Right Knee Pain

[chezmouse]

Hey Guys,

I am currently experiencing pain in the right knee, especially when pushing the pedal down and when out of the saddle. The pain is dull to moderate at times.

I have considered my saddle height, and have adjusted by .5inch, which does not seem to have made a difference.

My cycling style is consistent, and I ride at a high cadence (usually 100+ unless severe terrain).

I have considered adjusting my cleat position, but they feel comfortable and the the pain is only in one knee so this leads me to believe they do not need moving?!

The pain first appeared on approx 73 miles of a 102 mile ride 4 weeks ago, since I have been using pain management (ibuprofen and paracetamol) whilst simply spinning the bike commuting to work. I had no pain during these spins, however, I went out Saturday and spun a fast 40-miler on relatively flat terrain and by 26 miles the dull pain was back?!

Can anyone suggest anything on this? Whats the best approach to ease this condition like should I take complete rest? Should I be spinning? Should I leave the bike alone and perform basic knee exercises? If so which ones?

I would appreciate as much info on this as possible as I need to find the road to recovery asap as I am intending to race early May in a 100+ mile race.

Many thanks in advance, should anymore info be needed with the exact pain location or my cycling styles please ask....

Regards

Jimbo

[Alex Ramon]

Sorry to hear that, I know how annoying it is. I used to the have the exact same problem, but never figured out why. I took a break from riding for a few months and the problem went away.

[DaveM]

Well, probably not something anyone can diagnose well in a forum like this. But I will say that bike fit is more complex than just saddle height and several factors can affect your knees. And just because only one knee hurts doesn't mean that it isn't a fit issue. Finally, you are right that it could be a strength imbalance issue that could be addressed by some exercises. But again, you probably need some expert help beyond "my buddy's knee hurt and he did this." But don't ignore it. If it's lingering around long enough, it probably is only going to get worse if you don't find the cause.

I'd ask around serious riders if there's anyone local who does a good professional bike fit and/or see if you can get a referral to a good sports medicine doctor who may be able to diagnose what is injured which may help indicate what is causing it.

[Joe_W]

I'd go and ask an expert (= medical doctor) about that. We here might be experts on bikes but I don't know whether anyone here is actually a doctor (I know some have a degree in science but that doesn't count in this case).

----
Edit: I found that picking up running helped me with my knees. I have some dysbalances (three different diagnoses, though) and doing workouts for the vastus medialis (the muscle just above and a bit to the inside of your kneecap) helped a lot. I have heard this being referred to as "cyclists' knees". Still: you should go and ask a doctor.

[dannymac]

How's the going!! I was a long sufferer of knee problems kinda like your problem and I see like me your a bit of a runner too. If when u run on impact do you also get this pain? I had knee pain for about 3 years which started out light and got worse and worse to the point that i was sure my sporting life was finished. In those 3 years I spent a fortune going from every mickey mouse (GP) doctor and every local physio i could find. They all done work on me but not one of them diagnosed me with anything.

I also got an MRI scan and was told there was nothing wrong with me by a specialist!!!! Sorry for wobbling on now but I finally went to a sports physio who had B.Sc (hons) M.S.C.P M.C.S.P which cost a little extra.

My pain started on one knee and quickly switched to both knee's. He said my quadriceps muscles were so tight they were pulling my knee cap's upwards which was causing friction on the back of the caps wearing down the bone layers causing my pain on the bike and on impact. That was last April, I now do 2 simple quad stretches (no longer than 5 mins) morning and night and the pain went away over a few weeks and I'm back running and time trialling as if I've never been away. My advice is go to a proper physio and make sure u get diagnosed. If you want the stretches ill give them to you!

[chezmouse]

Hey guys

Thanks for the reply, obviously I am in the process of elimination and ultimately I am seeking out professional help. With regards to bike fit I am going to see a local club tomorrow to ensure that all is set correctly, they are a reputable and very successful club so I should be looked after well.

As it happens on the physio front my sister in law is a sports physio and she has told me that the knee requires ultra sounding to establish the problem, so this is also in the pipeline.

