Pain under knee cap, post ride. Patellar tracking?

foggybike

Hi,

Just after a bit of advice really, although I think I know what the answer is going to be.

For the past few longish ride 40-70 miles my left knee has be aching a bit whilst riding. I have had a fit so i'm happy the bike is setup right. The problem comes after riding when I get some serious pain behind the knee cap when bending the leg, not some much bending the knee but at a certain point when straightening again, almost like a shooting pain.

I'm using ice and compression and ibuprofen to help afterwards.

The problem is i'm doing the Manchester 100 next sunday and i'm pretty worried i'm not going to make it round. It seems ok if I get in the right gear with a high cadence. But any sort of pressure and I can feel it behind the knee cap.

I plan to visit the docs as sons as i'm back off holiday as I suspect some needs sorting out.

Any other advice to help me try and get it right for next Sunday. Any ideas what could be causing it. Very annoying because generally I feel fine after a long ride i'm just being held back by my knee.

ai_1

Could be weak stabilising muscles around the kneecap, could be tight hamstrings, glutes, ITB, etc. Could be bike setup (a bike fit isn't a guarantee). It could be a combination of these. I'd go to a decent physio and get their opinion.

jgsi

Well you dont have to be a genius to know what the doctor will say
Hurts when cycling?
Yes
Dont cycle then.

ai_1

JGSI wrote:

Well you dont have to be a genius to know what the doctor will say
Hurts when cycling?
Yes
Dont cycle then.

What rubbish.
If you're refering to my comment, I didn't say doctor, I said physio.

Although your comment is rubbish, I too would skip the doctor.
They'll probably just refer you to a physio anyway. That's what a physio is for. Incidentally any decent physio is highly unlikely to tell you to stop doing something unless they believe you're doing damage, in which case they'll come up with a way to restore function and get you back cycling ASAP if it's possible. As much as I like cycling, if I was doing permanent damage to my knee (pretty unlikely), I'd want to know about it and act accordingly.
A large proportion of most physios customers are athletes, and many physios, in my experience are also athletes themselves. So it's not like they'll think "stop doing it" is an acceptable answer without a damn good reason. Of course you can always ignore any advice you may get if you're so inclined but there's no point burying your head in the sand.

I've been to several physios over the years. One was rubbish, most of the others were extremely helpful and effective. Get a recommendation if you've other athlete friends or from clubmates if you're in a club. I had a few issues over the past 15 years including minor back and neck problems and sore knees. Never spent a better €50 than attending the phsyio for my back problem. Any real problems I've had have been sorted by following physio advice. Those few small niggles that remain are the result of my laziness in not continuing to do the prescribed strengthening excercises or stretches after the first few weeks when the bulk of the issue was resolved.
If a phsyio seems to want you to keep coming back for follow-ups, be suspicious and consider switching to a new physio. There are certainly some that try and milk you. One or two visits have been sufficient to resolve any of my issues, there may be cases were more is warranted but if in doubt try someone else.

dw300

Ai_1 wrote:

JGSI wrote:

Well you dont have to be a genius to know what the doctor will say
Hurts when cycling?
Yes
Dont cycle then.

What rubbish.
If you're refering to my comment, I didn't say doctor, I said physio.

I'm not sure he was talking to you, think he was talking to the OP.

Anyway.. OP, you've probably got tight tendons and/or muscles. This could be pulling your kneecap tighter against the joint than it should be. Tendons take a while to heal and you need a fairly long period (weeks) of not going past the point of when it starts to bother you in order to recover. However, you're doing the right things to help with the ice and anti-inflammatories (take those at the recommended dose for a few days. They build up in your system and allow faster healing, theyre not just pain killers for after cycling). Try and keep your leg straight when not using it too.

If the pain is in the knee cap its probably tight quad tendons, or tight quads and hip flexors, as well as probably a slight tightness in the patellar tendon. I bet it hurts worst when you get up from being seated with a bent knee or walking down steps?

If you stretch plenty (everywhere below the waist) and warm up well on the day, you could well be fine. I find i get days where im bad, and sometimes I'll have no pain the next day at all, pointing towards the pain being related to the degree of tightness in the legs. I try to stretch, do some massage and foam rolling, including prior to the ride, and although my pain isnt completely gone, its not so bad that its slowing me down. I've been riding with knee warmers lately too which may stop the problem coming on as badly.

