Feels like a screwdriver being shoved into the side of knee!

stephen365

Hi
Bit of a long shot this, but I'm looking for some advice to stop something from totally making a boll*cks of my cycling.
When I ride anything over an hour, I start to get a feeling in my left knee like someone is pushing a screwdriver into the right hand side of my knee. Once this starts, the pain increases to the point whereby the knee will bear no pressure at all and I'm effectively cycling one-legged.
I've been to the leech-keeper and had an x-ray, but nothing doing and his alternate suggestion of "Why don;t you just stop" made me want to assault him with my track pump!
Anyone had anything similar or got any thoughts of what it might be? I love my bike and don't want to have to give it up.
Help!

alfablue

It cold be an overuse injury involving the knee ligaments (lateral collateral ligament?). Yo need to see a physiotherapist (or sports physiotherapist). Your GP should refer you, if that takes too long or you want a sports physio, see if your local university has any sports physio's, they will often see you reasonably cheaply. I think the ligament on the outside of the knee can become inflamed by the friction caused as it passes over the bone as you go through the pedal stroke. I should add that I have no expertise in this area, so these are just a lay person's suggestions.

It makes my blood boil when some GP's are so ignorant and just suggest "stop doing it" - some of them actually would seem to prefer we lead sedentary lives!

alfablue

just to add, prevention wise, once it has settled down, it would be well worth getting a professional bike fit and having your pedalling action and cleat position analysed. If you don't use clipless pedals, they possibly could help maintaining a decent action (for instance a sloppy action could mean your knee takes the forces unevenly), though equally, a bad pedal/seat/cleat setup could cause problems.

dennisn

alfablue wrote:

It makes my blood boil when some GP's are so ignorant and just suggest "stop doing it" - some of them actually would seem to prefer we lead sedentary lives!

Problem is, the doctor is correct. The pain will stop if he quits doing whatever it is that makes his knee feel like that. I feel for him if cycling is the cause and it turns out to be something really bad down there, but not giving it a chance to heal will proably make it worse or maybe even chronic. Had a friend who had an Achilles tendon problem. Doctor
told him to rest it or it would get worse. It got a lot worse. He now has a tumor the size of
a ping pong ball on it. Won't submit to surgery and hasn't ridden in years. People will do what they will, but in the long run you'll be better off taking a bit of rest and trying to find out what's going on(see the doctors and listen to them). Or not, your choice.

Dennis Noward

alfablue

I do agree with some of your sentiments Dennis, and your warning. However just saying stop is too simplistic. Yes, rest will be necessary, but unless there is proper diagnosis of the problem then the OP gets no other options.

It is very likely that with the help of physiotherapists and/or orthopaedics specialists there could be a long term solution that allows the OP to continue with cycling AFTER recovery, and without problem in the future. I too have been in a similar situation (had bursitis) GP referred me for steroids injections into hip joint, which was probably appropriate as far as it went, but omitted to follow up with physio - after 4 years of chronic pain, and at the point of giving up cycling entirely, I got the help I should have had right at the start, and fortunately now all is well. It could have been irretrievable, due to this negligence.

To me this GP is just not doing his job - health is far more than just freedom from disease, and a GP's role should be equally concerned with health promotion.

Rant over (for a few minutes )

stephen365

The really peculiar thing is that I also run a lot and get no problems whatsover from that so I'm convinced it's not something particularly wrong with the knee per se, but that it's the action of cycling that brings it on.
In my experience, docs usually do things by trial and error and if you get them on a bad day, you get bad advice.
I'll go down the Physio and bike setup route. Thanks Alfa - appreciate the advice.

Infamous

flat head or philips?

GavH

I'm fairly new to cycling but I too suffered with pain in the outside of my left knee which came on after about 90 mins on the bike. It didn't happen during any other physical activity. I googled it and also spoke with a friend who is heavily into Triathlon and the answer seemed to be the same - Seat Post height. Funny thing, when I raised my saddle height by a mere cm/half an inch at most, not even remotely noticeable to the eye or even in terms of feel but it certainly stopped the pain. I then changed my saddle and seatpost, thought I'd put the new ones in to the same setup as the last one and lo and behold, got a bit of pain in the same place on Sunday after 90 mins of riding. I've not been out since but I'm betting that if I raise the post a touch I'll feel it less in the knee.
Try it, what harm can it do?

McBain_v1

Infamous wrote:

flat head or philips?

