Knee Pain

SJDobby

Hi

I know the subject of "knee pain and what causes it" is covered all over the place in various forums (fora?), but I just thought I would like to air my particular issue just in case anyone had any more than "generic" advice.

My left knee and right knee are different - the left is shall we say "knobblier" than the right one (always has been I think). I have been "seriously" riding for the last year or so (mountain bikes most of last year, MTB + road since Xmas), am in no way over-weight [10st 7lb, height 174cm] and (according to my latest company health check!) above average fitness. Both my bikes have clipless pedals on, all pedals adjusted to be "loose", giving my feet the maximum lateral float.

Occasionally in the past I have had slight and temporary "day after" pain immediately above the left knee after a heavy session (that included hills), which I accepted as par for the course. A couple of weeks ago I did 53 miles (over the course of several hours as part of a particularly rainy relay event) in the hills of Cornwall and Devon. This resulted in knee pain "in the usual place" (i.e. just above the left knee) that actually lasted for about a week.

Over the two weeks since then I have hit the gym twice (normally do every working day), being careful not to antagonise the left knee, so did rowing, gentle cycling and a bit of leg-weight work. Yesterday I went out on the mountain bike for some not-too-strenuous off-roading (2 hours), again being careful not to be in too low a gear on the hills, keep the cadence up, stay in the saddle as much as possible, etc. Today I have more pain in the front of the left knee, this time actually on top of the knee rather than the areas immediately above it. The surface of the knee is quite warm relative to the right knee. The pain is most evident when moving between the 90-degree angle and leg-straight; it more or less disappears in the fully-flexed (heel-to-backside) position.

The only real difference in my recent exercise regime has been: (a) 2 outings of more than 50 miles and (b) a reduction over the past few months in the amount of "leg-weight machine" exercise I do at the gym (I have focused more on stationary bike, rowing and a little bit of gentle [6mph] treadmill work).

My current thoughts are:
(1) Seat position perhaps too far back? (the fact that I have recently had slightly different symptoms on a mountain bike compared to those on the road bike perhaps suggest that the different bike setups may be having an effect). Not sure why this would affect one knee and not the other, though.
(2) By reducing my "total leg" training (i.e. leg-weight-machines at the gym) my leg muscles are perhaps getting dis-proportionate, causing the knee to be pulled/pushed to a different position (strange I don't have this with both knees, though, even considering the aforementioned physiological differences between left and right that I have).

Apologies for this ramble, but I am working towards my first century ride in October and would rather not simply "take a guess" as to what is going on with my knee, self-diagnose and self-treat with more leg-weight exercise if that actually does more harm than good. I am tempted to see my GP about it just in case he has some professional opinion, but I would be interested to know if anyone has had similar symptoms in the past and has an idea of what I could do to minimise future issues. A big question is: do I rest the knee up, or do I do more exercise of a different sort (e.g. get back to the weight machines rather than spend my time on the staionary bike)?

Regards
Simon

marksimon69

How old are you? ............... I had similar aches and pains and went to doctor, had an xray and it was onset of mild arthritis (hereditary apparently). Doc said keep on exercising it and I also take cod liver oil tablets every day which seems to have stopped any more pains.
Whoops ...... I'm a fairly fit 51 year old !!! :shock:

SJDobby

A lightly-framed 42 year-old. On my dad's side there is a bit of history of slightly dodgy joints (ankles and knees) but I don't think that arthritis is common in the family.

Tom Dean

Any of: poor bike fit on road and MTB, gym bikes, rowing, running or leg weights could be the cause.

From a cycling perspective I would get a good bike fit done and ditch all the other stuff. Certainly don't look at weightlifting as a cure.

Cleat Eastwood

pain above the knee can be due to seat being set too low. I had a nagging ache for a while and got rid of it altering the cleat position, the original position had moved slightly and pointed my right foot outwards - I needed to set the cleat to a neutral position and make small changes to it till I found a position that helped me

SJDobby

Tom - a bike fit is certainly something I'd like to do, but I don't think I could get "clearance" from the missus to fork out the sorts of wonga the bike-fitters seem to want (although, saying that, £50 spent now to stop me grinding my knee-joints to dust seems like a good investment). I am going to re-visit my cleat setup just in case it is not where I thought it was; plus at the same time see whether the seat positions are too far back, perhaps.
I've not changed the bike setups recently, so am not sure why (other than the extra distances I am now cycling) bike setup [on both bikes simultaneously] would only now be causing me problems. Maybe my 42 year old body components are starting to tell me something!!! :-(

Tom Dean

Maybe your current bike position is fine. If the problem is caused by lifting weights or running on a treadmill then getting a bike fit won't make any difference.
I'm confused as to why you think 'being careful not to antagonise the left knee' would include lifting weights? (or rowing, - is rowing easier on the knees than cycling?)

