Desperately seeking a solution - knee pain

lloyd_bower

I've been suffering from knee pain for a year now. Mine came on shortly after coming back from being knocked off my bike, and damaging in the main my left foot. Returning to cycling, though the pain was in my left knee, outer above the knee cap, and below on the inside towards the end of long and then increasingly shorter rides.

From before doing regular 120k+ rides, daily commuting to work by bike (70k round trip) and loads of hill walking, I was left in the stage where I got pain simply walking. I went to a physio nearly a year ago now, who diagnosed patella femoral syndrome, and I had accupuncture and physio, and was given stregthening exercises - squats, leg raises, scissors etc. which I followed religiously. Three months of this and also stopping cycling altogether, and I was in worse state than before. Practially permanent knee pain, worse from when sitting down I guess (desk job )

I tried a chiropactor to see if it might be related to my cycle accident and caused by hips, or ankle - but no joy there. Saw a GP who referred me to a orthopeadic knee specialist who recommended further rest. With no improvement at all, I started to resume light cycling, which was OK for short distances, certainly no worse than resting.
Going back to the knee specialist after no improvement, I had a MRI scan which has just now come back negative. He said simply that there is nothing structurally wrong and that I should try to resume my full cycling, which is ridiculous as I have knee pain simply from simply walking.

An attempt to slightly increase the amount of cycling produced the inevitable increased knee pain again. So I'm back to square one again, except more than a few dollars poorer.

I'm lost as what to do next. :? I've never had any knee pain before, but there's clearly some thing wrong and giving me my the knee pain. It's not just cycling, walking's the same. The other noticeable symptom is regular clicking if I bend my knee. There's no change in my bike set up, which I've happily managed along for years (42 now).
I've tried total rest, but that seemed to be worse than doing shorter and easier commute into work.

I'll probably have to bite the bullet and try another physio and hope for the best, but it's so infuriating. If I hadn't managed to keep active through increased sea kayaking this last year, I'd have gone stir crazy.

Anyway be interested if anyone has any similar experiences.

agg25

Hi mate,

Yep had similar experience myself, you'd think if they could put a man on the moon they would know how to fix a knee but apparently not. My opinion of doctors is a lot lower than it used to be, I think they're only really good for dispensing pills.

Anyways...I hurt my knee in Austria going down a toboggan run when my right foot (which were the brakes) got too much grip and caused my leg to swing back with a little cracking sound coming from my knee. The next day I couldn't walk thus ending my first skiing holiday.

I went to the local doc their and had an xray which showed no breaks, got some crutches and went on me way. Back in England recovery was slow so after a bit of a wait got an MRI done and it came back as nothing wrong, even though the Austrian doc said it was probably a torn cartilage.

So I just carried on, disgruntled with the inabilities of the medical profession to find the problem when I could feel something was not right. This was a few years ago now and my knee is mostly good now although it still isn't quite 100%. I still feel a slight twitching pain in it when loading it up but it doesn't really stop me doing anything.

My last holiday in France I fell off landing on my little finger expecting it to be broken. It wasn't but 4 months later, it's still swollen and sore despite 3 doctors saying nothing can be done about it.

Moral of the story...don't rely on doctors to fix you, most of them are pretty useless.

mea00csf

not sure what you're after there, but i'd find a very good sports physio. I would also when you do manage to get back on the bike, I'd get a proper bike fit done. As you're in Australia can't recommend one, but the one I know of in England, they film in slow motion, put sensors on your joints etc so they can see EXACTLY what's going on and change you're position.

ride_whenever

Go and see a DECENT sports physio, one with either cycling or rowing experience. I'll ask a few rowing buddies if they have any contacts in auckland...

STOP using clipless pedals if you currently do.

From the sounds of things you've got a load of generic patella/knee exercises rather than anything specific. I'd really suggest a better physio as yours sounds rubbish! Avoid osteopaths as they are very often rubbish also.

stubs

ride_whenever wrote:

Go and see a DECENT sports physio, one with either cycling or rowing experience. I'll ask a few rowing buddies if they have any contacts in auckland...

STOP using clipless pedals if you currently do.

From the sounds of things you've got a load of generic patella/knee exercises rather than anything specific. I'd really suggest a better physio as yours sounds rubbish! Avoid osteopaths as they are very often rubbish also.

