Knee Problem... Need advice!!

[Kaizen]

Here's a little background. I'm 30yrs old and ride 5-6k miles (on average) per year. At the end of this year my left knee started to ache. On one particular ride the pain got pretty bad after mile 40 and I had to stop. I took a week off. Got back on the bike and everything was fine for the first hour and half and then the same thing... pain started to get bad so I stopped. I have since taken a full month off and just this week got on the rollers. I'm doing 20 minutes and I'm getting that gradual ache that I was getting a month ago...

Has anyone else encountered this problem? Please let me know.

Other things I've tried over this past month: Chiropractor, Yoga, Stretching

 

[frenchyge]

I'm not going to claim that I know what's wrong with your knee, but the times that I've had joint or tendon discomfort it's taken quite a long time to go away completely and seems to recur as you described. Are you taking the time off, expecting it to go away completely, and then going straight back to what you were doing before? I'd suggest taking a short time off completely, and then easing in with some *very* light resistance spinning for short periods, gradually building back up, but consciously keeping the resistance very light to try to determine whether it's motion related or pressure related.

Have you made any changes to your bike lately (position or equipment)? Are you keeping your knees warm during your rides?

 

[Kaizen]

I have many theories as to why, one of which is the seat height adjustment. Others would be dramatically increased climbing (training for an event). Also I slipped out of my pedal when starting from a stopped position - a week prior to the pain... I plan on having an MRI to rule out cartilage damage...

 

[frenchyge]

MRI's probably a good idea. Good luck.

 

[Billsworld]

Where is the pain? Under the cap or in the joint?.. If under the cap that is often caused by a tight ITB band . Goes from the hip down the side of the leg to the knee. It ties into the cap and pulls it out of track.(the simple explanation) The tightness can be caused by a number of things. Overuse , mechanics etc..If thats the problem, you need to get that loose .The surgery to fix it is called a lateral release....it sucks!! I have had one. 1) stretch the ITB any way you can 2)find a good Therapist to help. 3) ice after every ride. Good luck bp

I have many theories as to why, one of which is the seat height adjustment. Others would be dramatically increased climbing (training for an event). Also I slipped out of my pedal when starting from a stopped position - a week prior to the pain... I plan on having an MRI to rule out cartilage damage...

 

[Kaizen]

Where is the pain? Under the cap or in the joint?.. If under the cap that is often caused by a tight ITB band . Goes from the hip down the side of the leg to the knee. It ties into the cap and pulls it out of track.(the simple explanation) The tightness can be caused by a number of things. Overuse , mechanics etc..If thats the problem, you need to get that loose .The surgery to fix it is called a lateral release....it sucks!! I have had one. 1) stretch the ITB any way you can 2)find a good Therapist to help. 3) ice after every ride. Good luck bp

I was told by my Chiropractor that I had a very tight ITB Band... Any idea on how to stretch that? How did you know you needed surgery? Did you have an MRI done?... Sorry so many questions as you may understand this is priority #1 on my list.

Other theories are... underdeveloped quad, patello-femoral pain syndrome

 

[Billsworld]

The vmo (inner quad) can be underdeveloped which causes the outer quad/itb to pull the cap. Developing that vmo will help. You need a good doc and or pt to help you out, if the rest and strectching ,ICE!! doesnt work. Trust me the knife is a last resort. The other guy that recomended the yoga etc.. seems like good advice. Its a hard place to stretch, so youll have to go by feel, or get someone to help. Unless the MRI is fully covered I would try the other options first. I am not sure it will show much. My guess is that the less force you apply to the crank the less pain you are in; so high rpm low tourqe riding might be ok. go by feel. I am not a in the med field so these are just my thoughts based on past experience........I cant sit in an mri. Too high strung.I think I should have tried more alternatives before the knife. I noticed your a sox fan. If Boston is your home Health Point in Waltham Ma. Celtics home. Dr. Brian Mckean or Arnie Scheller Good luck

I was told by my Chiropractor that I had a very tight ITB Band... Any idea on how to stretch that? How did you know you needed surgery? Did you have an MRI done?... Sorry so many questions as you may understand this is priority #1 on my list.