SJDobby

My usual training (due to very little spare evening time) involves: 1 hour Pilates (Mon), 3 to 4 x 30mins gym (Tues-Fri lunchtimes)(sometimes I substitute a 10 mile TT-practice by going out on the road bike on a Friday lunchtime), 2 to 3 hours road or mtb ride (most Sundays) - hence I generally get out on a real bike once a week.
The gym sessions have of late involved a lot of quite hefty "interval" sessions on the bike (100 to 250W range), which I suspect puts more total stress on the knee than moderate "calf raises" [typically 52kg] / "seated squats" [61 kg] / "leg curls" [42kg] (2 to 3 sets of 15 reps on each machine). (I don't actually do "weight lifting" in the bar-bell/powerlifting sense). Actually, the reference to the weight training was more an indication of focusing on all the leg muscles rather than just the primary ones used when cycling. And with the rowing, both legs are being stressed at the same time, which should mean there is less "rotation" or side-to-side rocking [e.g. that cycling involves] that could be applying unwanted torsion to the knee joints.

ariege_cyclist

As has been said above often knee pain can be caused by a too low saddle height.
I suffered for years with left knee pain, a combination of lots of driving in traffic (really aggravated my knee due to all the clutch work) and slightly too low saddle.
For me the cure was a slightly raised saddle, more miles on the bike, a good amount of swimming, and less driving in traffic!!
3 weeks ago I rode the Lakeland Loop back on my summer bike for the second time in the year, awful pain in the last hour, only to find when I measured up that the saddle was 12mm lower than it should be, took 2 weeks of gentle riding and being careful with the clutch again to cure it.
My advice, avoid the gym bikes as the set up is very hard to get right and even a few mm can make a big difference, get a bike fit or start to raise the saddle a couple of mm a time.

ut_och_cykla

Sounds like it could be an inflamed tendon from the thigh muscle /quads. Probably overuse and/or perhaps saddle height/cleat position. Rest & ice. Don't do anything that makes it hurt for 6 weeks would be a possible the physio response.
See a good physio. get it sorted. If its position it won't go away by itself and may probably get worse.
Whats seated squats? They could be irritating the same muscles

SJDobby

ut_och_cykla wrote:

Sounds like it could be an inflamed tendon from the thigh muscle /quads. Probably overuse and/or perhaps saddle height/cleat position. Rest & ice. Don't do anything that makes it hurt for 6 weeks would be a possible the physio response.

Thanks - the "just above the knee" ache that I got after the road-riding [a few weeks ago] was very localised (about a square inch); I'm no expert (clearly!) but to my untrained mind that could suggest a tendon rather than muscle or joint problem.

ut_och_cykla wrote:

Whats seated squats?

Probably more accurate to call them "reclined squats" - basically, in a nearly-reclined position, you push away from a "wall", raising the selected weights [vertically] as you do so. I am a big fan of this exercise, and I recall Sir Chris Hoy saying recently (I paraphrase) "if there is just one exercise you want to do with your lower body, it is the squat".

ut_och_cykla wrote:

...They could be irritating the same muscles

Oddly, the "knee pain" has only occurred since I stopped doing these leg exercises, which is why I suggested maybe that these exercises were perhaps good for preventing knee pain rather than causing it.

Btw, the knee pain this morning (brought on by Monday morning's MTB excursion) - while not entirely gone - has subsided considerably.

Giving the knee a rest sounds like a sensible plan; I am due to do the Wiggle Bournemouth Sportive (70 miles) at the end of the month, so I will probably give the interval training a miss and focus on arm/shoulder and gentle CV work (gentle biking/rowing - not running!) until then, and will certainly not over-push myself on the event itself.

ut_och_cykla

Check out your clips - not everyones knees like to have their feet locked in one position. Most riders don't need it either. If they keeping clicking out theyr're wrongly set! I use SPDs with plenty of float & fairly loose. Might explain the pain on ceasing gym exercises - you've exercied in one plane & built up 'strength' but now you're riding more/harder its in another (Different) plane & causing some irritation.

utgaardaolle

You are 42 and your only problem is a dodgy knee? Ten years from now this will be the good old days....

Mike67

Ariege cyclist wrote:

As has been said above often knee pain can be caused by a too low saddle height.
I suffered for years with left knee pain, a combination of lots of driving in traffic (really aggravated my knee due to all the clutch work) and slightly too low saddle.
For me the cure was a slightly raised saddle, more miles on the bike, a good amount of swimming, and less driving in traffic!!

^I have had almost exactly the same experience in the last few months.

I had a bike fit shortly after getting my current bike a couple of years ago and all was well.
This year I started getting knee pain in my left knee (also hurt more whilst driving) which I put down to me also increasing the amount of riding I was doing.
I tried altering cleat position (as they were new) to no avail and double checked my bike fit measurements. Turned out my saddle was the issue in that it was 'sagging' by about 1cm or more when I sat on it.
Putting on a new saddle eased the problem slightly but not totally. I then put the saddle up (higher than the original bike fit height) and over the last couple of weeks the pain has slowly disappeared.

Short answer in my case was to check your saddle isn't knackered.

Also, even with a bike fit I'm guessing that the ideal position can change over time. Not sure why, but could be down to body/muscle changes due to extra training, becoming more/less flexible, pedalling technique changing (e.g. more or less toe down) over time etc.