Agree with that apart from the stopping using clipless. I have a right knee knackered by years of rugby and falling off motorbikes and pushbikes, I cant ride flat pedals for more than an hour before I am in agony.

I need my Time pedals to ride any distance because they give lots of float and mean my heel can waggle from side to side when pedalling. Sticky shoes and pinned flats lock my foot in position forcing my dodgy knee to waggle causing swelling and pain.

Not everyones problem is the same and the OP needs to find out what suits his individual problem with the help of a bike fit expert and a proper sports physio who understands cycling. Unfortunately a rare pair of people who charge a lot because they are so much in demand, my physio works with the Liverpool football team and the Waterloo rugby team so has lots of knackered knee experience.

MountainMonster

I've got a bum left knee from motorcycle accidents, and wanted to ask if you wear a brace while riding?

I was ok riding for a while with no pain, but suddenly my pain started acting up again and I immediately started riding with the brace on again. Not some fancy brace, but the kind you get from tescos for a tener and it just velcros on. It has worked wonders in terms of the pain. It may be a bit uncomfortable, but if you manage to get a decent one with a tiny bit of leg room, I sowed together a sleeve from a really soft t-shirt and wear that in between the brace and the back of knee where the joint it. Helps with the rubbing and not causing uncomfortableness from that.

SPD's are also a no no, I ride with them still now that i'm wearing my brace, but my pain wasn't that bad, and didn't sound as bad as yours in the slightest.

ride_whenever

My point re: flats was that he's riding clipless and getting knee pain, which means they're not set up right. Flats will at least eliminate some of that.

stubs

Didnt realise he was on clipless it doesnt mention it unless I have misread which is possible I am on a phone and reading lots of text is a ballache

agg25

I would say clip-in pedals wouldn't be an issue here. I use them and they don't aggravate my knee. They put your foot in a constant position so once set up right, they should be better than flats. Just make sure you pedal with your knees not sticking out too much, try to keep them close to the top tube when pedalling and adjust the float to suit.

agg25

I would say clip-in pedals wouldn't be an issue here. I use them and they don't aggravate my knee. They put your foot in a constant position so once set up right, they should be better than flats. Just make sure you pedal with your knees not sticking out too much, try to keep them close to the top tube when pedalling and adjust the float to suit.

PresumingEd

I have suffered with similar knee problems for about 20 years. I first knackered them playing rugby and then noticed quote a rapid deterioration until I was eventually referred to a podiatrist.

It turned out that my knee problems had only gotten so bad because I have fallen arches, which meant my feet were pronating. The pronation was then causing my keecaps to move slightly out of line, leading to inflamation and pain.

I was prescribed orthotics to keep my feet in the right position, which appear to have helped massively. The pain has never truly gone away and recently I had to get another referral to get the orthotics adapted, which in turn led to a referral to physio, but it has allowed me to continue with pretty much whatever exercise I want, with cycling causing no notioceable pain (I use SPDs, by the way)

Accordingly, I would recommend that teh OP visits a podiatrist as well as trying to find a decent physio

sad Bastad

Your problem sounds very similar to my experience, albeit mine was not accident-induced.

I started riding about 2.5 years ago when I was fifty, after 30 years of doing no real exercise, although I was not over-weight. After about 3 months I developed a knee pain that, though never excrutiating, caused discomfort, just as much when seated at my desk as when cycling. Stop cycling and it stopped very quickly.

I went to see a sports physio who said it was allied to the way I slept and was part of a total issue I had with a bad back and tennis elbow. He treated my back (which was not giving me any problems) but it made no difference to my knee.

I went to my doctor who referred me, under BUPA, to a specialist who said it was PFS, and recommended I do exercises consisting of lifting up each leg in turn while sitting forward in a chair, with my leg turned out and an ankle weight attached. After about 4 months of doing this with no improvement I went back to the Consultant complaining that the regime he had given me wasn't very professional and had made no difference. So he recommended I undertake physio at the local BUPA hospital. I went for about 10 sessions.....but no improvement.

