More knee pain....

milese

I've got a sore knee and am looking for some help.

I could right a short story about my knees so I'll try and keep it snappy.

About 3 years ago I started running and training for a half marathon. I got to about 10 miles but stopped due to pain in both knees. Diagnosed by different people as tight ITBs or calves with no conclusion, but a major factor has to be going from virtually nothing to too much too quickly.

Tried running a half dozen or so times since and all is fine til I hit an apparent threshold of 3 miles, after which they start to feel a bit sore. I tried this about 8 weeks ago (before pain on bike) and its still true.

Cycling has generally been fine, but recently has changed. It started coming on 40 odd miles into longer rides, but has gradually been coming on sooner and now starts on my 7 mile commute.

I've started increasing mileage and intensity. Weekly mileage is generally 60-150 miles.

I gave it a complete week off everything, but it came straight back half an hour into a ride this weekend.

My sister is a newly qualified sports therapist, and has been giving it ultrasound treatment, massaging my legs and reckons none are particulary tight.

Pain is a building dull ache, never a sharp pain. Its always at the front of the knee around the lower knee cap. Whenever I think I've pinpointed the location it seems to move.

I've never had a proper bike fit or used any science in setting up my bikes. I've tried playing with saddle height and position with no change. Get pain on both bikes.

Can anyone recommend a bike fit service or professional with experience of knee injuries in the South West? (Plymouth)

Any other thoughts?

Thanks.

milese

Also, is a weeks rest a reasonable amount? I would of though I should see some improvement in a week of complete rest if rest was the prescription of choice?

ut_och_cykla

I'm sure your sister is competent but see a sports physio and get someone to look at bike fit - as you have suggested.
Could be that the muscles that hold kneecap in correct tracking are out of balance/too weak - most likely the inner front thigh muscles - hence problems regardles of bike, set up, running vs cycling etc. Think this condition has a name like chondro-something:oops:
The pain will go if you become a couch potato - but specific exercises will fix it if it is the problem I've suggested.

milese

Thanks for the reply.

Chondromalacia, characterized by pain or crepitation in the retropatellar area, is described as a grating sensation with anterior patellofemoral discomfort that worsens with climbing, squatting, or prolonged sitting. The condition may be caused by articular cartilage breakdown or chronic synovial inflammation. Excessive patellar shear forces over the femoral condyles and patellar groove with malalignment of the patella contribute to cartilaginous breakdown. Cyclists who have pes planus, overpronation of the foot, or hindfoot valgum may also have a greater degree of patellar malalignment. During cycling, the pain is precipitated by riding up hills or when the rider pushes higher gears with a slow pedal cadence.

I've read that taking anti inflamatories is a good idea. Is this just popping 2 ibruprofen's 3 times a day?

wetnwindy

Ibruprofen is a short term solution to serious pain long term heavy use will give you major stomach problems. I had a neck injury last year 12 weeks rest and seeing a sports physio got me sorted. Although I too now have a knee issue from over use similar to yours just below the knee cap in the tendon area, rest ice and light stretching, usually work.

mask of sanity

I wouldn't recommend taking anti-inflammatory's. They'll mask the pain and you'll be doing yourself damage without being aware of it. There's also the GI problems as wetnwindy mentioned.

I had bad knee problems from bad cycling position but it was pretty much sorted by converting my town bike to a fixie and making sure my feet were in a good position in the pedals. The fixie bit helped as the over gearing on the hills meant that the weaker muscles developed quickly. That's my theory anyway and seems the logical one.

popularname

Milese - I have a very similar history and went to see my physio yesterday. The short version of our conversation is that cycling with high cadence and lower gearing is one of the best activities to help MY kind of knee pain; a very few stretches with low number of reps repeated regularly throughout the day are going to help a lot; and (we finally decided) taking glucosamine is likely to help (I am 50 and may have the beginning of arthritis). His big message was that the worst thing you can do is NOT move the knee; and that the best way to move it (and best muscles to build to move the tendons and realign the kneecap) is cycling.

While you might get different advice from a physio based on your case, there really is hope. I started doing regular miles again about 6 months ago and it is working - the knee pain is gradually diminishing. I can't recommend a proper bike fit highly enough. I got one here in Edinburgh and the difference in saddle height instantly took a load of pain away.