Suprised the doctor didn't ask this vital question :!:

SCR Pedro

Hey there,

This sounds a lot like the tendonitis I had earlier in the year. Go and see your physiotherapist. My therapist was really helpful and knew her business well. It turned out that one simple stretch done regularly enough was enough to clear it.

I never did find the true cause of it, but it only started when I bought a Specialized Allez which was too big for me. I traded that in for my Giant and I've never had a problem since. Coincidence? Maybe, or maybe not.

Cheers
Pedro

PS: Mine was a Flat-Head Screwdriver. Stainless steel too.

biondino

This screams cleat position to me. If the pain is in the outside of your knee - let me see if I remember this right - you need to adjust your cleat so that the foot is pointing more towards the bike. The idea is that your foot position on the bike equates to the position your foot hangs in naturally when you sit with your legs dangling in the air.

stephen365

Thanks for the advice all.

PS not sure on the head type, but it;s an effin big one! :x

jocksyboy

It Could be Iliotibial band syndrome pain often defers from the actual source google it for many definitions and exercises.

itboffin

Sounds like cleats to me, have you tried adjusting the pedal tension to it's looses setting. I came within two days of having a major knee op which I'm almost certain was caused by my set-up, I still suffer now after a hard ride. I now strap my knees after a hilly ride and have my pedals as loose as they'll go without unclipping.

Bike set up is the key, having the wrong saddle height can also cause lots of pain.

sylvanus

You really need to see a proper sports doctor - I'm amazed by some of the poor advice you've had here!

Try these guys if you're near London - they're outstanding:

http://www.puresportsmed.com/

Otherwise do some googling and local research - ask around locally - whatever you do don't waste your money on the snake oil salesmen like osteopaths or chiropractors!

dennisn

alfablue wrote:

I do agree with some of your sentiments Dennis, and your warning. However just saying stop is too simplistic. Yes, rest will be necessary, but unless there is proper diagnosis of the problem then the OP gets no other options.

It is very likely that with the help of physiotherapists and/or orthopaedics specialists there could be a long term solution that allows the OP to continue with cycling AFTER recovery, and without problem in the future. I too have been in a similar situation (had bursitis) GP referred me for steroids injections into hip joint, which was probably appropriate as far as it went, but omitted to follow up with physio - after 4 years of chronic pain, and at the point of giving up cycling entirely, I got the help I should have had right at the start, and fortunately now all is well. It could have been irretrievable, due to this negligence.

To me this GP is just not doing his job - health is far more than just freedom from disease, and a GP's role should be equally concerned with health promotion.

Rant over (for a few minutes )

I know what you're saying. It is really hard to stop doing something that you like.
However, If you happen to blow you knee out skiing you had best not ski again until
you get it healed, repaired, replaced, or whatever. It is obvious that cycling has something to do with this injury and there is not a doctor that I have ever heard of that will
tell him to "keep riding". He can go to 100 different doctors and they all will advise him to
seek further help(x rays, MRI, those kind of things) to try and help identify the problem.
Getting pissed off at your GP because he couldn't "cure" you in 5 minutes is not the road to go down. You must trust someone(your GP) and try to get him to be a bit more proactive in your treatment. The OP says he's had X rays and that's a good start as it didn't show anything. Further investigation is warranted, rest is probably warranted, and NOT getting pissed at doctors also helps. In a completely fair and perfect world you would be back hammering with the guys tomorrow but injuries happen and USUALLY if they
are not treated properly(by the doctor and YOURSELF) you're in for more misery and more time off.

Dennis Noward

alfablue

Hi Dennis

I maybe didn't express myself well enough, certainly the OP will need to desist from cycling temporarily, my issue is where he goes after that. It seems that the GP has examined him, done the x-ray, found nothing, and just said stop cycling. So is this stop for good, or just stop till it is recovered, then start again without changing anything? The problem will surely return, and the OP (unless he takes matters further) will probably have little choice but to give up for good - as I was faced with this standard approach.

No one expects a cure within 5 minutes, but the OP didn't even get a proper diagnosis (there have been more suggestions worthy of investigation, on this thread already). As you say, the x-ray was a good start, but it seems this was also the finish as far as the GP was concerned.

To just say stop and offer no other help is without any doubt, negligent. It is quite understandable that the issue is beyond the expertise of the GP, they are obviously generalists rather than specialists, which is why they have the ability to refer patients to specialists and physiotherapists. Unfortunately SOME GP's see any form of sporting activity as just some sort of hobby that can easily be excluded from someone's life as soon as it causes problems. Just imagine what sort of Olympic team we would have left (or Rugby Union, or any sport), if the sum and total medical response was "x-ray, nothing visible, oh well that's it then! Next patient please."