Over the period I had two bike fits, one with Specialized, the other (better) with Bike Dynamics in Leamington Spa. No major problems were identified

I then made enquiries with the physios about who was the best consultant and came up with a name they rated the best. A professor and a leader in the field, heading up a very prestigious institution. Although much in demand I got to see him after a month, and he could detect nothing on visual inspection. And nothing on subsequent MRI. He sent me to his retained physio at his Harley Street premises (a charming and very fit 78 year old who had been physio to both Arsenal and the England football team). I had about 6 sessions with him. No improvement. Another MRI was undertaken which again revealed nothing untoward.

As a last option the Consultant suggested an arthroscopy to see if that threw up anything. Desperate for a solution I went ahead. After the operation he came to see me and said there was really nothing, a slightly sore red area, but he was "hopeful that inflating my knee to 30 bars of mercury would do the trick"

After 2 weeks or so I was back on the bike and, hey presto, although my right knee is always slightly sore after a ride it is 95% better, and I get nothing like the discomfort I did previously.

Following up with the Consultant he has no real idea why the act of arthroscopy itself should have significantly improved the situation, but he has previously seen a similar result.

So, I don't know if this is any real help to you but my experience of doctors and physios when they're confronted by a cyclist with a problem knee is that it must me PFS. It was only my perseverence of seeking out a renowned specialist (and, financially, it must be said, my BUPA membership) that has provided me with a solution, which 6 months later appears to be permanent...

Good luck.

ireland57

I've had crook knees most of my life.....hockey, off-road motorcycles, carpenter....all contributing heavily to damage.

I've found stretching and strengthening my back, core, thighs/quads, hips making a big difference to the knee pain which has shortened a few rides for me.

Things are on the improve. A month ago I couldn't stay on a group ride (knee pain); now I can sprint with them.

I changed some bike parts as well to ease things a bit....shorter cranks, spinning gears instead of pushing.

d87heaven

Have you had an ultrasound scan?
Clicking of the knee could be a Plica snapping over the femur. Plica don't show on xray or mri but an ultrasound used by a good sports doc will be able to pick it up.
An inflamed plica or inflamed synovium is a bit like biting your gum. You nip and it gets irratated and infllamed so it gets nipped again.
You can often feel a plica between the knee cap and the jointline of the femur and the tibia. Its like a hard length of spaghetti that you can flick your thumb over.
Commonly confused with patella femoral. An ultrasound guided cortisone injection or surgical removal is the cure.

But you need a ultrasound scan and a good sports doc. Local football club docs often have good facilities/docs/knowledge if you can get access to them

dennisn

Sad to say but I think you also need to look at this as an injury that may never heal short of knee replacement. I only say this because simply wanting to ride, run, or whatever
isn't going to make your knee heal. It's been my experience that most injuries will heal with time but most people don't give them the time they need. There are plenty of people in pro sports who's careers have ended due to knee problems and they don't have much recourse but to accept it.
Hope it all works out for you, I really do. Good luck.

d87heaven

:roll: He needs a diagnosis, by a sports doc, different surgeon and/or a biomechanics set up to check everything is in line etc. You can't just say its an injury that will never heal. Most footballer knee injuries are of early onset artheritic type, ligament damage, or worn/torn cartlidge type injuries. Lots of twisting and turning and lack of recovery time for healing is a footballers priviledge. These show well on mri/xray and a good surgeon should be able to spot these.
Don't give up. Get an answer to why you have pain and then you can decide a course of action.

lloyd_bower

Hi,
Thanks for the responses.

I do use clipless pedals, the shimano mtb spds but I don’t think that’s the issue.

Yes, I seek out another physio, I’ve been looking locally for recommendations and will see what comes up.

I tried one of the cho-pat knee straps, it didn’t seem to make a a great deal of difference, sometimes better, sometimes worse.

Not had ultra-sound, had x-ray and mri scans. Pilca does sound like a possibility, first I have heard of it.

Yes, it’s been a year, but I’m not ready to get that negative yet. The injuries you mention are ones that should typically show up on a mri scan.

stubs

Have you tried orthotic shoe inserts. They are a custom made wedge that goes in the heel of your shoe that alters the angle of your heel, ankle and knee. They are made by a specialist watching you walk then heating one of various sizes of foam wedge you do up your shoe with the hot pliable wedge and then have to hold a position whilst it cools and sets. I have been using them for years getting new ones on the NHS every 12 to 18 months.

