Knee Pain

[nodor]

I started doing spin class three weeks ago and have been going 2-3 times a week. After the first few times I noticed a slight pain in my left knee. I didn't think much of it because I haven't been very active the past few months and figured I was just out of shape. My right leg is also my strong leg so I figured my left leg just has some catching up to do. It would never hurt during the class only after and then would go away until after the next class. I went to one today and pushed myself harder than usual and midway through my left knee started hurting so I took it easy for the rest of the class and the pain was pretty much gone by the end of it. Now I'm sitting here two hours after the class with an ice pack on my knee and can't walk without spikes of pain shooting through my knee every time I take a step. I had never done a spin class until three weeks ago and haven't ridden regularly because I didn't own one until just this week. Does anyone know what might be causing this and how I can fix it? I spoke to the spin class instructor after the class today and she said it was likely because I did not have the bike set up correctly and told me to raise the seat and set it back farther so that my knee isn't coming in front of my foot during the pedal motion. I'm going to try it but I figured I would be having the same problem in my right knee if that was the case. My right knee is perfectly fine. Thanks!

 

[jagonz456]

your instructor is right.You should get to your spin class early and have him/her help you setup your bike. You should also take notes of the number or letter where she/he is setting you up so that you can do the same next time. Getting the right fit is very important. In the first few months of spin don't worry about going fast or getting a lot of miles make sure you get your mechanics in order. keep your knees in and make sure you have some weight on your bike at all time. you should have enough resistance on your bike to hold your weight when you stand up. If your able to afford indoor spin shoes i would buy them they will help you pedal better. you should be pushing down on your heals not your toes and pull up with the same motion. Spin class is a great way to get fit but you need to pace yourself its better to go in and give 80% and feel good the next day then give 100% and your out for weeks. One last thing cross training take other classes at your gym yoga twice a week would be a good idea that way you can give your knees a rest if you don't have yoga/palates then maybe you can do some weight training.its a good idea for you to give your body a day of rest in between classes. you should start doing 2 spin classes a week and when you get use to it add another. so your gym schedule should look like this Mon (spin/running/cardio) Tues (chest/arms/yoga) Wednesday (spin/running/cardio) Thursday (back/core) Friday (off) Saturday (choice) Sunday (choice)

 

[zapacoman]

I am looking for some feedback. I am new to cycling. I have been spinning regularly and intensely for 9 months, and I just started on a road bike last week. I did 5 days of 20-24 mi. straight and now my knees are hurting. I have quick stabbing pains from all different angles - front top/bottom/left/right/corners and even the back at times (similar to a feeling of post-hyperextension)...I looked through sites that describe the causes of knee pain and all of them seem to identify the cause by the source of the pain...but my pain is all over! So, I think I may have just generally overdone it(too much too soon), used too high gears @ too low a cadence, and went into intense intervals too soon off the bat...how long should I rest before heading back out for some easy rides?

Once I get back out on the road, how far or long should I be biking each day? I just read about doing 1000 base miles before you start pushing it...but I need to get an idea of what I should be doing daily. Any insight you could provide would be greatly appreciated!

 

[OldGoat]

I think you've got a good handle on what may have caused your pain (mashing big gears, too much intensity too early). Don't claim any medical expertise, but think your doc would probably put you on some NSAIDs and tell you to lay off the bike until the pain goes away. And if you're like me, you'll take the Ibu/Naproxen/Aspirin/whatever and try to ride through the pain. And in doing so, you may aggravate the situation and do yourself some real damage.

I think you should also consider, however, that bike fit may be a big contributing factor. A seat that's too low and too far back, for example, can lead rapidly to severe I-T band pain. I suggest you find a trained and well-reputed bike fitter (not just the salesman at your local LBS, though he/she may be able to refer you) in your area; I think you'll find the small cost will yield a big benefit.

 

[zapacoman]

And if you're like me, you'll take the Ibu/Naproxen/Aspirin/whatever and try to ride through the pain. And in doing so, you may aggravate the situation and do yourself some real damage.

I am resisting the very strong temptation! I think I'm going to wait this one out...because the last thing I need is to cause prolonged problems due to impatience - which is a bit easier to do since I'm only 1 week in. The addiction has not wholly devoured me yet.

I think you should also consider, however, that bike fit may be a big contributing factor. A seat that's too low and too far back, for example, can lead rapidly to severe I-T band pain. I suggest you find a trained and well-reputed bike fitter (not just the salesman at your local LBS, though he/she may be able to refer you) in your area; I think you'll find the small cost will yield a big benefit.