I am a health care professional and I have worked with doctors and GP's for more than a quarter of a century. As such I feel I am in a position where I should be able to criticise where I feel it is due, they ain't gods (some think they are). For the most part they are superb, but occasionally one does come across these sorts of attitudes, and they are to be deplored. The OP's sport is, for him, possibly as important to his health and well being as it is to a a top end athlete.

In contrast, I broke my pelvis in 2 places some years ago (the acetabulum, the internal face of the hip joint) , I get annual examination from a orthopaedic consultant, I had extensive input from a physio, and they have, with their specialist knowledge, and after offering the full range of rehab resources to me, advised me what sports I am okay to do - I have had to give up road running and squash, but I am fine for cycling and swimming. It was hard to take (I loved the sports I gave up) but I feel I have been given every possible investigation and opportunity, and that makes it easier to accept, knowing every possibility has been investigated. That's what the OP should get, nothing less.

But yes, you are right, as things stand he had better quit cycling because if nothing changes he is very likely to screw his knee up permanently.

alfablue

That said, cleat position and seat height and position would be worth investigating, and a professional bike fit analysis, such as by Kinetic-One may be useful.

ColinJ

I've given myself knee pain by getting my cleat position out by just a couple of mm. Sorting it out didn't take rest, or visits to doctors. I just had to make sure that my knee was not being twisted as I pedalled.

I'd really take a good look at your cleat setup. Ideally (as suggested above) get someone who knows what they are doing to check every detail of your bike and cleat setup.

[You could try putting a pair of flat pedals on your bike and seeing if you still have the same problem. Your feet could move to wherever they naturally wanted to go. I'd bet that your knees wouldn't hurt then. If you can run, there surely isn't a major problem with them?]

SteveR_100Milers

Agree with itboffin:

If the pain is *in* your knee (and not the knobbly bit outside and below it where your ITB join the shin bones) then its got to be the lateral angle that your cleats are set to. I have no problem with my road bike, but on my MTB I use shimaon SBD's which have less float and muhc more resistance to your foot moving twisting as you pedal through the full circle. I get pains in my left knee within minutes if I don't twist my foot to the "right" position.

itboffin

Here's an update for you all

I recently switched from SPD to Look pedals for no reason other than vanity, I did a couple of 50 ish mile rides during which I adjusted the cleats back and forward side to side until I had them in what I assumed was a comfortable position then last weekend I did a sportive holding a good pace which was all fine for about 20 miles then I started to develop pain in the Lateral Collateral Ligament of my right knee being a complete fool I continued to ride at the same pace then 40 miles in the pain became so sharp I was forced to stop and rest for a few minutes I was almost concerned that I might have to abandon.

Anyway during the same ride I had cramp in the left hamstring twice which in its self was strange as I never cramp i'm now beginning to think the two are related, poor cleat position causing an imbalance causing cramp perhaps?

So today after a week of rest and very gentle cycling I took to the road this morning on a completely different bike with SPDs one which I ridden loads pain free but 7 miles in and the pain was back in force, effectively ending my ride.

Hopefully I haven't seriously damaged my knee I think a trip to a sport therapist is in order.

BikeDynamics

Hi

I have not read all the other posts but in answer to the original question this sounds like inflammation of the medial patellar femoral ligament (MPFL). To quote 'Andy Pruitts Complete Medical Guide for Cyclists'

The symptom of MPFL inflammation is a sharp pain on the medial (inner) side of the knee. It can isolated to a pinpoint pain on the inner edge of the kneecap.

Causes include a saddle that is too low and pedals that have too much float. Knock knees, flat feet or tight illiotibial bands can also cause MPFL inflammation.

Hope this helps

Mike at http://bikedynamics.co.uk/

ut_och_cykla

INSIDE of knee is probabaly not iliotib inflammation. New clips suggests they (the new ones) are wrongly set up for you. Your left knee is probabaly travelling inwards and stretching teh ligaments. You might consider moving the clip nearer the inside of your shoe. BUT given teh level of pain I would also not ride until I had a diagnosis from a (sports) physio therapist and any inflammation has died down compleletly. Continually riding and irriattaing teh situation will at best not allow things to heal properly adn at worst might cause permanent damage!
Just a lay persons advice tho'.....