Knee Pain - inside/top

I developed a pain around the top-inside of the knee after doing a hilly century ride several
weeks ago (I have ridden several other centuries this year with no issues), right where the
quadricep muscle attached to the knee joint. I can ride, but it hurts and I can't apply full force
to the pedals.

I have not changed my shoes/pedals or anything else significant with my bike, though I did recently
change my cleats. Does anyone know what could cause this problem? Are there changes I could make to
my pedal type, cleat postion or seat hight that might help me fix this issue before I cause
permanent damage? I have never had this type of knee pain before and have been riding for several
years. Thanks.

-Ravi

 

On Sun, 18 May 2003, "Ravi Raman" <[email protected]> wrote:
>I developed a pain around the top-inside of the knee after doing a hilly century ride several
>weeks ago (I have ridden several other centuries this year with no issues), right where the
>quadricep muscle attached to the knee joint. I can ride, but it hurts and I can't apply full force
>to the pedals.
>
>I have not changed my shoes/pedals or anything else significant with my bike, though I did recently
>change my cleats. Does anyone know what could cause this problem? Are there changes I could make to
>my pedal type, cleat postion or seat hight that might help me fix this issue before I cause
>permanent damage? I have never had this type of knee pain before and have been riding for several
>years. Thanks.
>
>-Ravi

Repetivitive stress injury? Not enough pre-ride warmup? Who knows, not even the doctor. That you
haven't changed shoes/pedals suggest little. An x-ray will probably reveal nothing. I'm sure your
bones look great. But the doctor will say the ususal, "take advil for the inflamation, and don't
ride till the pain is gone." And some sort of anti-depressant till you're 100% again.

N.M.

 

"Ravi Raman" <[email protected]> wrote in message news:<[email protected]>...
> I developed a pain around the top-inside of the knee after doing a hilly century ride several
> weeks ago (I have ridden several other centuries this year with no issues), right where the
> quadricep muscle attached to the knee joint. I can ride, but it hurts and I can't apply full force
> to the pedals.
>
> I have not changed my shoes/pedals or anything else significant with my bike, though I did
> recently change my cleats. Does anyone know what could cause this problem? Are there changes I
> could make to my pedal type, cleat postion or seat hight that might help me fix this issue before
> I cause permanent damage? I have never had this type of knee pain before and have been riding for
> several years. Thanks.
>
> -Ravi

Does it hurt like this from the start, or does it start after it's been used a while? Does it hurt
doing anything off the bike (climbing\descending stairs, for instance)? What type of pedals are you
using, and who installed the cleats?

If you have not had your position checked by a top-notch shop, I'd ALWAYS recommend that - while
they may not fix your problem, they may well tell you that you need to adjust your post\saddle
differently, which will give you a better ride.

 

> I developed a pain around the top-inside of the knee after doing a hilly century ride several
> weeks ago

I have the same problem. I think it will go away eventually. Put some heat on it, make sure you
warm up gradually. I'm going kayaking over memorial day, and that will give my bum knee a 4 day
rest. You might want to get a knee support at your local drug store, but I have no idea if those
work or not.

 

"Ravi Raman" <[email protected]> wrote in message news:[email protected]...
> I developed a pain around the top-inside of the knee ...

I am fairly frequently contacted by cyclists with knee pain. Frequently enough that I have composed
the note below as a response.

--
Mike Murray MD

About the only knee problems seen with any frequency in cyclists are Patello-Femoral syndromes, i.e.
things related to the knee cap mechanism and the joint between the knee cap and the femur. There are
several different entities which can cause this; patellar or quadriceps tendonitis, chondromalacia,
patellar instability, etc. The tendonitis problems are caused by strain and subsequent inflammation
on the attachment between the tendon and the bone. Chondromalacia is a problem with developing
irregularities under the knee cap in the patello-femoral joint. Pretty common problem for bike
riders. Patients often notice a clicking or catching when extending the knee from a flexed position.

For all these problems the pain is in the anterior portion of the knee, around the knee cap. They
will all get worse if there is increased force applied by the quadriceps, particularly if this
occurs while the knee is in a more flexed position. Climbing stairs or ladders causes more problem,
as does riding up hill or in higher gears.

In general for all anterior knee pain problems and cycling the approach is the same; heat before and
ice after riding, NSAIDs (ibuprofen, et. al.), keeping knees warm while riding, lower gears,
standing occasionally rather than sitting and grinding. For positioning you want to raise the saddle
and put it further back. It can also help to use a shorter crank. These positions make it so there
is less flex in the knee at the top of the stroke (during max quadriceps contraction) and therefore
less force against the patello-femoral mechanism. Avoiding hills and using lower gears is also a
good idea. Standing, rather than sitting and grinding, on hills is probably better. This decreases
the force across the patello-femoral mechanism.

Stretching the opposing (hamstring) muscles may decreased force a bit. Use of a knee sleeve or
infra-patellar strap may limit the excursion of the patella or move forces away from the
attachment of the tendon to the patella and help somewhat. Exercises are often recommended but I
suspect that they are probably more useful in the non-athletic population and/or those with
patellar instability issues.

Beyond this there really isn't much info. Unfortunately there are not many orthopedists that have
much experience with problems seen in cyclists, in part because the number of injured cyclists is
pretty small.

There is a reasonable article at: http://www.aafp.org/afp/991101ap/2012.html

Posterior knee pain is usually a sign of inflammation inside the joint and possibly a development of
a Baker's cyst (an extension of the knee joint capsule into the "knee pit"). The other alternative
is tendonitis of the hamstrings, which is fairly uncommon. Hamstrings tendonitis should be treated
by lowering the saddle, using lower gears, keeping the legs warm, etc. Baker's cysts need to be
addressed by looking at the underlying problem, often a cartilage tear obtained in another sport.

 

Ravi: The simplest thing to try, and frequently effective, is to move your cleat further back on the
shoe. This reduces leverage on tendons & ligaments, and will sometimes have miraculous results. Best
thing is that it cost nothing to try. We have "cured" many knee issues, including people who had had
a lot of advanced therapy and sometimes surgery to deal with it, just by moving the cleats rearward.

No guarantees, but it's worth a try.

--Mike-- Chain Reaction Bicycles http://www.ChainReactionBicycles.com

"Ravi Raman" <[email protected]> wrote in message news:[email protected]...
> I developed a pain around the top-inside of the knee after doing a hilly century ride several
> weeks ago (I have ridden several other centuries this year with no issues), right where the
> quadricep muscle attached to the
knee
> joint. I can ride, but it hurts and I can't apply full force to the
pedals.
>
> I have not changed my shoes/pedals or anything else significant with my bike, though I did
> recently change my cleats. Does anyone know what could cause this problem? Are there changes I
> could make to my pedal type, cleat postion or seat hight that might help me fix this issue before
> I cause permanent damage? I have never had this type of knee pain before and have been riding for
> several years. Thanks.
>
> -Ravi

 

"Mike Murray" <[email protected]> wrote
>
> I am fairly frequently contacted by cyclists with knee pain. Frequently enough that I have
> composed the note below as a response.

Very informative. Thanks.

 

I used some of those "big meat" tilt controllers so my foot tilts outward more. Now my knee moves up
and down more o less in a vertical plane instead of swerving inward at the bottom of the
pedalstroke.

I also raised my seat.

So my knee is better, I got stronger, but now my hip hurts!

Any ideas?