Just get your legs as loose as you can this week, and dont over-exert between now and the event and that could get you enough relief to have an enjoyable event.

neal1984

I've had the same problem. Multiple visits to the phisio has helped wonders but not solved the problem. For me I had tight hip flexor / tight glutes and one quad weaker than the other. I've recently been to the doctor as it is not as good as it should be and he has refered me to a knee specialist so will see what they say now.

As others have said phisio is the first step.

foggybike

Hi,

Thanks for all the replies. Got the docs this afternoon to see if I can get referred for some physio.

I hope you are right about things just being tight, it's weird the pain is not there all the time. Sometimes i can bend my leg with a little aching and then other times (most) it's this strong shooting pain under the top of the knee cap.

I'll get on with the stretches and ice and see how it goes. See what the docs says this afternoon, although i'm just going to ask for a referral.

The main problem i'm having is pressing the clutch on the car...... not good.

ai_1

You don't need a referal for a physio. The physio does their own diagnosis they don't need anything from your doctor.
In other situation the doctor serves an essential function but for this the doctor is just a pointless middleman taking a fee. It's neither expected nor advantageous to use a doctor.
I'd just get a recommendation from friends or look up the phonebook and call a physio for an appointment. A sports physio may be best in your case but any will do!
If you look up a physio practice's website they'll often say if they have specialists in certain areas but all physios can handle basic musculo-skeletal issues and this is likely to be just that.

foggybike

I had to see the doc to get the referral for Bupa. Off to physio today at 5pm so we'll see what they say.

foggybike

Well visited the physio last night.

After explaining my initial problems (tight/aching from hip down outside of leg) and explaining previous physio said ITB was tight. We moved to the knee pain and she said it's probably somehow all related.

After various tests and stretches she thinks there is a problem in and around my L3 vertebrae, potential impacting the Femoral nerve. I presume that this maybe leading to me pedalling differently and therefore potentially cause my knee problem.

With the knee she is not too sure about what is wrong with but proceeded to electrocute it for 10-15 mins (not sure of the correct term). But it bloody worked albeit temporary.

Earlier days and have two appointments next week so we'll see what happens.

awallace

Ive just recently been to the doctors as ive had knee pain for 18 months. She referred me to an NHS physio who has diagnosed ITB. Ive now got exercises and stretching to do as it has been a result of a weaker left hip / thigh.

It was slower than going straight to a paid for physio but cant fault the service. If you have a pain that's limiting you just see someone. I self diagnosed and peer diagnosed and had all sorts of issues!

foggybike

Right finally got to see someone this week and feel some progress is being made.

Firstly left leg is approx 1cm shorter than right. This is due to bend in my leg from the knee downwards, also walk with my feet sticking out.

Now being treated for gluteus medius tendinopathy & patellofemoral pain syndrome.

So bike fit done, seat position moved up 15mm and back 15mm. Also switched my pedals back to standard axle from 4mm extension.

Got loads of exercises to do. Fingers crossed all this will make a difference.

Anyone want to buy some 4mm Dura-Ace 9000 pedals? Use probably 20 - 30 times boxed with unused blue cleats.

dennisn

Ai_1 wrote:

A sports physio may be best in your case but any will do!

I know some physio's claim to be "sports physio's" but I would ask - just what is a "sports physio"? If you have torn a ligament in your knee, have some arthritis, tendonitis, or any of a whole bunch of possible problems does it really matter how you did it? Whether cycling or lifting a frig? Damage is damage, and while I know that some people want to think they are athletes, going to a so called sports doctor, in my opinion, is not at all necessary. Nor will it help you heal faster.

foggybike

Well been doing my tennis ball rolling, foam rolling, clam, bridging, etc for a week now.

Things is have noticed, back is aching less in the morning when I wake up (added bonus). Hip does feel less tight and possibly less painful although this could all be in the head.

10 mile ride on bike, 0-6 miles knee is not right, 6-10 miles knee felt perfect. Couple of hours after riding and following days knee pain returns and eases off again.

