopes 8/2/10 & 16/12/10
RK scope 5/2/15 (menisectomy, Hoffa’s fat pad trim)
LK scope 10.1.19 medial meniscectomy, trochlea MFX
LK scope 19.4.21 MFX to both condyles & trochlea, patella cartilage shaved, viscoseal, depo-medrone

Offline kneegeek2020

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #18 on: September 08, 2021, 09:49:13 AM »
Hey Vickster,
I remember talking to you in past and you mentioning no quad atrophy, you're lucky in that regard. 

AMI (arthrogenic muscle inhibition)
arthro-joint
genic-creation
ami-the decay of the quad originating from knee pain.  But it's actually the brain that becomes the problem. 
« Last Edit: September 08, 2021, 09:50:45 AM by kneegeek2020 »

Offline react2resist

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #19 on: September 08, 2021, 04:43:47 PM »
Hey Kneegeek,

Whats the difference between a TENS machine an E-stim?

Mark

Offline kneegeek2020

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #20 on: September 09, 2021, 07:48:06 AM »
Tens just messes w/ the nerve signals.  EMS (e-stim) triggers a muscle contraction.  Tens typically used w/ back pain.  If you've seen Rocky- EMS was used to help ivan drago get jacked.

Offline Limping_Loafer

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Re: London (UK) based PFPS Rehab Center/ Physio??
« Reply #21 on: September 13, 2021, 03:13:32 PM »
Hi react2resist, just wanted to let you know I'm unable to reply to your pm as I haven't made the requisite number of posts yet. I think the most important thing for you to do is to find out what exactly is causing your pfps. In my case, it was chronic fat pad impingement but you may have a different issue. I've been to see Claire Robertson and she taped the knee and, although it didn't really help, I wouldn't discount seeing her for physio treatment. What happened is that 4 weeks after taping and 8 weeks after my initial injury I found Charles Willis Owen in Bournemouth. When I went to see him he told me straight away that it looked like I was dealing with fat pad impingement. An MRI then confirmed this. He then injected my knee (directly into the fat pad) with 80mg kenalog and the knee settled down over the next week or two and I was able to get back to my sport (ice skating). Over the next 18 months I had two further incidences of trauma to my knee and whilst few injections I had really helped, I've reached a point now where the fat pad needs to be trimmed and I'm scheduled for an arthroscopy with Mr Willis Owen in October. I've been unable to walk normally since June and Mr Willis Owen has recommended a physio in Wimbledon with whom his patients have had good success in the past. His name is Pat Gillham and he's at Pure Sports Med which is located at the David Lloyd Gym. I've seen him twice now and will see him again once more prior to surgery. He's got me using a compex machine to build up my quad muscles without putting strain on the knee joint. It's incredibly effective. I also work on my posterior chain with exercises at home. I'm glad I've got a physio in place prior to surgery and am hoping this will help me achieve a good clinical outcome.