Being treated for Patellar Syndrome, seeking your input

Hello everybody. I'm an active 24 year old man undergoing treatment abroad so I would appreciate some English-speaking input from you all. About a year ago, I was playing football (soccer), running quickly with the ball, when somebody coming from my left hit my left knee hard. I immediately crumpled to the ground and could slowly get back up but merely limp off in great pain. Stupidly, I just got a friend who is a physio to check it out casually a few days later. He couldn't detect any problems so he told me to put ice on it and do a few stretches which I never bothered with. I could barely walk for a week or two but, after a month or so, it felt fine again so I didn't worry anymore.

Six months ago, I tried to play football again. My performance was good but not long after starting, I felt the posterior of my left knee tighten up. I got it scanned (MRI and X-ray). I live in France now so it's not always easy to understand, but my doctor made it clear that I had 'syndrome rotulien', which seems to translate to 'patellar syndrome', as well as some leftover fluid in there from the initial impact. My kneecap isn't moving into the right position when I bend my left knee, due to problems with the muscles around it, if I understand correctly.

I have been going to physiotherapy for a few months now. The first month or so was just massage and the physio moving my left leg in different ways. Then I started machines and exercises, which I continue to do twice a week. The machines are the leg press and the rear kick. The exercises vary, using trampolines, balance boards, medicine balls, ladders and so on. There is always a massage roller to apply on the front, side and back of my left thigh, and the left buttock, and a stretch for my hamstring to do at the start, and after each round of exercises. I normally do four rounds of about five or six exercises, taking just over an hour in total usually.

Like I said, I am doing this physiotherapy in a foreign language so communication can be tricky. I asked if I can do sport. I was basically told 'as long as it doesn't hurt'. I've been running for over a month, getting up to a half-marathon a couple of weeks ago. I've been swimming a few times. I've just started road cycling. I bought a massage roller the other day to do, along with hamstring stretches, in the morning and the evening - or before and after a sports session.

My legs definitely feel stronger, as I have increased the weights significantly on the machines and have better balance when stood on either leg. But my left knee still pops sometimes and sometimes the posterior feels tense again, or recently the knee gets a little sore on the right-hand side right on the bone.

So, essentially, I'm seeking a second opinion on my treatment program. Your input would be greatly appreciated. Am I going about this all the right way? Are there things I should or shouldn't be doing? How long should I expect it to take before I can play football again? If you need any more details, please do ask.

Thank you for reading! Adrian

Hey mate,

I'm a Physio from Australia. Thought I might start being active on this forum so this is my first post reply!

My main tip would be to ensure you are working on returning to full, loaded ranges of motion.

So for example, can the knee tolerate full, loaded flexion - say a deep squat, a pistol (single leg squat), saddle position (Yoga position).

This applies to other ranges and other joints of course.

Be mindful that connective tissue takes much longer than muscle to remodel and adapt.

Obviously it is very hear to give clear, accurate and specific information with just a written response.

Let me know if you have more questions and we can discuss more mate.

Scott