And in doing so I will need to overcome another personal defect: being a cheap ass! But seriously, I know I should get a pro bike fit. I have a slight leg length discrapancy and a history of ITB problems - from running - that's why I got into spinning in the first place!

Thanks for the feedback!

 

[genedan]

Definitely get your bike fit. Fitting is not something I would recommend doing yourself as many of the criteria are counterintuitive. I had knee issues too before getting my bike fit, and the fitting made it feel a lot better.

Do you wear cycling shoes? If you do, make sure you get your cleats adjusted as well. If you have the money you should consider hiring a personal trainer to structure your workouts if you continue to have problems over/undertraining.

 

[jays35]

Had a bike fit about three weeks ago...WOW! What a difference! No knee or foot pains and I have noticed an increase in power. Highly recommend it.

 

[gman0482]

+1 on the bike fit. I had knee pain before, when my seat was too high, and my legs were extending too far, becoming almost completely straight and making that 'snap/tug' in the knees.

That's not good. Get fit by a pro.

-Greg

 

[jarodwinn]

I have a slight leg length discrapancy and a history of ITB problems - from running - that's why I got into spinning in the first place!

I too have suffered from ITB problems in the past, most of which came from over training. It got to the point where I couldn't even ride 10 miles at an easy pace without excrutiating pain shooting through my knees. A bike fit will help tremendously. When I was competing in college I saw Scott Peterson (he use to work for foot fitness in my home town but he's now starting a new company... I think it's called cycle soles? He does professional bike fitting as well as custom foot orthodics for cyclists. He works with a ton of pro riders and though his services aren't cheap it's well worth the money. If you're looking for a cheap way out try your local bike shop, they should be able to do a general bike fit for under $50 which could help quite a bit.
Aside from getting a bike fit done, I've made a few small but HUGE changes in my training this past winter which have helped out tremendously! Try icing your knees. On days that I ride I'll usually ice up after the ride and then once again before I go to bed. On my off days, I'll still ice up before I go to sleep. On top of that I've started stretching and I've included some core strengthening in my training. While my knee problems aren't gone completely they're much less of a problem and I can now complete rides around 100 miles!
Best of luck!

 

[rockapple]

Bike fitting is a great start.. However most bike fits are geared for optimum power ratio. Sometimes you need to sacrifice optimum power for comfort. Get the fitting and if your knees still are bothering you adjust your saddle height until you start feeling better. Eventually you will find your sweet spot..

Rock

 

[zapacoman]

Dang, this knee pain thing is a mo'fo. It's just so complicated - the more i read the more I begin to think that I'll never find the magic combination. Some of the factors seems to include (in no order):

-Seat Height
-Cleat position
-Cleat rotation
-Pronation/Suppination
-Shims
-Inserts
-More pedal float
-Brace (last option)
Other:
-bike fit
-Cold weather
-Not physically capable of the demand due to insufficient training
-Pushing high gears
-Riding up steep hills when not used to it
-Bad luck or bad knee's (genetically)
-Poor conditioning (lower trunk strength work and general stretching)

I found this article which seems to sum it up pretty well for anyone that wants a quick overview of cycling knee pain:
The Physician and Sportsmedicine: Knee Pain and Bicycling

Since I posted, I went in and got "fitted" by some dude that supposedly studied at some bike fitting program in Boulder,CO. He dropped my seat almost a half-inch. I then rode for about 200 miles. The pain worsened...I started icing. I went to the sports doctor, he told me it was patellar tendonitis. I went to the PT, kept icing, kept riding until it became an all out sharp pain instead of a dull discomfort. I stopped. i went back into the bike shop, and the girl said my seat was too low & raised it. She moved the cleat on my right foot back & the cleat on my left foot forward (because my right leg is shorter). She added a special sole insert that was thicker on the big toe side of my right foot to correct a slight duck-footed tendency.

I took 2 weeks off as suggested by another cyclist. I spoke with another cyclist who said that if your feet bow out while you walk, that's the way you should position your foot while you pedal. I've heard contradictory statements to this. I just got back on the bike yesterday and did a half hour (approx. 9 miles) and stopped because I didn't want to push it. I felt ok and no noticeable pains.

My questions are...what the hell should I do to try and fix the problem mechanically?
-higher float pedals?
-lemond wedges?
-stretching?
-strengthening (weights?)? hamstrings? quads or both?

AND

What would your next month look like if you were me? I'm looking for any idea of time/distance/times per week...

Any insight you guys could provide would be greatly appreciated. I've really enjoyed biking, but I'd hate to create some sort of permanent problem here.

