Roadbike knee pain not found on TT bike... explanation?

[aslanspaws]

I've been trying to locate the cause of a few different knee problems and have managed to work out my ITB irritation in my left leg (however, not all of the subsequent problems). Next up is my right leg.

Knee pain is above and outside the right knee. Occurs (as far as I can tell) at the very end of the muscle, where it connects to the knee.

Original thoughts were that I was simply pushing too big of a gear too early. However, I would guess that if this were so, I'd feel this every time I pushed hard, and that I'd get this feeling in my left leg also (it is certainly the weaker).

I've noticed that on TTs my right pain never seems to show up. Trying to locate the possibilities, I've remeasured the setups of the two bikes.

TT Bike 30.25inches from saddle to center of BB
Roadbike 29.75inches from saddle to center of BB

The distance is measured not from the center of the saddle, but from where I sit on the saddle, as I typically sit further up on the TT saddle.

The TT bike has 170cranks vs 175mm on the roadbike. So total difference in distance from the saddle to the pedal is probably around 5mm longer for the TT bike than the Roadbike (pedals are the same).

Should I consider raising my saddle to alleviate this pain? Does this sound like a pain caused by a saddle that is too low? Any ideas out there, similar experience, etc?

Thanks,

Rem

FWIW my inseam is around 33.5inches

 

[Josh13]

I've been trying to locate the cause of a few different knee problems and have managed to work out my ITB irritation in my left leg (however, not all of the subsequent problems). Next up is my right leg.

Knee pain is above and outside the right knee. Occurs (as far as I can tell) at the very end of the muscle, where it connects to the knee.

Original thoughts were that I was simply pushing too big of a gear too early. However, I would guess that if this were so, I'd feel this every time I pushed hard, and that I'd get this feeling in my left leg also (it is certainly the weaker).

I've noticed that on TTs my right pain never seems to show up. Trying to locate the possibilities, I've remeasured the setups of the two bikes.

TT Bike 30.25inches from saddle to center of BB
Roadbike 29.75inches from saddle to center of BB

The distance is measured not from the center of the saddle, but from where I sit on the saddle, as I typically sit further up on the TT saddle.

The TT bike has 170cranks vs 175mm on the roadbike. So total difference in distance from the saddle to the pedal is probably around 5mm longer for the TT bike than the Roadbike (pedals are the same).

Should I consider raising my saddle to alleviate this pain? Does this sound like a pain caused by a saddle that is too low? Any ideas out there, similar experience, etc?

Thanks,

Rem

FWIW my inseam is around 33.5inches

The bike I had last year the pedals were a little farther apart than the bike I have this year by about 1 1/2cm. Not a big difference but the little bit of knee pain went away.

Josh

 

[bikechiro]

Hi,
Now these are things you have probably gone through, however maybe not.

Ok, from what you explained, the pain is lateral and superior to the patella, this is a common site of irritation for cyclists. The cause is the distal fibres of the ITB as they pass over the lateral femoral condyle ( the bump ), at certain angles approaching extension the ITB is loaded heavily on the downstoke and if the combination of leg extension and ITB tightness and failing cellular mechanisms of repair you will begin to become aware of the damage...pain.

It is common for a TT bike to have a postion more over the pedals, this takes load of the ITB due to a less extended leg (usually). Also, TT couses are usually less hilly which allow for a less torque requirements and a subsequent higher cadence and less loading at angles approaching extension of the leg which is where the irritation occurs. Whilst everybody pedals slightly diferently, these generalisations hold true, from what I have seen with riders on the Computrainer in my clinic.

So, try the following:
1 lower seat .5cm and add setback of approx 3mm
2 stretch your itb, quads
3 massage you lateral thigh before rides and ice the lateral superior knee post rides ( 15min on 15 off x 2 daily )
4 if it persists contact your local chiro/physio who understands cycling loads, you may have weak glut med on that side also which loads the itb for stability, among other weak links.

Let me know how you go.

Ian

 

[aslanspaws]

Thanks for the adivice guys.

Ian, as I've experienced ITB pain in my left leg, I'm quite certain that it's not the problem in my right leg. However, giving thought to your comparisons of position & style of riding in a TT I think I'm on to something. I think that this may be largely caused by straining the tendon that connects my vastus lateralis (excuse my very poor understanding of anatomy) to my knee (muscle insertion?). Probably caused by racing too soon, pushing too big of a gear, perhaps just the extra effort my right leg put in to get me home on rides that my left ITB became extremely irritated.

I noticed on a ride yesterday, that the pain really only comes with hills or headwinds when my cadence drops below 90rpm. Around 60rpm and the pain is very intense.

So my intent is to finish April as planned, and simply keep my cadence high and intensity pretty low. I have a three day break next week that will be good. And then a week of no riding at all in May. Hopefully that will be enough to allow it to repair itself. Assuming of course that my self-diagnosis is at least partially correct.

 

[aslanspaws]

Update:

April 12-20th took a few days off and stretched. Got back on for a few thirty minutes spins starting on the 18th... and then I did something very stupid. I went to the mountains. I put on a low gear of a 34-27, and was spinning 90+ up the mountains, but it made no difference (actually reinjured the left knee at the same time).

Since then I've been off the bike. This is 14 days of RICE
I went to the Sport Medicine clinic here at Univ. of Georgia and recieved little help; just a prescription for better NSAIDS - not even a diagnosis. Today I was on the bike for 22 minutes before I became aware that my knee was beginning to rub. Immediately got off. I've lowered my seat a little to try and alleviate it. To no avail. Tomorrow I'll see if I can have my bike refit.

My intentions are to continue to take it easy with 30 minute rides at 110rpm 3 times a week in May, just to keep myself sane. Then try to increase things a bit in June, hopefully back to racing by July. This is depressing.

Any other advice? Anyone have experience with MRIs or orthopedists for help to diagnosing and treating these things. I feel like these knee pain threads have been beat to death, but it's hard for me not to ask.

Thanks,

Rem

 

[Skoorb]

Any reprieve for you yet?

 

[bikechiro]

What a pain. Find a chiropractor who has experience with cyclists, simple as that. Stay away from any chiro's who will not give you a diagnosis and talk to much about subluxations, but your entire biomechanical chain needs to be assessed, this is because the knee is the meat in the sandwich between two areas that commonly have correctable "misallignments" that being the pelvis and the ankle.