1 year+ persistent bilateral knee pain.

Richratz

Hi all...

I have been suffering from bilateral knee pain now for just over 1 year. Despite having seen 3 different PTs and being pretty good with the recommended rehab e.g. usual stretching (quad, hip flex, hams) and strengthening (clams, bridges, lunges) its persisting and simply not going away. I have also tried complete rest (3 months) which actually made my knees feel worse with other niggles.

The aching pain is generally always there. About 1 or 2 on a scale of 1-10 (10 being max) when walking about. After 5-10 miles on the bike it increases to 5-7 and persists for a while (3-4 hours) afterwards.

Things that do not aggravate (but I some ways I would have expected them to) include
Stairs (going up or down)
Leg extensions
Lunges
Spin class (with the exception of seated slow cadence climbs)

The only thing to guarantee a flare up is riding my road bike or walking fast. I have had a very good bike fit 6 months so I'm confident that isn't the problem. I feel no pain when climbing out of saddle, but sitting down and climbing anything remotely hilly causes pain in that area which is quickly followed by stiffness around the top of the knee.

Other things to note...

I have tight hamstrings (always have, even before the pain started) and no matter what static stretching I do, they get no better.

Right calf muscle often feels stiff and tight.

Side of my legs are tender. Possible ITB soreness.

The pain started on my right knee but then my left knee flared up a few weeks later. Now the both have the same symptoms

No obvious swelling after cycling. The just feel stiff, sore and weak. Which can last for a few days.

MRI of both knees show nothing remarkable. Perhaps grade 1 (if that) chrondromalica on both knees

X-rays show some small bone spurs on the knee joints. One Physio and GP did not believe these are related to my pain.

Ice helps. But only temporarily. Pain comes back as soon as I get back on the bike and do anything other that very very light spinning.

You can see from the photos https://goo.gl/photos/jTKVohWX8rWw1e5R8 the pain presents just above and slightly off centre (towards the outside) of the kneecap. The area I have circled is where the pain radiates from and is slightly sensitive to clothing friction or hot water (shower)

Watt bike shows a 10% imbalance in power for any given session. Left is higher than right.

Right knee started hurting after having a week off cycling last April. After my week off, I put in a good week (10 hours on the bike). The following week, the pain started. Before the week off I was doing 8-10 hours of riding every week all Autumn and through Winter.

Help / thoughts would be very much appreciated. :-)

jgsi

Sooooo you are 100% satisfied with your bike fit? Is it still hurting....?
I'd get a second opinion....anyways
nice to turn to the best advice ever from the Forum warriors here... we come to help when the fitness/medical professionals let you down.
Have you tried cabbage leaves on the knees?

styxd

I would suggest using something like the handle of a screw driver on the areas for some myofascial release. Do it on all the areas you have issues with. It'll probably hurt. Worth a go since it won't cost you anything (unless you don't have a screwdriver).

Flâneur

Visit the GP - demand a specialist.
Whilst you wait, go find the nearest good knee physio

The internet isn't a good medical advice center, someone may suggest doing lateral skater lunges or hill sprints on sand dunes

Richratz

Flâneur wrote:

Visit the GP - demand a specialist.
Whilst you wait, go find the nearest good knee physio

The internet isn't a good medical advice center, someone may suggest doing lateral skater lunges or hill sprints on sand dunes

Hi, I totally agree, but I'm feeling like I've come to the end of the road with 'specialists' . The first NHS Physio I went to see didn't really care. When I explained that my pain starts after 5-8 miles of gentle cycling. Response was 'don't ride more than 5-8 miles then. Also, I explained that it helps the pain to take paracetamol and use a Voltrol cream, the response was, oh, just use that then. Do some quad stretching and book into see me in 4 weeks. I'm now seeing another NHS Physio. This one seems better but has prescribed all the stuff I've done before. The 'pathway' to see a consultant I suspect is to exhaust the Physio route first. Another few months I suspect.

I have also seen 2 private physios over many sessions. Much the same, strengthing and stretching. Which I do. I'm now very good at clams, bridges and lunges. I've 'buns of steel' if I say so myself. In fairness, it has seemed to stabilise a right knee wobble at the top of the stoke but the pain is still there. :-(

I need to perhaps find a Physio / specialist that has seen this exact problem before or someone else that has had the same issue and can recommend a good Physio that managed to fix it.

Websta24

Have you tried tracking down a knee specialist/physio that has a background in cycling injury and rehab?

trek_dan

Have you tried having a sports massage by someone who really understands cycling and cycling injury?

Richratz

trek_dan wrote:

Have you tried having a sports massage by someone who really understands cycling and cycling injury?

No... but I'd be willing to give that a try and will probably be my next course of action. I have found stretching on a powerplate (particularly the hamstrings) makes me feel good. Sadly, it does not last long though. About 15mins.

styxd

Have you tried what I suggested?

Richratz

styxd wrote:

Have you tried what I suggested?