Other theories are... underdeveloped quad, patello-femoral pain syndrome

 

[frenchyge]

I was told by my Chiropractor that I had a very tight ITB Band... Any idea on how to stretch that?

From http://www.itbs.info/html/body_stretches.html

"This is the standing version of the classic ITB stretch. Give it a try.​

• To stretch the IT band of your right leg, stand with your left side facing the wall. Cross your right leg behind your left, while putting your left hand against the wall. Put your weight on the right leg and lean against the wall by pushing your right hip away from the wall. Be sure that your right foot is parallel to the wall during the stretch. You should be able to feel the stretch in your hip and down the IT band (in this case, along the right side of your right leg). Hold for five seconds and do this ten times. For the left leg, do as above, but stand with your right side facing the wall, and put your left leg behind your right."

 

[squidwranglr]

I was told by my Chiropractor that I had a very tight ITB Band... Any idea on how to stretch that? How did you know you needed surgery? Did you have an MRI done?... Sorry so many questions as you may understand this is priority #1 on my list.

Other theories are... underdeveloped quad, patello-femoral pain syndrome

Kaizen,

I went through a similar bout which showed itself with symptoms very similar to a tight IT band. I am a triathlete and IT band problems are more common than compared to "pure" cyclists, so it all made sense, but even with the appropriate stretches, etc., the pain wasn't going away.

On a hunch, I checked the cleats on my bike shoes. It turned out that the left cleat had slipped in its screws and my left food was internally rotated (i.e. toes pointed too far in). I fixed the adjustment and the relief was immediate - I was able to go the distance on the very next ride with absolutely no pain.

So, whether you've done any adjustments to your bike recently or not, you may want to check a few adjustments such as cleat alignment and seat height to make sure nothing is out of whack.

I found this site to be useful:

http://www.cptips.com/knee.htm

Wishing you a quick recovery,

Berend

 

[wiredued]

I like to put in my two cents whenever knees are mentioned. I have knees that have caused me pain in the past and I seem to be able to train harder now than I ever could I believe I have found what I was lacking in nutrition. 200mg MSM(sulfur supplement for cartilage maintainance), 50mg Hyaluronic acid(water holding molecule for tendons) 100mg on long ride days or on mountain auto road days at maximum sustained effort it makes stretching afterwards painless. I hope you find what you need.

 

[Billsworld]

I dont have enough years of cycling to have thought of that,but it sounds like wisdom to me

Kaizen,

I went through a similar bout which showed itself with symptoms very similar to a tight IT band. I am a triathlete and IT band problems are more common than compared to "pure" cyclists, so it all made sense, but even with the appropriate stretches, etc., the pain wasn't going away.

On a hunch, I checked the cleats on my bike shoes. It turned out that the left cleat had slipped in its screws and my left food was internally rotated (i.e. toes pointed too far in). I fixed the adjustment and the relief was immediate - I was able to go the distance on the very next ride with absolutely no pain.

So, whether you've done any adjustments to your bike recently or not, you may want to check a few adjustments such as cleat alignment and seat height to make sure nothing is out of whack.

I found this site to be useful:

http://www.cptips.com/knee.htm

Wishing you a quick recovery,

Berend

 

[2zanzibar]

Where is the pain? Under the cap or in the joint?.. If under the cap that is often caused by a tight ITB band . Goes from the hip down the side of the leg to the knee. It ties into the cap and pulls it out of track.(the simple explanation) The tightness can be caused by a number of things. Overuse , mechanics etc..If thats the problem, you need to get that loose .The surgery to fix it is called a lateral release....it sucks!! I have had one. 1) stretch the ITB any way you can 2)find a good Therapist to help. 3) ice after every ride. Good luck bp

Hi Billsworld,
could you say more about your Lateral Release, has it moved you forward or just made things more complicated? My surgeon wants to perform one on me but the physio says NO WAY! I'm a candidate because I've a tilting patella and have exhausted almost every other treatment, but the physio is adament about this (he did his Masters thesis on Patellofemoral pain) it rarely works. My other option is to have an arthroscpe and they wash out the joint and scrape loose cartilage. I'm at a bt of a loss as to what to do. I'm still riding and managing the pain so it doesn't flare up, but the knee won't let me push past a certain point.