I know there's a spesh store in Bristol that will do bike fit. I think you have to pay extra for a peddle fit as well, but go for it - before I found the guys in Edinburgh, I was thinking about flying down for a weekend.

100% ditto on not taking anti-inflammatories. Bad news in the long term. Exercising the knees is a slower fix but a better one.

Good luck!

___________________________

milese

Thanks again for the replies. Its encouraging!

I'll avoid the ibruprofen. Is there anything that can help reduce swelling without offering pain relief?

I think physiotherapy is that it is as much of an art as a science, and without the experience you cant develop the art.

After the weeks rest I made a big effort to spin easier gears rather than grind bigger ones. Naturally I am more of a low gear, low cadence grinder.

I'm only 26 so the thought of not being able to sort them out now doesn't bode well for the next 26 years.

There is a Spesh concept store within a mile of my house. I just phoned them and they do a BG bike fit. A full fit (3 hours) comes in at £120 and a smaller fit, for about 2 hours costs £60. Said can book the shorter one and carry on through to the longer one if we think worthy.

They said they'll give me all measurements so that I can apply them to my second bike.

What muscles should I focus on stretching and strengthening?

Thanks again.

mask of sanity

Milese wrote:

I'll avoid the ibruprofen. Is there anything that can help reduce swelling without offering pain relief?

You wouldn't want to reduce swelling too much as it's part of the healing process. Swelling is also partly responsible for the pain as it causes nerve compression and allows certain chemicals to come into contact with with the nerves. I believe ice on the area after trauma is a good way of reducing swelling and pain without slowing down the healing. The pain would still be present though so should limit your use of the injured area.

The best thing you can do is to address the cause of the pain e.g. bike fit and pedalling style (cadence etc.)

Mettan

Milese wrote:

Also, is a weeks rest a reasonable amount? I would of though I should see some improvement in a week of complete rest if rest was the prescription of choice?

If its a minor articular cartilage issue - No - 3 - 6 weeks rest ideally - if it's a patella tendon overuse issue, again No - personally I'd take a bit longer than a week and do some muscle strengthening around your knees in the meantime - also check your bike -fit when restarting.

huuregeil

Milese wrote:

I think physiotherapy is that it is as much of an art as a science, and without the experience you cant develop the art.

No, not really, the body is generally reasonably deterministic :-) But a good physio does need to think extremely laterally (maybe this is the art...!), and not many do this. I'll say this much when it comes to finding a physio (and this is based on experience of good and bad ones over the years): the best physios are those who are active sportspeople, who take a proactive interest in preventative training, and those who are extremely good with their hands and use lots of manual therapy (and almost no ultrasound!). Go and hunt one out! And get that bike fitted ;-)

You do need to get rid of the pain. Ice is awesome, two to three sessions per day of 15mins with a bag of peas on your knee is not too much, and you can do this for as long as you have pain really.

What muscles should I focus on stretching and strengthening?

Subject to the physio's advice, all the action is in the quads. You need to stretch these gently and effectively. Strengthing - forget about muscles, focus on movements. You'll need to develop a good squat, and ultimately a good one-legged squat - the best preventative exercises for knee problems. But see a physio first and manage the pain in the meantime.

milese

I'll try and seek out a good local therapist, and start applying ice a few times a day.

In the meantime I'll rest and book a bike fit.

Another thing, is it usual to have very 'clicky' knees? They click a lot, and often you can tell that they need a click, and a few straightenings of the knee later they click and comfort resumes.

I'm booked in for the Cornwall Tor Sportive in the middle of May. What are my chances?!

Its so disheartening because I am genuinely in the shape of my life.

weapons

I've been reading this thread with some interest. LIke Milese, I have been experiencing knee pain with symptoms associated with chrondromalcia in my right knee which my physio thinks it is down to an underdeveloped glute which means my knee cap was inward pointing. Also looking at my pedal stroke in the air, it looks like my right foot is pronated so am getting a bike fit and seeing whether I possibly need orthotics. Has anyone else had this problem?

