Return to tennis after patellofemoral pain

[MikhailT]

Went skiing for the first time in my life and overdid it a bit, which led to some sharp pain on the outside of the right knee when playing tennis (or running). I had some foot injuries in the past and back then an orthopedist diagnosed me with a muscle imbalance (desk sitting job) - overactive quads, weak glutes, duck walking, strong anterior pelvic tilt. They told me to work on my glutes and continue with sports as long as I am not in pain. So I guessed the cause for the knee problem is the same (besides the sudden overuse during the skiing trip). And indeed, working my glutes and consciously squeezing them while running, climbing stairs and hitting against the wall allows me to do it all almost pain-free. At most the pain level goes up to 2/10, if I relax a bit and forget to squeeze the glutes. Also the pain (while decreasing) has shifted from the outside of the knee more towards above the knee cap and is now generally more diffuse.
So my question is to everybody who had something similar - should I wait until I am pain-free completely? Will it heal faster if I not provoke the (mild) pain repeatedly?
My current plan would be to hit against a wall and increase intensity and duration as long as the pain stays at 2/10 or under. I started with 10 minutes and am currently at 30 minunutes hitting with medium intensity. I noticed that the most problematic part are the half-lunges when hitting backhand.
Btw the injury happened 8 weeks ago, but then I reinjured the knee by returning to tennis too quickly with no adjustments 6 weeks ago (I was pain free in daily activities, so I thought I am good to go).

 

[EggSalad]

Not sure what to tell you about the knee pain, but this is a great exercise for strengthening the glutes:

How to Do a Glute Bridge: Form, Workouts, and More - NASM

Learn how to perform a glute bridge! A simple and effective exercise that can easily be added to any exercise routine.

blog.nasm.org

I do them but hold it for 1 minute at a time. I do 2-3 sets every day with some other core work mixed in.

 

[MikhailT]

Not sure what to tell you about the knee pain, but this is a great exercise for strengthening the glutes:

How to Do a Glute Bridge: Form, Workouts, and More - NASM

Learn how to perform a glute bridge! A simple and effective exercise that can easily be added to any exercise routine.

blog.nasm.org

I do them but hold it for 1 minute at a time. I do 2-3 sets every day with some other core work mixed in.

Yeah, I do different modifications If this one every other day: one-legged; the one where you put your feet one foot further than normally and also the hold, but I do the clam shells while I hold. It's good to feel the glutes firing.

 

[Injured Again]

This sounds like something that a session or two of physical therapy may help resolve. Especially those therapists who deal with movement biomechanics, they can spot asymmetries in motion and help you with exercises to correct deficiencies.

Good luck.

 

[yossarian]

Especially those therapists who deal with movement biomechanics, they can spot asymmetries in motion and help you with exercises to correct deficiencies.

Overrated and unreliable

 

[Injured Again]

Overrated and unreliable

That was not my experience. I had right knee and hip pain from compensating for a failing left knee and my therapist identified, diagnosed, and provided instruction as to exercises to retrain how to move properly. It worked and my right hip and knee are now pain free and moving as they should. The exercises have helped me to identify when I improperly internally and externally rotate through my hip, and what to do to correct that in my my walking and running stride. It's a matter of getting a good therapist.

 

[MikhailT]

I dont even know where to find a sports physiotherapist. 99% of PTs and orthopedists covered by insurance here are only doing post-surgery rehab for elderly people.
Also I must add, I was very skeptical about foam rolling ("IT band is a fascia that cannot be stretched yada yada"), but it really helps, at least in combination with glute strengthening exercises

 

[yossarian]

That was not my experience. I had right knee and hip pain from compensating for a failing left knee and my therapist identified, diagnosed, and provided instruction as to exercises to retrain how to move properly. It worked and my right hip and knee are now pain free and moving as they should. The exercises have helped me to identify when I improperly internally and externally rotate through my hip, and what to do to correct that in my my walking and running stride. It's a matter of getting a good therapist.

Likely a non specific effect of the exercises compared to actually correcting any sort of biomechanical issue

I’m a PT

 

[innoVAShaun]

Exercise to strengthen those quads.

 

[MikhailT]

Exercise to strengthen those quads.

I think my imbalance is due to weak glutes and over-active quads. My quads are tight and hurt like hell when I foam roll them. TFL also hurted badly while foam rolling initially, but it got better after two days. I hope quads will get less painful as well.
Anyway, I am currently pretty happy with the exercises I am doing and recovery. The only painful day-to-day activity remains going down lots of stairs

 

[innoVAShaun]

Stairs and ramps are my worst enemies.

 

[MikhailT]

so I went again to an ortho and they ordered an MRI, which came back with lots of stuff obviously. Most severe stuff in a report to me is a "not recent partial tear to ACL" and a "clear chondropathy of trochlea femoris". Anybody knows whats the last part is? Is it something that everybody has? My ortho doctor did not say a word about it. She was only talking about another thing in the report which is "very mild tear in posterior horn of medial meniscus". Told me to try physio for 2-3 months and if the symptoms remain, then she will forward me to a surgeon for an arthroscopy. My symptoms have nothing in common with a meniscus tear though, they are way more in line with the ACL tear and this chondropathy thing.

 

[yossarian]

Degenerative changes to your trochlear cartilage

 

[MikhailT]

Degenerative changes to your trochlear cartilage

so it is like chondromalacia patellae, but on the opposite side? Is there a more wide-spread name for that? Cant seem to find much information about it. In the extended MRI report it is described as a "substantial fissure of cartilage down to the osseous boundary layer". On the imaging it looks like a very narrow but deep crack in the soft tissue, right in the middle of the "saddle" of femur. Not similar to thinning out of the cartilage I found on MRI examples in the internet. The orthopedist was not concerned about it at all, but my physio thinks this is the main source of pain.