Just keep on with the exercises i guess :-)

neal1984

I saw the 'knee specialist' via my doctor on Tuesday. She said she does not believe there to be anything wrong except for a muscle imbalance but as I've been unable to fix the problem for 9 months she has refereed me for an MRI as a precaution.

ai_1

dennisn wrote:

Ai_1 wrote:

A sports physio may be best in your case but any will do!

I know some physio's claim to be "sports physio's" but I would ask - just what is a "sports physio"? If you have torn a ligament in your knee, have some arthritis, tendonitis, or any of a whole bunch of possible problems does it really matter how you did it? Whether cycling or lifting a frig? Damage is damage, and while I know that some people want to think they are athletes, going to a so called sports doctor, in my opinion, is not at all necessary. Nor will it help you heal faster.

Like I said either will. The advantage of a "sports physio" is that they will likely be more familiar with the activities you're involved with. Therefore less time explaining what you do and where you want to get to, what equipment you have available etc. A sports physio may be more inclined to push a faster and less conservative course of treatment for example, given that many runners, cyclists, etc will be willing to put in some extra effort and endure more discomfort in order not to lose half a season of activity (bear in mind athletes tend to have better pain tolerance than others). All physios should be competent to deal with these injuries but one more familiar with your circumstances should have a slight advantage anticipating your priorities, understanding your circumstances and treating you in the most appropriate manner.

dennisn

Ai_1 wrote:

dennisn wrote:

Ai_1 wrote:

A sports physio may be best in your case but any will do!

I know some physio's claim to be "sports physio's" but I would ask - just what is a "sports physio"? If you have torn a ligament in your knee, have some arthritis, tendonitis, or any of a whole bunch of possible problems does it really matter how you did it? Whether cycling or lifting a frig? Damage is damage, and while I know that some people want to think they are athletes, going to a so called sports doctor, in my opinion, is not at all necessary. Nor will it help you heal faster.

Like I said either will. The advantage of a "sports physio" is that they will likely be more familiar with the activities you're involved with. Therefore less time explaining what you do and where you want to get to, what equipment you have available etc. A sports physio may be more inclined to push a faster and less conservative course of treatment for example, given that many runners, cyclists, etc will be willing to put in some extra effort and endure more discomfort in order not to lose half a season of activity (bear in mind athletes tend to have better pain tolerance than others). All physios should be competent to deal with these injuries but one more familiar with your circumstances should have a slight advantage anticipating your priorities, understanding your circumstances and treating you in the most appropriate manner.

I'm not convinced. Pretty much anyone can call themselves a "sports" physio and in fact quite a few most likely do, even though it's only an advertising ploy. Like I said before, tendonitis is tendonitis no matter whether you did it playing tennis, cycling, or laying bricks.

ai_1

dennisn wrote:

Ai_1 wrote:

dennisn wrote:

Ai_1 wrote:

A sports physio may be best in your case but any will do!

I know some physio's claim to be "sports physio's" but I would ask - just what is a "sports physio"? If you have torn a ligament in your knee, have some arthritis, tendonitis, or any of a whole bunch of possible problems does it really matter how you did it? Whether cycling or lifting a frig? Damage is damage, and while I know that some people want to think they are athletes, going to a so called sports doctor, in my opinion, is not at all necessary. Nor will it help you heal faster.

Like I said either will. The advantage of a "sports physio" is that they will likely be more familiar with the activities you're involved with. Therefore less time explaining what you do and where you want to get to, what equipment you have available etc. A sports physio may be more inclined to push a faster and less conservative course of treatment for example, given that many runners, cyclists, etc will be willing to put in some extra effort and endure more discomfort in order not to lose half a season of activity (bear in mind athletes tend to have better pain tolerance than others). All physios should be competent to deal with these injuries but one more familiar with your circumstances should have a slight advantage anticipating your priorities, understanding your circumstances and treating you in the most appropriate manner.

I'm not convinced. Pretty much anyone can call themselves a "sports" physio and in fact quite a few most likely do, even though it's only an advertising ploy. Like I said before, tendonitis is tendonitis no matter whether you did it playing tennis, cycling, or laying bricks.