Hi, yes, I have introduced this into my routine. When stretching my hamstrings I am doing some MFR using the edge of my phone on the tender areas in my quad. Also working on them when sitting at my desk. Pressing moderately hard for 20-30 seconds and then releasing. Repeat 3 times. Interestingly I cycled home from work yesterday (30 miles) a little harder than usual and was relatively pain free. A little ITB soreness (which is new), but not the usual knee pain. Still early days but promising :-) Thank you for the tip.

styxd

Richratz wrote:

styxd wrote:

Have you tried what I suggested?

Hi, yes, I have introduced this into my routine. When stretching my hamstrings I am doing some MFR using the edge of my phone on the tender areas in my quad. Also working on them when sitting at my desk. Pressing moderately hard for 20-30 seconds and then releasing. Repeat 3 times. Interestingly I cycled home from work yesterday (30 miles) a little harder than usual and was relatively pain free. A little ITB soreness (which is new), but not the usual knee pain. Still early days but promising :-) Thank you for the tip.

Good stuff. TRy a foam roller for a similar effect on the ITB.

Gringo74

Can I just pitch a curveball here?

I too had chronic knee pain. It was the result of an arthroscopy to investigate (irony of ironies) chronic lateral knee pain. So in the end the original knee pain (which was ITBS) was replaced with post-op knee pain. One year of the ITBS and then one year of post op pain.

After seeing a baker's dozen of physios/GPs/surgeon/chiro, etc I decided to give hypnotherapy a go. It wasn't cheap (relatively speaking). But the difference in knee pain was remarkable. From doing 80 uncomfortable/painful miles a week (absolute max, often much less) it doubled in the space of a month, the pain reduced to the odd niggle. Amazing. In fact I remember going out on the bike next day and after two hours suddenly remembering; "my knee is usually in agony by now! what's happened?!?"

In truth I wish I had went for hypnotherapy before I had the knee op, It may have saved me time and the NHS a fair bit of money.

I reckon my own experience was like this; I developed a real bout of ITBS. I recovered from the ITBS due to rehab with a physio, resting and not cycling, etc. But my brain had got so used to the sensation of pain that it 'filled in the blanks' producing the feeling of pain. A similar cycle of 'pain/recovery-but still feeling pain' happened after the arthroscopy. It was only the intervention of a hypnotherapist to 'deprogramme' my brain thats had any success.

The sensation of pain is often based on context/past experience. This video explains a lot better than I can. It's a wee bit long but the lecturer makes some great points (including a terrifying personal one) about pain sensation and management;

https://www.youtube.com/watch?v=-3NmTE-fJSo

redvision

Are you sure it's your knees?
I know that's where the pain presents itself but as it's in both knees and you have tight hamstrings, it could well be a back problem.

Get to a physio and get your lower back looked at.

Richratz

Gringo74 wrote:

Can I just pitch a curveball here?

I too had chronic knee pain. It was the result of an arthroscopy to investigate (irony of ironies) chronic lateral knee pain. So in the end the original knee pain (which was ITBS) was replaced with post-op knee pain. One year of the ITBS and then one year of post op pain.

After seeing a baker's dozen of physios/GPs/surgeon/chiro, etc I decided to give hypnotherapy a go. It wasn't cheap (relatively speaking). But the difference in knee pain was remarkable. From doing 80 uncomfortable/painful miles a week (absolute max, often much less) it doubled in the space of a month, the pain reduced to the odd niggle. Amazing. In fact I remember going out on the bike next day and after two hours suddenly remembering; "my knee is usually in agony by now! what's happened?!?"

In truth I wish I had went for hypnotherapy before I had the knee op, It may have saved me time and the NHS a fair bit of money.

I reckon my own experience was like this; I developed a real bout of ITBS. I recovered from the ITBS due to rehab with a physio, resting and not cycling, etc. But my brain had got so used to the sensation of pain that it 'filled in the blanks' producing the feeling of pain. A similar cycle of 'pain/recovery-but still feeling pain' happened after the arthroscopy. It was only the intervention of a hypnotherapist to 'deprogramme' my brain thats had any success.

The sensation of pain is often based on context/past experience. This video explains a lot better than I can. It's a wee bit long but the lecturer makes some great points (including a terrifying personal one) about pain sensation and management;

https://www.youtube.com/watch?v=-3NmTE-fJSo

thanks, I will take a look. I did a 27 mile flat ride yesterday (commute home). Pain and tightness returned within 10miles. Interestingly, pushing harder (power zone 3-4 and 5, seems to cause less pain for a while on the bike. Almost as if other muscles are being utilised. When I return to zone 2 (easy / moderate effort) the pain returns. My mileage is about 60-80 miles per week currently. ITB (both legs) are almost always tender. Paracetamol helps on cycling days.

Richratz

redvision wrote:

Are you sure it's your knees?
I know that's where the pain presents itself but as it's in both knees and you have tight hamstrings, it could well be a back problem.

Get to a physio and get your lower back looked at.

Thanks, it could well be a back issue. Lower back specifically. This usually hurts after a few hours of walking. I have seen a number of Physios. None have looked at my back.