Cyclist with Knee Pain

Daniel is a 19 year-old elite cyclist who was signed with a professional team for the year of 2016 but was unable to race, much less reach his full potential, due to a nagging injury of the left knee.  He had partially torn his patellar tendon and received a Platelet-Rich Plasma injection (PRP).  This injection ameliorated his symptoms for 1 year but he began having symptoms again in January of 2017.  Subsequent MRI demonstrated another small partial tear in the patellar tendon.  Upon evaluation at Beyond Exercise in March of 2017, several pertinent and objective findings were discovered.  Dan had weakness of the hip abductors and a misaligned pelvis/pubic area.  There were also considerable adhesions and trigger points discovered in the lateral (vastus lateralis)  and middle quadricep (rectus femoris) musculature, as well as the medial aspect of the distal quad (vastus medialis obliqus).  Tenderness was noted on these areas, as well as to the patellar tendon.  Dan's left hip and pubic bone were elevated with respect to the right side, possibly due to several crashes he had been involved in earlier in his career.  This was forcing Dan to possess a functional leg length discrepancy, meaning that his left leg was acting as the shorter leg (although it was not actually shorter when measured).  But because his left leg appeared shorter than the right, he had been riding with spacers in his left cleat to adjust for this difference.  At this point, his training was greatly reduced and he was unable to ride at all some days because of pain.  Manual therapy was performed to correct the pelvic/pubic obliquity, as well as to address the tissue adhesions and scar tissue in his quadricep.  Dry needling was also performed to release the trigger points in the above-mentioned areas.  Dan was provided with several exercises to self-correct the scar tissue and to strengthen the lateral hip musculature.  Also, the left spacers were taken out of the cleat, since there was no true difference in his leg length.  After manual therapy and adjustments, his pelvis and pubic area were now aligned, negating the need for any corrections in the cleats/shoes.  He was seen once per week for 30-60 minutes.  Within 3 weeks, he was able to ride over two hours with little to no pain and after five weeks, he was riding pain-free and was able to perform his workouts prescribed by his coach.  He was racing again by the end of April for a new team, achieving anywhere from 2nd to 5th place in the Mens Pro/1/2 criteriums.  Daniel has been racing back-to-back days in highly competitive fields.  Below are a few of his results over the past month:

12th/45 at Cobb Park, Illinois state championship criterium

13th/73 at the Tour of Grandview

12th/55 at the Whiskey City Twilight criterium

4th/75 at the Hyde Park Blast/Ohio state criterium championships (he was 3rd in the state)