I am targeting the Tour of Wessex at end May but not too hopeful for this after over a month off proper cycling training and lack of winter miles. That said, I went out for a 30 miler today wearing a knee brace to keep the patella in place and seemed to be ok without pain,

I have a clicky right knee too where I sometimes have to pedal out of the saddle for it to click and the pedal stroke becomes comfortable after that. I am trying glucosamine sulphate to see if this works.

keef66

Pain, clicking and swelling suggest to me some kind of damage to the meniscus (commonly referred to as torn cartilage)

I had knees that would behave like this from late teens onwards. Finally got to have them operated on when about 35 yrs old. Identical tears in the medial meniscus of both knees. Problem free for the next 15 years, then my right knee suddenly went again. More serious tear this time, more aggressive surgery, longer recovery, but 18 months later it's back to normal. I'm afraid the left one is going to go pop in the near future. Consultant cheerily tells me I'll need knee replacements by the time I'm 60. Seven and a bit years to go!

The good news is that cycling is the best kind of exercise for my knees, and the more muscle I have, the easier rehab from knee replacement will be.

I suggest you get your GP to refer you to a joint specialist

Rest and keep the affected leg elevated to help reduce any swelling

milese

Have you been given any exercises to develope the glutes weapons?

So do you think the knee brace is worthwhile? What one have you got?

As for swelling, I cant see anything, but guess internally there will be some.

I sure hope that I dont need surgical intervention.

weapons

Milese - glute stengthening exercises I've been given:

1. lie on your back, bend the knee of the side you want to strengthen and liift up through this leg keeping the other leg parallel to the body. Hold for 4 secs and repeat 20 times.

2. Lie on front, bend knee of the side you want to strengthen so that the lower leg is perpendicular to the rest of your body. Use your glute to raise this leg, hold for a few secs and repeat 20 times.

The glute imbalance makes sense for me - before cycling, I rowed seriously for nearly 10 years so being an assymetric sport would have caused this. It may not be the same cause for you though.

The knee brace I have seems to work hold the kneecap up (as mine droops) so keeps it on top of the cartilege that is meant to sit below the kneecap. It's this one:
http://www.vivomed.co.uk/KB1000_1087/PS ... Strap.html

From what Ithe physio has said and from what I have read, surgery seems a bit drastic and is only used as a last resort. Rest, icing, bracing and possibly a bike fit to identify the cause seem to be the preferred solution to knee pain.

weapons

That was meant to be a link to the psb patella strap btw - this one
http://www.littleniggle.com/item/PSB_PS ... 0_8_1.html

surfgod

Ok now listen up.
Your tight IT bands are the result of having too low a q-factor on your bike.
Your knees are not tracking in a straight line,
Get a loan of a turbo- trainer, mount your bike in it...making sure it's level.
Have someone video you from the front, while you ride.

Now your knees, should track, ie move up and down in a straight line.

If you have broad hips, you may need to change to speedplay Zero pedals, speedplay sell longer than standard pedal axles.
Or look Keo max 2 pedals have an extra long threaded portion, enabling you to install a 2mm washer between the crank, spreading your feet wider appart.

I myself, use Speedplay Zero pedals with a longer spindle. these enable my knees to track vertically, in a straight line.

Hope this helps

Happy Riding

seanoconn

As mentioned previously in this thread, your problems could all be down to something as simple as poor bike fit. I had all the symptoms you had, pain above and below the kneecap, constant aching and my knees would really stiffen up after sitting for a while. Started feeling a bit down as i enjoy cycling, had recently spent alot on a new bike and was worried i would soon have to stop cycling for a long time.

When a set my bike position, i did it on my own using a plumb line which i held at the bottom of my kneecap and dangled it over what i thought was the pedal spindle below the ball of my foot, big mistake. After getting knee pain i checked my position again, getting my wife to take a picture from the side. Put the picture on my lap top, drew a vertical line through the kneecap to the spindle and found my saddle was way off where it should be, at least for a starting point. Had to move it forward 3/4cm. Within a week no more pain, started feeling better almost immediately.

Hope it proves that simple for you. Good luck.

paul.k

as said make sure bike position is 100% spot on and get to see a physio,if it turns out to be a injury like mine ,soft tissue damage round the knee it can take ages to heal i had 4 months off the bike and started again in jan but only allowed to do short low intensity rides ,but you need a proffesional diagnosis ,trying to ride it off may make it much worse.

iPete

Think I may have the same issue as you, ran a half marathon 2 weeks ago and ended up with sore knees, lots of pain on the front/outside but still managed to run on.Annoyingly I've had to lay off the bike since (and running of course), which is driving me nuts, the pain faded after a few days but I can feel it lurking!