As for your problem Kaizen, it sounds similar to how mine started; though don't be alarmed! yours is far less advanced as mine (and you might have completely different issues) if I were to go back to that stage in retrospect I would concentrate on the following:

Keep riding; find your levels where you can do just enough with and without pain. The aim is to gradually try and increase it slowly. The symptoms can shift from week to week so do ten minutes gently if achey, and do 1 hour if not. Cartilage doesn't like to be shocked, if you keep taking 3 weeks off and then doing 40 miles it struggles to adapt.

IT Band; this is the bane of my life, keep stretching it and try and get someone who knows how to massage it. Its the main thing that has helped me. Particularly the tight structures around the kneecap (lateral retinaculum)

Get a physio who can show you some strengthening exercises. You only need to book them for a couple of weeks for them to show you what to do, but they should find out your weak spots. VMO is often mentioned and rightly so, but cyclists on average already have overdeveloped VMO's, you may need to look at hamstring strength and especially glute strength. These are afterall the largest muscles in the body and are great stabilizers in your pedal stroke.

It sounds like whatever you might have, it is at the very early stages which means if you put the effort in now you can nip this thing in the bud. Good luck!!

 

[Billsworld]

1) I should have tried harder to work around it. My pain was due to persistant heavy squatting. I still have to be carefull with both knees. Right knee had acl replaced left had the lat.release. My personal training style requires weights and shorter high intensity rides that are done with lots of recovery.I have to take days off and swim for fitness instead of ride/lift. Kaizen uses his bike to commute and most likely for fun too. As you noted his symptoms are early and most likely treatable. I hope its a cleat adjustment or something simple like that. 2) the surgery took about a year to start feeling better. The acl was easy compared to it. The acl reqired work to rehab. the release was lots of rest,ice and low intesity stuff.Drove me nuts!! I would seek out the best Ortho.doc you can find prior to any decisions(more than one) Oh almost forgot;this might raise a few eybrows, but gravity boots(hanging upside down) seems to help alot.I dont know why.Best of luck BP

Hi Billsworld,
could you say more about your Lateral Release, has it moved you forward or just made things more complicated? My surgeon wants to perform one on me but the physio says NO WAY! I'm a candidate because I've a tilting patella and have exhausted almost every other treatment, but the physio is adament about this (he did his Masters thesis on Patellofemoral pain) it rarely works. My other option is to have an arthroscpe and they wash out the joint and scrape loose cartilage. I'm at a bt of a loss as to what to do. I'm still riding and managing the pain so it doesn't flare up, but the knee won't let me push past a certain point.

As for your problem Kaizen, it sounds similar to how mine started; though don't be alarmed! yours is far less advanced as mine (and you might have completely different issues) if I were to go back to that stage in retrospect I would concentrate on the following:

Keep riding; find your levels where you can do just enough with and without pain. The aim is to gradually try and increase it slowly. The symptoms can shift from week to week so do ten minutes gently if achey, and do 1 hour if not. Cartilage doesn't like to be shocked, if you keep taking 3 weeks off and then doing 40 miles it struggles to adapt.

IT Band; this is the bane of my life, keep stretching it and try and get someone who knows how to massage it. Its the main thing that has helped me. Particularly the tight structures around the kneecap (lateral retinaculum)

Get a physio who can show you some strengthening exercises. You only need to book them for a couple of weeks for them to show you what to do, but they should find out your weak spots. VMO is often mentioned and rightly so, but cyclists on average already have overdeveloped VMO's, you may need to look at hamstring strength and especially glute strength. These are afterall the largest muscles in the body and are great stabilizers in your pedal stroke.

It sounds like whatever you might have, it is at the very early stages which means if you put the effort in now you can nip this thing in the bud. Good luck!!

