Bilateral Patella Femoral Syndrome for 6 months with no end in sight when do you consider surgery?

by Liesel
(Los gatos, CA)

I hiked every day (worked as a park ranger) this summer and developed very severe patella femoral syndrome. I have a high pain threshold(I pushed through pain this summer unfortunately and created this)...but this is something else.

I have been in 3 months of physical therapy including stretching, leg raises, hip strengthening. I am a very fit 42 yo female and athletics are an extremely important part of my life (I was a competitive cyclist, and recreational body builder before this summer...my vmo is plenty strong, but my flexibility was bad).

Orthotics have helped (I definitley had feet problems and pain that I previously just attributed to my footwear and now know it was my arches) , exercises have helped, but I am still constantly in pain (depending on what I do).

I do my exercises and stretching everyday because I want to get better so badly... but nothing seems to help. I just tried to do some partial (less then 70 degree) wall sits last week and my knees exploded in pain for several days after that and this is the trend.

I can do very little lower body exercise without my knees being in pain (I have resorted to rowing machine upper body only, weight lifting, and swimming without flip turns..this is the same person that was riding 200 miles in a day last year).

When do you consider surgery? I am baffled why this won't back down. I do have previous history of ITB syndrome in R knee, but no other specfic knee trauma or surgeries.

side note: I first developed the start of this in the spring along with patella tendonitis by overtraining and my orthopedist told me to do exercises and stretching. He said it was OK to go hiking all summer. I called him mid summer in severe pain and asked if I should quit hiking. He said just take 4-7 days off and continue. I specifically asked him several times if what I was doing could cause permanent damage....he said NO...this sure seems permanent to me. (Time to get a new orthopedist?) I finally did quit a week early because the pain was so intense and I was limping after all my longer hikes(at that point it did not matter what the orthopedist said).