As I probably won't get to a GP in the coming days, I've been looking around the net, closest symptoms I've found suggest Patellofemoral Pain Syndrome.
http://www.sportsinjuryclinic.net/cyber ... dexcmp.php

I'll also be looking into Chondromalacia & taking my glucosamine (although I'm also mid 20's so not sure how effective they are) and I'll be watching this thread closely!

Best of luck.

huuregeil

iPete,

In your position, I'd strongly recommend getting a sports massage, even if the pain has gone. That kind of "oops, I've run too far" knee pain is probably simply an inflamation of the patellar tendon, and tight plus weak quads are highly likely to be the main cause. Massage plus stretching is a very easy way of dealing with this in the short term, strengthening work in the longer term, if indeed this is the case.

milese

Thanks for the reply.

I saw a physio today who did an assessment and recommended some exercises.

She identified that I've got a weakness in my left ankle that has led to a reduced range of movement, and worse balance. I've sprained that ankle maybe 4 times in the last couple of years without any proper rehab.

Apparently nothing is actually 'wrong' with me, I just need to focus on some strengthening.

I've also need to work on strengthening my glutes and quads.

Exercises:

Heal lifts off a step
One legged half squats (with eyes open and eyes shut)
Full squats with back to wall
Balance board work
Lying on your side raising your bum off the ground

Am I going to get enough strengthening from this sort of thing? Any reccomendations on other worthwhile exercises would be good.

Bike fit booked with Specialized on Monday.

ut_och_cykla

Milese wrote:

Thanks for the reply.

I saw a physio today who did an assessment and recommended some exercises.

She identified that I've got a weakness in my left ankle that has led to a reduced range of movement, and worse balance. I've sprained that ankle maybe 4 times in the last couple of years without any proper rehab.

Apparently nothing is actually 'wrong' with me, I just need to focus on some strengthening.

I've also need to work on strengthening my glutes and quads.

Exercises:

Heal lifts off a step
One legged half squats (with eyes open and eyes shut)
Full squats with back to wall
Balance board work
Lying on your side raising your bum off the ground

Am I going to get enough strengthening from this sort of thing? Any reccomendations on other worthwhile exercises would be good.

Bike fit booked with Specialized on Monday.

Yes as a layman I would guess this will all help knee stability - but it will take time and requires doing it all religiously.....

milese

Thanks. What sort of reps should I do daily?

milese

I found this, copied out best bits, with added links to youtube exercises.

http://www.bikeradar.com/fitness/articl ... rt-2-17445

Ways you can look after anterior knee pain
The key to treating such a condition is to loosen off the lateral structures before attempting to redress the balance and concentrating on building medial muscle bulk.

• Try to keep your leg out straight, if you’re troubled with anterior knee pain of this type, whenever you have the choice.
• Building up the vastus medialis oblique muscle can also help. After a week or so of regular stretching and self-massage, work on building up the vastus medialis oblique muscle to balance out the stabilising forces on the patella. It’s slow and can feel pointless initially, but persist with loosening the lateral side then strengthening the medial side, and in a couple of weeks you’ll feel a difference.

http://www.youtube.com/watch?v=6X8vZ9VkfY8
http://www.youtube.com/watch?v=6HYQsZCT ... re=related
http://www.youtube.com/watch?v=me7fO0EcSoM&NR=1
http://www.youtube.com/watch?v=IrWHmmWb ... re=related
http://www.youtube.com/watch?v=Gkllf8Dg ... 1&index=48

How to manage iliotibial band syndrome
Rehabilitation after this is very similar to that described above for patellar compression syndrome, but with a focus on building up the gluteus medius muscle instead of (or as well as) the vastus medialis oblique.

Near-religious stretching, especially of the iliotibial band, should precede strengthening exercises. A return to normal activities should be phased in gradually, being guided by (a lack of) pain.