 

[OldGoat]

Maybe you're now somewhere near that sweet spot if no pain on short rides; you might try lengthening your next ride a bit & see how it goes.

For a superior bike fit, you might consult with High Sierra:
Homepage

In addition to bike fitting, they also manufacture and sell custom drop pedals and cleat blocks specifically designed to deal with leg length discrepancy.. In fact, their site says they can custom manufacture anything needed if off-the-shelf isn't good enough.

 

[jarodwinn]

I know how you feel man, I was in the same boat you're in last year... and though I'm not completely out of that boat yet my knees are much better. I was diagnosed with patela tendonitis and pes anserine bursitis.
A couple things I changed in my training over the past year (after I got out of physical therapy) were more stretching, core strengthening and lots and lots of icing. I sometimes ice 3 times per day if I'm riding a lot or picking up the intensity... especially when I was getting back on the bike. It took me about three weeks before I could really do any riding or spinning longer than 30 minutes (very frustrating!), but 30 minutes was better than no time at all. When I was in PT they gave me a list of excercises I could do at home to help strengthen my inner leg muscles (supposedly that will help even out the muscle distribution and help reduce the swelling in the petela area).
Another thing I want to do when I get the money is to get a professional bike fit done by Scott Peterson of cycle soles (Cyclesoles - Custom footbed technology). This guy fit my bike for me when I was a competitive cyclist in college and he knows what he's doing (he does bike fitting and orthodics for a lot of the pro cyclists today). He will not only fit you for your bike but he'll adjust your cleats and make custom orthodics for your shoes as well. His process helped cure me of these same problems when I was in college... unfortunately my foot print has changed slightly and my old soles don't fit me anymore. His services aren't cheap, but if you're looking for a proper bike fit and you're running out of options, this is the guy to go to! He's based in Central Oregon, but he travels around and has various clinics across the country.
Anyhow, that's my two cents worth. Good luck and happy riding!

 

[CdnRider]

Not sure if this would be applicable to your situation. But for me it has helped a lot. When I used to race for a club years ago. I developed knee problems too. Had little to do with my leg condition and overall strength as I was a very strong and athletic individual. Anyhow.....turned out that I was pushing my big 52 ring way too much. Low rpms. My coach noticed this right away and got me into the habit of dropping down to the smaller 42 ring.

How about trying that when you finally get back on?

To this day, I'm very careful when i select the big ring. I'll often opt to push the smaller with the smaller cogs vs the big 52.

It SUCKS having bad knees. Unfortunately, it's quite common. Especially for those of us who've been very active in sports all their lives.

Rule #1. REST it until it's healed. Don't jump back on too soon. It'll be tough.

Good luck.

 

[grehamjones]

Prolotherapy for chondromalacia involves intra-articular injections as well as injections on the outside of the knee, stimulating the growth of many musculoskeletal structures around the patella. The meniscus is a thickened cartilage pad between the two joints formed by the femur and tibia. Exercises to strengthen the muscles that support the knee help reduce stress on the knee joint and prevent re-injury.

 

[john gault]

I’m one of those non-technical riders; in other words I don’t really get into the super high-end gear and minute measurements of seat height, sitting position, blah, blah, blah… However, I know that if your seat is a little out it can make a big difference, but it’s something I don’t need professional help with, because I’m not a wannabe Lance Armstrong.

Having said all that, I think your knee issues boils down to simple overuse/over exertion. I experienced the same thing when I did my first long distance bike tour – 1,500-mile circuit trip around the East Coast. I was doing all right until the end as we were headed back to my hometown when we did 300 miles through the mountains (Skyline Drive and Blueridge Parkway). After that trip I suffered the worst knee pain ever and it was some time before the pain subsided.

Long story short, doing one exercise (IMHO) is not healthy, because certain muscles, tendons/ligaments are worked harder than others allowing them to become very strong – to the point of overuse, but also the others become weaker over time. Kind of like doing only chest exercises, but not exercising the Back muscles or only doing bicep curls, but no tricep exercises – not a good thing.

I now participate in various exercises, including weightlifting, running, hiking… So when I develop a pain, say after too much running, I lay off for a while, but I’m still active.

Also, I never, never take "pain depressants", they don’t remedy the problem they only mask the pain. Pain is a signal to lay off for a while. So even today when I get knee pain from too much cycling, usually this now only happens when I’m on tour, instead of taking "medication" I change up how I’m cycling and slowly heal. You can’t avoid pain, just don’t mindlessly push through it.