 

[Fetus]

Where is the pain? Under the cap or in the joint?.. If under the cap that is often caused by a tight ITB band . Goes from the hip down the side of the leg to the knee. It ties into the cap and pulls it out of track.(the simple explanation) The tightness can be caused by a number of things. Overuse , mechanics etc..If thats the problem, you need to get that loose .The surgery to fix it is called a lateral release....it sucks!! I have had one. 1) stretch the ITB any way you can 2)find a good Therapist to help. 3) ice after every ride. Good luck bp

I actually had the same problem a few years back while I was racing. My problem was that I was training too much and not stretching nearly enough... if ever. I had an MRI done and went to a Physical Therapist. I will agree, surgery is the last option from all the horror stories I heard. While I was in therapy, they used a massage technique which they called rolfing (I don't know if that the proper spelling or not), it's about the same thing as a deep tissue massage. It hurts like hell, but when they are done it feels GREAT!!! When I first went to therapy I was at the point where it was getting difficult to walk long distances across campus and it would often get sore just from standing up.

My therapist also got me into weight training. Leg-press, hamstring curls, leg extensions etc. I wouldn't lift much weight, but I would do countless reps and sets. I guess this not only helps build your endurance but can also strengthen your tendons as well from my understaning.

I recommend Physical Therapy if it's an ITB band issue.

Good luck

 

[Kaizen]

Thanks for all the advice!! After hearing about the ITB Band I did some asking around at the gym and someone recommend I try a Bio-Foam Roller to "self" message the Band... Basically it is a foam cylinder that you place between your outer thigh and the ground and you roll from your knee to your hip... If you have a tight Band like I do, the pain of messaging it like this is torturous... but I think over time it will help... I just bought one at performbetter.com for 7.50

Kaizen

 

[Billsworld]

Thats good to hear. I think youll be ok. Anyone that puts that many miles on the bike must enjoy riding. Best of luck. BP

Thanks for all the advice!! After hearing about the ITB Band I did some asking around at the gym and someone recommend I try a Bio-Foam Roller to "self" message the Band... Basically it is a foam cylinder that you place between your outer thigh and the ground and you roll from your knee to your hip... If you have a tight Band like I do, the pain of messaging it like this is torturous... but I think over time it will help... I just bought one at performbetter.com for 7.50

Kaizen

 

[Re-tread]

Kaizen, you’ve got the effect, but before doing anything drastic, or spending too much on possibles, you need to ascertain the exact cause. I strongly recommend that you see a remedial massage therapist …a really good one, who knows exactly what they’re doing.



I say this because I had a left knee injury sustained from just one Leg Extension which was slightly wrong and I spent a month off my leg. Chiropractors are good, Physiotherapists are good, BUT, a good remedial massage therapist will look for the cause as well as providing a temporary fix until the body heals again. It is not cured until the trigger is removed.



My best friend is a sports and injury based remedial massage therapist. She has a 20 history as a radiographer, is multi-skilled in areas such as acupuncture and she studies power-trains of the body religiously. Quite often she tells me stories where the leg injury has been triggered by over compensations in the hips, back and even shoulders. This has come about from tight muscles being developed laterally from using a computer mouse. She looks for the cause as her primary concern as the body will heal in time, but a knee that tracks incorrectly because of some back compensation will turn someone into a re-offender (This maybe you right now).



Ask any Pro Cyclist, the massage therapist who works on them every day knows exactly what’s going on inside their body’s structure…add that to someone who knows as much about the body as a Chiropractor and Physiotherapist combined and you will have your solution in no time.



TIP: Look for a specialist who takes the time to plum-bob (For balance and alignment), measures you up (For symmetry) and asks a heap of questions (For possible repetitive physical behavior), as these types generally know what they’re doing and realise the true importance of power-trains.



Good luck.