Also shoes can make a big difference I only wear Specialized shoes because they come in wide fittings and with different thickness foot beds. If you have a Specialized dealer near you they might have the full fitting kit not cheap but might be worth it if your current shoes are near the end of there life

rock_hopper

Hey Lloyd,

Sorry to hear about your knee troubles, its such a complex joint but one that allows us to do so many activities, when its busted its very frustrating.

Ive just read your original post and the replies, definitely agree with trying to get a good sports physio, preferably one that specialises in cycling.

I had a similar problem and was very very lucky to find a physio who is a cyclist and is fantastic at his job, he is also now a very good friend. If the advice you have received hasn't worked, i.e. rest and strengthening exercises it could be as simple a tight muscles! Sounds like you've been doing a lot of riding and hiking, do you do any stretching at all? Exercise strengthens the muscles but also shortens them and creates micro trauma. If you don't counteract this my stretching and sports massage they can get so tight that they pull in the wrong direction. It sounds to me like your IT band/quad is very tight, pulling your knee out of alignment, causing the pain when you ride. If this is the case you need to loosen those muscles off and stretch them out........lots!! Either get a professional sports massage focusing on the IT band and quad or do it yourself with a foam roller, links below.

http://physiosupplies.com/acatalog/Fitness_Rollers.html
http://sportsmedicine.about.com/od/flex ... ller_5.htm

A professional sports massage is a good starting point but would recommend a foam roller for a cheaper massage, and something that you will use a lot to keep your muscles loose and flexible. Learn about your muscles and learn how to maintain them, our bodies need maintenance when we hammer the hell out of them like we do :-)

I'm not a professional or anything but I really listen to my physio and he makes a lot of sense, hope this helps some.

lloyd_bower

Hi,
Thanks for the reply. Yes, I regularly did lots of riding and hiking before my injury with no problems, but I haven't done any proper hiking at all for the last year because of my knee injury, simillarly cycling I've been no more than commuting to work. I only resumed this when total rest seemed to be worse if anything.

I have tried an strengthening/streching exercises included ITB stretches and similar self massage on the ITB using a wine bottel instead of the foam roller at teh suggestion of teh phsyio.

Tried practically everything except the kitchen sink, I'll have to try another sports physio and hope for the best. It's just been frustrating - it's kind of worse after a day sat down at work than anything else.

stubs

The more I think about your problem the more I think its possibly not a knee problem. Its sounding to me (I am no expert) like it could be something other than the knee, have you had your back checked out,

I am also a back sufferer and suffer back spasms at irregular intervals. When my back is bad and I am on painkillers for it my knee suffers because I am sitting, walking and riding differently. My physio tells me that I unconciously change my sitting, walking posture to protect my back, she shouts at me if I start to slump she shouts"your walking like a crab again straighten up". Its like being shouted at by a drill sergeant but it works

It might be something else to check out. Best of luck in your search for a cure I am off the bike at the mo because of a chest infection 2 weeks off the trail is doing my head in.

cyclingphysio

Check out the quad tip video here http://cyclingphysio.com/?p=72 , yours sounds more retropatellar but the imbalance that produces pain is the same. You can continue through life with imbalances like this and not know it, then get a whack to the knee and scuff the cartilage a bit and you don't recover because you are loading the knee too much as you ride. Also have a go at the gluteus medius and Maximus exercises, they are in the exercise library, if you are not great at them that is a pretty good sign that you overload your knee on the bike. Good luck

wastrel

I had outer and inner knee pain after breaking my patella - the patella never hurt at all.

It got worse with any high intensity bike training - not while riding, but in the days after it was making it hard to even take the dog for a walk without stopping to stretch every 10 minutes. Even staying off the bike for weeks made no real difference.

It went on for years and the knee just felt weak - specially when climbing stairs etc. Thanks to the guys on this forum i started on the rowing machine to do the 'C2 challenge' - nearby thread.

Within a fortnight the knee was pretty much bullet proof, and I'd learnt a new kind of pain in the lungs.

I just tried the exercises from the 'cyclingphysio' above and then jumped on the rower. My butt was instantly pretty sure that it targets the same muscles! Maybe they never 'got going' properly again after the accident?

I reckon it's worth looking at that site. Good luck with the knee.