 

[zapacoman]

I’m one of those non-technical riders; in other words I don’t really get into the super high-end gear and minute measurements of seat height, sitting position, blah, blah, blah… However, I know that if your seat is a little out it can make a big difference, but it’s something I don’t need professional help with, because I’m not a wannabe Lance Armstrong.

Having said all that, I think your knee issues boils down to simple overuse/over exertion. I experienced the same thing when I did my first long distance bike tour – 1,500-mile circuit trip around the East Coast. I was doing all right until the end as we were headed back to my hometown when we did 300 miles through the mountains (Skyline Drive and Blueridge Parkway). After that trip I suffered the worst knee pain ever and it was some time before the pain subsided.

Long story short, doing one exercise (IMHO) is not healthy, because certain muscles, tendons/ligaments are worked harder than others allowing them to become very strong – to the point of overuse, but also the others become weaker over time. Kind of like doing only chest exercises, but not exercising the Back muscles or only doing bicep curls, but no tricep exercises – not a good thing.

I now participate in various exercises, including weightlifting, running, hiking… So when I develop a pain, say after too much running, I lay off for a while, but I’m still active.

Also, I never, never take "pain depressants", they don’t remedy the problem they only mask the pain. Pain is a signal to lay off for a while. So even today when I get knee pain from too much cycling, usually this now only happens when I’m on tour, instead of taking "medication" I change up how I’m cycling and slowly heal. You can’t avoid pain, just don’t mindlessly push through it.

That was well stated, and I think you're on to something. After taking a 2 week break, I've just tried to ease back into it. So, the first day I did 8-9 miles, then 2 days ago I did 15 miles, and yesterday I did 13 miles. Also, instead of doing 17-19mph, I averaged about 14-15 mph with much higher cadence. Truth be told, I was just as winded if not more so, and that works for me because I'm doing it for: being outdoors, getting out of my daily routine, and cardio - not become some competitive cyclist. I already exercise in many different ways: weights, hiking, eliptical, etc. So, I agree it's a matter of listening to your body & easing off biking into something else when it's telling you you've overdone it. On a side note, I tried some light Plyometrics the other day. I say light in the sense that I was doing modified moves for people with bad knees, and let me tell you - it's a great workout and really seems to work a lot of the knee stabilization muscles which I think I may be lacking. We'll see how it goes. For now, I'm holding off on the new shoes, cleats, bike fit, etc. and just focusing on self-control/moderation.

 

[zapacoman]

Ok, I biked 10 miles one day, no pain, I biked 15 miles two days later, no pain, I biked 15 miles two days later - a whole lot of pain that flared up my knee again and I'm taking more time off. I'm going with my gut here and saying that since my feet & knees usually bow out when I walk, the Shimano SPD pedals I have with no float are simply putting my knee in an unnatural position. So, dropping $100 on new shoes $115 on new Speedplay X5 pedals, and I'll report back once I've gone out a few times with the new setup. The saga continues......

 

[swampy1970]

Ok, I biked 10 miles one day, no pain, I biked 15 miles two days later, no pain, I biked 15 miles two days later - a whole lot of pain that flared up my knee again and I'm taking more time off. I'm going with my gut here and saying that since my feet & knees usually bow out when I walk, the Shimano SPD pedals I have with no float are simply putting my knee in an unnatural position. So, dropping $100 on new shoes $115 on new Speedplay X5 pedals, and I'll report back once I've gone out a few times with the new setup. The saga continues......

If you get the cleat setup correctly, even a fixed cleat would work fine.

Part of the bike fit process would include getting your cleats set. I'd do that before dropping a significant amount of cash on pedals and shoes and STILL need a bike fit.

 

[john gault]

Here's a few simple things to be mindful of when cycling Knock Out Knee Pain - bicycling.com

""Patellofemoral Syndrome in cycling results from the undersurface of the knee cap rubbing too hard and for too many repetitions against the femur, grinding away the smooth cartilage on both," says Brian Prax, a physical therapist based in Jackson Hole, Wyoming. Stay in the saddle and out of Prax's office with this knee-saving advice.

Raise Your Cadence A low cadence (fewer than 60 rpm) not only taxes your muscles, but also puts extra stress on your joints. Spin above 80 rpm.

Find the Right Float The wrong foot positioning can cause knee pain. Your cleat angle should mirror the natural angle of your heel. While no-float pedals have been linked to knee problems, too much float can be just as damaging. Most riders should be comfortable with a maximum of 4.5 degrees of float.

Move Back When in doubt—and in pain—try moving your cleat back a couple of millimeters. This tiny adjustment can drastically reduce the impact on your knees.

Pedal in Circles While maintaining a circular pedal stroke, make sure your knees aren't jutting outward or inward."