 

[jawnn]

TIPI-TOE MANEUVER

There is a zone in the crank circle where there is no power; because when your foot reaches the end of the push stroke the opposite foot is a quarter turn from the right place to push. To help your foot reach the right spot the foot at the end of the push must swipe threw and pull back, with recumbent cycles this is mostly just helping gravity. If you don’t wait until the foot is in the right space, you can push up your kneecap up, causing the infamous knee pain.

There are several mechanisms invented for stand up bikes to help your foot through this dead zone. Clipless pedals (cleats) or straps, and now a very expensive Rotor crank that eliminates the dead zone (rotorcranks.com).

Pedaling my 400lb sport utility vehicle (RCN #89 USX trike) gave me such pain in my knees that I had to back off from pedaling hard and try short cranks, which gave temporary relief, but soon led me to damaging my knee-caps again. As I was thinking about spending around $200 on clippless pedals and shoes, I reinvented a maneuver that places my foot at about 80 or 90 degrees to the crank arms at the beginning of the push stroke.

I push my toes forward as much as I can with out pain (it can’t be done with boots on) positioning my bones in such a way that keeps from pushing my kneecaps up. It’s amazing how much harder I can push now with out creating pain

At the end of the forward push I push down “swiping threw” and pulling back with my foot still on top of the pedal.

I don’t need clipless pedals with this maneuver but I do use BMX pedals and place the top of my foot arch on the pedal rather than the ball of my foot.

Short crank arms are not needed but they can help the foot reach the right position. One person told me that using this maneuver on his “stand on the pedals” mountain bike felt like running on his tippi toes.

Apparently some people can experience toe numbness from “anterior tunnel syndrome”. So don’t force your feet into this position.

I think the primary cause of knee pain is simply pushing before the right spot is reached. That’s why it is still possible for me to damage my knee with this maneuver.

I did move the seat closer to the crank to get more power to the pedals, but still there is a limit to how hard I can push with out lifting my kneecaps. And of course if I could lower the gear-inches below 10.5, I wouldn’t need to crank so hard, but it wouldn’t give me more power.

Then a faster cadence would be possible for most people. I can’t pedal as fast as some because of my large leg muscles. I believe that Power Saver pedal pendulums can help with cadence speed, but no one in America sells them.

I don’t think that the crank placement affects this maneuver but for comparison my crank is 4” lower than the seat.

 

[jlance83]

Here's a little background. I'm 30yrs old and ride 5-6k miles (on average) per year. At the end of this year my left knee started to ache. On one particular ride the pain got pretty bad after mile 40 and I had to stop. I took a week off. Got back on the bike and everything was fine for the first hour and half and then the same thing... pain started to get bad so I stopped. I have since taken a full month off and just this week got on the rollers. I'm doing 20 minutes and I'm getting that gradual ache that I was getting a month ago...

Has anyone else encountered this problem? Please let me know.

Other things I've tried over this past month: Chiropractor, Yoga, Stretching

Hi
i had exactly the same problem. After riding for about 30 miles id get an intense pain in my knee and had to go home slowly. It turns out that it was a nerve thats runs under the knee that was swelling up with fluid and the muscle that was sitting just above the knee was rubbing on the nerve causing the pain.

A friend of mine that has been cycling for over 20 years and has a wealth of knowledge told me to visit an accupuncture clinic. He also gave me some heat patches to put on the sore spot. The next day i went for an accupunture session, and then i put some more heat patches on for about 2 days. The accupunture relieved the fluid from the swollen nerve. I started riding my bike 2 days after the accupunture session. And i took it easy for the next couple of days on the bike. You dont wont to push your luck. I did 30 miles at 18mph, no faster than that and still felt no pain. I tried a sprint at the end of the week and i was fine. After that i kept training as usual.

All it took was one accupunture session some heat patches and a bit of patience. You might need a few sessions.

Btw i have never encountered that problem since.

Good luck

 

[Billsworld]

I have many theories as to why, one of which is the seat height adjustment. Others would be dramatically increased climbing (training for an event). Also I slipped out of my pedal when starting from a stopped position - a week prior to the pain... I plan on having an MRI to rule out cartilage damage...

Since this thread is active again, hows the knee ?