Knee pain - Please help!

markiegrim

I am very disappointed in the way my knee is behaving

2013/2014 I was cycling 30-40 miles with no issues at all. Then at the beginning of this season I went out and did 40 miles. Maybe it was too much too soon, but towards the end of the ride I got some very nasty stabbing pains front of knee just below knee cap. These pains have plagued me all year, usually whenever I get to 30/35 miles

I saw a physio in September who suggested tight hamstrings might be pulling on my knee cap and causing tracking issues. She recommended some hamstring stretches twice per day which I have been doing religiously

I initially thought that these exercises were making a real difference as I started riding 40 miles again with much reduced discomfort. However, yesterday got stabbing pains front and below knee cap at just 20 miles. Ditto at a similar mileage 2 weeks ago. This issue is now worse than ever despite the hamstring stretching !!

Not sure what to do for the best. Should I perhaps stop cycling altogether for 2-3 months? Maybe in an attempt to get my knee back to a "stable state"?

Or is it maybe something different to tight hams? Some sites suggest other things (e.g. structural things like Patellofemoral Malalignment) that, apparently, can’t be treated with physio!!! Not a cheery prospect

I really don’t think it is bike set up as my knee was fine at these mileages in 2013/2014. My saddle has not slipped and is at right height

N.B. Some 20 years ago (and still) I got severe pain in same knee when walking down mountains (normal hills, stairs, etc are fine). A knee arthroscopy and MRI showed no issue…so maybe indicating it is some sort of tracking issue? Could be that the cycling and hiking knee issues are one and the same?

N.B. My left leg is a bit thinner than my right leg. I am slightly bow legged

Any thoughts?

Thanks

jgsi

Do the basics.. have the bike setup checked.. and have your riding setup checked by someone with a cycling eye... some random non cycling physio aint much help

Bill Black

Likely irritation of the patellar tendon (portion between the bottom of the patella (kneecap) to the tibia). Often moving the saddle back a bit and down a bit helps but first allow the tendon to calm down otherwise you risk chronic tendinitis.
Bill Black

olake92

My go to knee pain solution is foam rolling and stretching. It's got a 100% success record

In all seriousness, do you stretch you quads? I'd go with regular and frequent (daily) bouts of stretching your calves (gastrocnemius and soleus), quads, hams, glutes and hip flexors. If it's a flexibility issue that would most likely solve it. I can see what your physio was thinking re stretching the hams; a tight antagonist (relaxing muscle) can inhibit the agonist (contracting muscle) and cause excessive contraction/tightness/pain. However, my first thought would be to deal with the agonist and see if that fixes the problem.

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19747371#p19747371]markiegrim[/url] wrote:

N.B. Some 20 years ago (and still) I got severe pain in same knee when walking down mountains (normal hills, stairs, etc are fine). A knee arthroscopy and MRI showed no issue…so maybe indicating it is some sort of tracking issue? Could be that the cycling and hiking knee issues are one and the same?

N.B. My left leg is a bit thinner than my right leg. I am slightly bow legged

That sounds like what is expected from that sort of exercise; walking downhill or generally an activity that elevates your heels while putting stress on your quads loads your patellar tendon much more than if your heels were flat ((higher quad activation/glute activation respectively) forces of up to 7/8x bodyweight are transferred through your knees when walking downhill). My totally non-medical explanation would have been some minor tendonitis or the precursor, aka tight painful muscles/tendons.

All the thinner leg tells me is you have one leg stronger than the other, I do too, it's no biggy :P

All of this doesn't exclude more serious problems, knee tracking problems or pain caused by something I have no idea of! It's just what I'd do, having had lots of niggles and injuries over the years.

markiegrim

Olake92 and Joe2008

Thanks for your interesting and encouraging replies

I'm only stretching hams right now

What do you reckon to just stopping cycling for a couple of months (a wrench that that will be)?

Perhaps I just need another massage to get rid of any knots

Markie

kajjal

Have you changed the setup or components on your bike ?

For example having the saddle too high will cause over extension leading to knee pain and other strains.

markiegrim

[url=http://www.bikeradar.com/forums/viewtopic.php?p=19747941#p19747941]Kajjal[/url] wrote:

Have you changed the setup or components on your bike ?

For example having the saddle too high will cause over extension leading to knee pain and other strains.

no, no changes to set up