Knee's hurting.. going to see a physio

alihisgreat

So I've finally made the sensible decision to see a physio despite my left knee being a bit dodgy from the outset.

It can't really cope with longer, harder rides (eg 50+ at a high intensity) and something needs to be done!

Does anyone have any experience of NHS Physios? I'm based in Oxford at the moment so need a referral from my GP (which I assume they will give me without any problems?) Will I get to see a Physio relatively quickly?

Basically I'm not too pleased though.. its looking like at least a few weeks off the bike

SwainsL

You may not be directed to a physio, they are over-populated, cost the NHS a lot since there's always the need of a regular check up and sessions last up to 30mins.

In my case I was given a routine plan of what to do with my injury. You don't necessarily have to not ride at all, just take it easy, you haven't broken anything. The shock of not doing any active motion wouldn't really help.

Having said that, NHS physio's aren't that great on a whole, which is why many people go private.

markp80

If you're going to your doctor about your knee then I personally wouldn't want to be going down the physio route. I'd be pushing for a scan to see properly what's going on. If you've got cartiledge wear then a physio isn't going to help. Your doctor can refer you for an MRI without referrring you to a specialist. (I do have a level of personal experience with injuries to both knees)

Cheers,
MarkP

alihisgreat

Really? I thought only consultants could refer you for an MRI? I'm going to the GP tomorrow and will see what they say...

Depending on the wait or lack of referral I'll probably end up going private anyway. £50 for a first session Isn't outrageous. Then hopefully it will just be a case of rest, addressing muscle imbalances, and a new bike fit.

dw300

Yes. They were pretty useless. They'll only really be able to help you if they can recreate the problem in their surgery. Unless of course you can find one that cycles.

alihisgreat

Saw my GP today who seemed keen to help

he played around with my knees a bit and they seem stable so I shouldn't have any serious damage.. it turns out I can see a physio privately through Uni and it shouldn't cost much; if not I have a referral and can investigate NHS or other private clinics.

markp80

ALIHISGREAT wrote:

Really? I thought only consultants could refer you for an MRI? I'm going to the GP tomorrow and will see what they say...

Depending on the wait or lack of referral I'll probably end up going private anyway. £50 for a first session Isn't outrageous. Then hopefully it will just be a case of rest, addressing muscle imbalances, and a new bike fit.

No, well not in my personal experience. My GP referred me directly for an MRI. The scan comes back to the GP with a report on the findings, not just a picture. Your GP can then refer you as appropriate.

Cheers,
MarkP

markp80

ALIHISGREAT wrote:

Saw my GP today who seemed keen to help

he played around with my knees a bit and they seem stable so I shouldn't have any serious damage.. it turns out I can see a physio privately through Uni and it shouldn't cost much; if not I have a referral and can investigate NHS or other private clinics.

The stability tests your GP does will show if there is any ligament damage - front and back for your ACL for example, or side to side for the medial colateral (and the one on the outside I cant remember the name of). The stability tests won't show if you have any cartiledge damage though - you need either a scan or a look with a camera to show that.

Reading between the lines above, I think I may have missed the thread on what's happened to you though. If you've had an accident, then obviously wear and tear isn't an issue. The stability tests are therefore appropriate to check for ruptured ligaments. Strained or partially torn ligaments is a different matter though. These take a long time to heal, and require you to do nothing, basically. What did your Dr advise you to do?

HTH,
MarkP

Curious Yellow

Took 3 months for a physio to see me on the NHS. He was Dutch and understood how important it was for me to keep cycling and I appreciated that he didn't feed me the usual bullshit "stop what you are doing right now and rest! LOL!" bullshit. However, he was pretty strapped for time and it was obvious that the service wasn't geared to help someone whose complaint was along the lines of "my left knee is a bit swollen after riding 100km or more, but gets better when I rest it", it's more geared towards "I was in a crippling car accident and I want to learn to walk again" type thing.

Investigated physio through BUPA privately and it sounded like they would lay out the works. Physio with cycling experience and so on.

Personally, I reckon the NHS won't care if your injury is something that gets better when you rest it and you've not broken or damaged anything. They're not there to help you achieve a PB on your Saturday morning club run. Getting people to walk after serious breaks and so on are more their business.