Gluteus medius strengthening exercises
The following exercises are all designed to strengthen the gluteus medius muscle – an important core abductor of the hip, oft neglected by cycling. It’s a smallish muscle which, when contracting, can be felt as a lump at the top of the “scoops” of your buttocks – it’s a good idea to place a hand on this area when doing the exercises, to make sure you’re exercising it.
• Side-lying leg lifts
An exercise performed by lying on your good side, with lowermost leg bent for balance. Keeping the uppermost leg straight, and with the foot rotated out to 45°, raise it up and slightly backwards, holding just for a couple of seconds. Lower the leg and repeat, feeling for the contraction of the muscle with your uppermost hand.
• Rotating dip
Stand sideways on to a wall, balancing on the affected leg, with the unaffected leg lifted just off the ground and pressed against the wall for support. Now slightly bend the knee, dip down by a few inches and hold this position. Keeping your weight on the outside of your foot, now try and twist the knee outwards, stabilising yourself against the wall with your other (raised) leg. This is an excellent way to build the gluteus medius, has the added advantage of also indirectly stretching the fibres of the ITB and what’s more can be done while cleaning your teeth!

Four strategies for loosening tight lateral muscles of the thigh
As well as the usual stretches for quads and hamstrings – always a good idea – there are two stretches that target the lateral structures, in particular the iliotibial band. Contrary to popular belief, it is possible to stretch the lower end of the iliotibial band.

ireland57

Depending on where the knee pain is I've found icing can make the problem worse sometimes making it very stiff.

I now use a compression bandage overnight (firm, not tight) and usually the next morning it's back to 90% of "the best it's going to be." I've had life long knee issues.

If it's a bad one two nights with the bandage may be needed.
I've used all types of healing rub-ons and find them hit and miss.

Since I've been cycling as long as I don't push too tall a gear my knees are better than they've been for years.

Lowlander

I've been reading this with interest - and hoping to get the benefit of everyone's wisdom on it.

Been ramping up the training pretty hard in an effort to make the Tour of Wessex a viable 3 days in the saddle. Especially been trying to take every opportunity to get multiple big days in, since knowing I can do this should give me the confidence and endurance I need to get through and enjoy it.

Then... had to pull up at the weekend mid-way through a second consecutive century with sharp pain at top/outer side of left calf/back of knee. It built gradually until eventually even soft-pedalling was really excruciating. I live in holland, so everything I do distance-wise is pretty flat and high cadence. The strength stuff I save for the turbo.

I took a day off then attempted a gentle hour on the turbo just to test the waters and after half an hour it came back again with a vengeance. Feel it only slightly when walking/climbing stairs but the pedalling action seems to really bring it on.

So a couple of questions:

- what is it? tendon which connects calf muscle to knee perhaps? everything else I read seems to be more about pain at the front of the knee and very quad focused
- what should I do about it? i.e. complete rest, or keep trying to gently train to keep it moving. very concerned about losing condition/training time with my key goals pretty nearby now
- what can I do to avoid it? my first thought was to adjust my pedals (speedplay) to allow my left heel to rotate inwards more as I pedal for a more natural action.

All advice very welcome!

ut_och_cykla

Could be any number of things but it sounds like a problem my hubby had after long/hard rides. His foot was positioned too far out in relation to SPD clip - and he was correcting this (unknowlingly) by trying to lift up the outside of his foot. He moved the clip a millmetre or 3 so his foor got better support and the problem disapperaed.....but it could be where the hamstrings tie in to lower leg - in which case it might be a saddle height/sitting unevenly problem - see a physio?

milese

From what I've read pain at the back of the knee is associated with excessive saddle height, so thats definately worth checking.

What should you do? The two main things are see a physio and get a bike fit. Might cost you £100 for the two, but if your anything like me thats not a great deal in comparision to what you spend on the rest of bike stuff, nor compared to to the annoyance of not being able to ride.

It also allows you to focus on a plan / exercises set out by a physio, rather than doing what you read on the internet and hoping that its helping.

If you can stand it swimming cant hurt to allow you to at least do some exercise, so long as it doesn't hurt.

The cleats should allow your feet to take up their natural position, not force toes square to the bike if they dont want to be there.

paul.k

after a frustrating time i am finally seeing light at the end of the tunnel, lots of gentle rides and gradually building up my weak knees , once i got the physio diagnosis i knew exactly what i had to do ,and am getting stronger week by week ,but i have still got to remember not to push too hard or i will put my knee out again ,which will then wreck my summer ,so it looks like build up a good base then increase intensity gradually