It doesn't appear to be a marketing ploy to me. Simply a statement of speciality. Not all physios are the same. I presume the primary physiotherapist training is fairly standard and covers all the foundations of the profession to provide all round competency. That doesn't mean there are not specialities and further development routes open to physiotherapists after they qualify, as in most professions. I've attended physiotherapist practices a couple of times where there were several physios working out of the same offices. When I rang for an appointment I'd be asked what the issue was so they could assign the best suited physio. If you look up websites for some physio practices you'll see some of them will provide credentials, backgrounds and special areas of interest for each physio. Marketing? No, I don't think so.
Regardless, I'm not really trying to convince you. I'm not a physio nor an expert on the subject. I've just attended them a few times over the past 15 years and with one exception I've always found it worthwhile.

davoj

foggybike wrote:

Well been doing my tennis ball rolling, foam rolling, clam, bridging, etc for a week now.

Things is have noticed, back is aching less in the morning when I wake up (added bonus). Hip does feel less tight and possibly less painful although this could all be in the head.

10 mile ride on bike, 0-6 miles knee is not right, 6-10 miles knee felt perfect. Couple of hours after riding and following days knee pain returns and eases off again.

Just keep on with the exercises i guess :-)

Hi,

I seem to be suffering from a similar issue now and was wondering how the recovery is going? Did you take much time of the bike?

foggybike

davoj wrote:

foggybike wrote:

Well been doing my tennis ball rolling, foam rolling, clam, bridging, etc for a week now.

Things is have noticed, back is aching less in the morning when I wake up (added bonus). Hip does feel less tight and possibly less painful although this could all be in the head.

10 mile ride on bike, 0-6 miles knee is not right, 6-10 miles knee felt perfect. Couple of hours after riding and following days knee pain returns and eases off again.

Just keep on with the exercises i guess :-)

Hi,

I seem to be suffering from a similar issue now and was wondering how the recovery is going? Did you take much time of the bike?

Well I have been working with the new Physio for just over a month now and can ride without knee pain being brought on the day after. Started off spinning mostly and last few been pushing through my knee a lot harder. It aches a bit whilst riding but but seems to be getting better with each ride.

So far so good, got to continue with the exercises, tennis ball and roller. But i'm well please so far.

tangled_metal

Ai_1 wrote:

It doesn't appear to be a marketing ploy to me. Simply a statement of speciality. Not all physios are the same. I presume the primary physiotherapist training is fairly standard and covers all the foundations of the profession to provide all round competency. That doesn't mean there are not specialities and further development routes open to physiotherapists after they qualify, as in most professions. I've attended physiotherapist practices a couple of times where there were several physios working out of the same offices. When I rang for an appointment I'd be asked what the issue was so they could assign the best suited physio. If you look up websites for some physio practices you'll see some of them will provide credentials, backgrounds and special areas of interest for each physio. Marketing? No, I don't think so.
Regardless, I'm not really trying to convince you. I'm not a physio nor an expert on the subject. I've just attended them a few times over the past 15 years and with one exception I've always found it worthwhile.

I tend to agree that not all physios are good at helping out the more active and sports orientated clients. I have been to physios a few times over the years for knee issues. All NHS physios and they mostly focus on just getting you walking around in your day to day life and not fit for sports IME. Last time I saw a physio she was a very keen runner (completely a skinny racing snake fell runner type). She knew about what an active person is like and knew a lot more about sports in general. That session was very helpful and I got a lot of good exercises that were focussed more on what activities I actually did at the time. I recovered better and also felt that I wasn't fobbed off with a one size fits all exercise regime that was ineffectual.

Then the GP as a gatekeeper of all NHS services is also an annoying waste of time too. Recent knee problem resulted in th GP diagnosing and giving me a printout from the local trust's Physio department. A generic printout for anyone with similar knee pain irrespective of what was the cause or the patient's lifestyle (for example are they active sportsperson or sedentary). It is seriously a case that a good physio and a good GP that is interested and involved in sport tends to give better service for sporty patients. The tagline sports physio is perhaps a marketing ploy but if they can back it up with sports focussed physio treatment and exercise then that is not marketing but a form of specialism.