If you've got loads of time and don't mind waiting and having it wasted because the service isn't intended to do what you want, then go ahead and see an NHS physio. If your time is precious and you want targeted advice, then go private.

Not dissing the NHS. When I've had serious breaks I have been very happy that it existed. However, it's not a sports clinic and does not pretend to be one.

alihisgreat

Thanks for the advice, I booked a private Physio on Tuesday and Since I'm still a student I should be covered on my parent's Bupa insurance which is good.


Have done more research I've got what I believe to be an accurate 'google diagnosis' (which matches what my GP wrote on the letter of referral -> my google diagnosis came first though ) ->

I can noticeably feel that my ITB is tight in my left leg which is causing tendon pain and tension pain down the outside of my knee and into the top of my shin. A tight ITB is a classic symptom in cyclists since the outside of the quad doesn't get stretched out on the upstroke of the pedal motion (as you bring your ankle back up towards your glutes you can feel the stretch on the top of the leg/quad.. this doesn't happen on the side).

So since my ITB is tight its likely that I've got muscular imbalances in my left leg which means that my stability and Patellar tendon tracking is bad.. and that's the source of my knee pain down the front of my knee.

Causes of the imbalances? probably a strength issue.. I've noticed in the past that I tend to lunge with my right leg when playing squash (waking up the next morning with one leg aching glute is odd!) and as such its stronger and more balanced.

Then it becomes a spiral into my current situation because as my right leg gets stronger, and my left knee gets a bit dodgy, I tend to use my right leg more and left leg less.. worsening the balance, strength, and stability in my left leg.

What I'm going to do?

-foam roller -> Its quite fun in a sadistic kind of way... and I can feel a difference in my legs.. (not so much my ITB yet) after a few days of rolling.
-Take my stretching more seriously -> 10 mins of yoga in the morning followed by a few extra ITB related stretches.
-even everything up -> unclip with right and left leg evenly, focus on using both legs as equal in other areas.
-Leg strength and cross training -> Going to get some recommended exercises off the physio

If I want to perform like an athlete.. I've got to train like an athlete right?

lef

Are you sure position on the bike is good? If bad could be upsetting the knee. things like cleat angle could be responsible.

philclubman

So since my ITB is tight its likely that I've got muscular imbalances in my left leg which means that my stability and Patellar tendon tracking is bad.. and that's the source of my knee pain down the front of my knee.

I'm just going through a similar process at the moment. My GP was very dismissive unfortunately, but I appreciate I'm not probably a priority for the NHS.

I'm having pain in the front of my knee around the knee cap. I'm thinking that it might be the way that my knee cap tracks, so am looking into Specialized footbeds and shims to try to get it tracking straight vertically.

I have high arches that collapse quite a lot, so I have bought some Spesh BG shoes and the green footbeds - the footbeds feel great under my feet when standing, so I hope they do the job on the bike. I'm going to have a play with the shims and see how I get on. My LBS have offered to let m use their turbo and help me too.

If this doesn't work, I think I'll bite the bullet and book with The Bike Whisperer. They sound like they know what their doing with regards to setting up cleats, shoes etc.

I'll post back in a week if anyone's interested.

Best

Trev The Rev

Clipless pedals can cause knee problems.

pigeontoes

Had a similar problem in my right knee and waited until I couldn't walk up stairs after riding before seeing private physio. I was told to do various strengthening exrecises and ITB stretches which have helped but as soon as I up the mileage to more than 60 miles a week or do hill training (road or MTB), I start to get same problem again. Am just about to book a bike fit at Worcester Uni as I think my bike/cleat set-up is part of the problem.

Was chatting to the guy in the LBS and he mentioned he got a knee a problem when wearing tight leggings (think he meant on a bike rather than anywhere else!). I've noticed when I wear my thermal winter full length bib, I get the knee problem much quicker. Guess it is something to do with not letting your knee cap move properly.

Calpol

pigeontoes wrote:

Had a similar problem in my right knee and waited until I couldn't walk up stairs after riding before seeing private physio. I was told to do various strengthening exrecises and ITB stretches which have helped but as soon as I up the mileage to more than 60 miles a week or do hill training (road or MTB), I start to get same problem again. Am just about to book a bike fit at Worcester Uni as I think my bike/cleat set-up is part of the problem.

Was chatting to the guy in the LBS and he mentioned he got a knee a problem when wearing tight leggings (think he meant on a bike rather than anywhere else!). I've noticed when I wear my thermal winter full length bib, I get the knee problem much quicker. Guess it is something to do with not letting your knee cap move properly.

Hmmm this is interesting as I only started getting an issue when the weather got colder and I had leg warmers/bib longs on. Might have to man up a bit!!

Dunkeldog

Had a similar dismissive experience with my first GP. Changed practice, first appointment with my new GP and was instantly referred to a consultant. Saw the consultant three weeks ago and had arthroscopy on my knee two days ago to repair a torn cartilage. Oddly enough I had to stress I was a cyclist and my summer had been wiped out by this painful knee. Doctor said she would have simply said I 'got on with life' had I not made a strong case. I guess the moral of my story is be forceful with your GP! I think you have to tell them what you want, not simply wait for them to tell you what they think you require. I've got a month or so of rehab but can finally look forward to starting Spring training.

Calpol

Saw my brother in law yesterday. He is a physio and agrees that my issue is strain on MCL (medial Collateral Ligaments) probably caused by pronation and weak glutes/flexors not keeping knee in line. I will be strengthening the controlling muscle groups and adjusting my cleat outboard and ensuring if anything I have some "toe in". Going to try those things for a week or two and see what difference it makes.

markp80

Calpol wrote:

Saw my brother in law yesterday. He is a physio and agrees that my issue is strain on MCL (medial Collateral Ligaments) probably caused by pronation and weak glutes/flexors not keeping knee in line. I will be strengthening the controlling muscle groups and adjusting my cleat outboard and ensuring if anything I have some "toe in". Going to try those things for a week or two and see what difference it makes.

That was the one I snapped in a tackle (along with my ACL). It's held on with screws now (as is my new ACL) :roll:
That was when I took up cycling and I haven't looked back.

Wrath Rob

I had ITB problems when I did very little cycling during the week and then tried to do a 40 mile MTB ride at the weekend. By stretching, using a foam roller and increasing my fitness the problem gradually resolved itself. Get a proper diagnosis from the physio though, as if its not your ITB then you could end up doing more harm than good by following a Google diagnosis!

pcb24

Alihisgreat I am sorry to hear that your knee is giving you problems. I would definitely follow Wrath Rob's advice on seeing a physio for advice. You can not treat something if you don't know 100% what it is and you may waste your time treating the wrong thing. I wanted to dispel a couple of things written on here:

1) "NHS physio's aren't that great on the whole" - the private physio you see more than likely works in the NHS also (many do part time private work on the side). So you will receive the same care but you may not have to wait as long. However waits will vary. Also a lot of the countries best physio's work in the NHS (a lot in the sporting field) .

2) Most G.P's do not specialise in muscles and bones and therefore you may want to get a physio diagnosis as they are the specialists.

3) An MRI scan is not the be all and end all. It is merely a still picture and will not show what happens when your knee is moving. For instance, would you buy a car based on a pic, or would you want to test drive it first? Also what you see on the scan may be a coincidental finding, cartilage tears are not always painful.

4) Don't fall into the self-diagnosis trap. Would you follow a get rich scheme on the internet? No. me neither, anyone can write anything on the internet. See a medical professional.

Good luck with your knee and I hope it gets sorted. Remember to stick with your treatment plan and also that every cycling team has there own physio and so they must be doing something right!

alihisgreat

I saw the physio a few weeks ago -> went private and got it slightly cheaper through Uni.

She basically said I need to work on my ITB and my left leg as a whole unit isn't as strong as my right which is probably the root of it.

So i've got a list of stretches and strength exercises to do.

pcb24

ALIHISGREAT wrote:

I saw the physio a few weeks ago -> went private and got it slightly cheaper through Uni.

She basically said I need to work on my ITB and my left leg as a whole unit isn't as strong as my right which is probably the root of it.

So i've got a list of stretches and strength exercises to do.

Excellent - glad you've got to the bottom of it.