DannyMac- if you could please inform of the quad stretches then I would be grateful also, many thanks for this.

Thanks guys for all the replies.

Jimbo

[jr14]

Tell her to check your foot position in relation to the pedal. My friend (Also a sports physiologist) said that more often than not, over pronation of the foot causes knee pain in cyclists. Of course this is a VERY general thought, since no one here can see your knees, or feet, or anything else for that matter.

I agree with seeing the sister in law. Its about the only way to solve this issue.

[dannymac]

No prob:
Strech 1.
STANDING POSITION - Stand up straight with your back to a kitchen table and place your hands on the back of a kitchen chair directly in front of you for support. Place your right leg on the table so that your heel can touch the bottom of your back side. (If your heel struggles to touch your back side then ur quads are extremely tight but get as close as you can)
STRECH - Now drop slowly downwards by bending your left leg at your knee and push your right leg gently back towards the table, this will cause your heel to slide up your backside until you feel the strech. Hold this position for 30 seconds then return to the standing position. Take a deep breath and repeat 2 more times! (Then change legs to strech your left quads)

Strech 2.
STANDING POSITION - Now move out the chair a half metre more from the table and stand up straight directly behind the chair once again with ur back to the table with ur right foot reaching back to the table. (Dont try to touch heel off your backside on this one)
STRECH - This time drop slowly down towards the ground by bending ur left knee as low as you feel comfortable with the slowly push back towards the table until you feel the strech and once again hold for 30secs return to standing position, deep breath and repeat 2 more times and onto the left leg. (this strech can be tough to hold)

Hope it helps u out. Even if you injury is different than mine its still a good quad strech to use as part of a training session!!!

[chezmouse]

Many thanks for the stretches...

I will try them out and due course and report back.....

I jogged down to the gym tonight to do resistance training on chest/triceps and no pain in knee, however, I did notice in work today that when climbing stairs, one at a time is ok but when I went for 2 or even 3 steps per stride and the knee was fully compressed if you like, as I powered upwards the pain was present....

First stop after work tomorra is my bike fitting, then will be hassling the sister-in-law (always find it a hassle asking family members to do things in their free time as they don't like working when not in work?!), to get some advice/rehab/plan sorted to get me back on track- I only hope it doesn't set me back too long as to be fair iv already built up a good base this season and am hoping to compete early May, so could do with being tip-top by then....

Will keep you posted as I solve bits of this issue....

Ongoing thanks for all the input.,

Jimbo

[chezmouse]

Hey

Had my bike fit, took quite a while actually! If i'm being honest they didn't alter an awful lot at all, the geometry wasn't far off as it was. Iv been advised to change to red cleats from grey as they have more float in them, so will do on Monday when I get paid....

Still trying to get hold of sister-in-law to get a diagnosis on what is actually wrong with the knee, cycled to work today (8-miles), high cadence, very little or no pain, but no real power exerted through the knee....

saga continues.....

[madcyclist]

(03-09-2010, 03:12 PM)chezmouse Wrote:  Hey

Had my bike fit, took quite a while actually! If i'm being honest they didn't

keep us updated! I have no pain but i never rode that long longest ever is 100km. but i have clicking sound in my knee while sitting on ground and standing up. Done want to ruin my knee though.
and i am suggested some stretches. still have to do them

[chezmouse]

Hey Guys,

Heres my knee update...

As previous stated had bike fit, no major changes, very minor, changed cleats from Grey to Red also to "give more swing", 9 degrees to be precise.

Managed to collar the sis-in-law (Sarah), who said to take 7 days off and to swim if felt needed to do something...

We performed Ultra Sound on my knee, which Sarah went on to tell me that I had overloaded my Patellar Tendon! Best she could explain it was that it is like an elastic band and slides in a grove, having overloaded it has caused minor damage and as a result a small amount of thickening or scar tissue has developed.

So...

Sarah very kindly gave me an ultra sound machine and gel and at home twice daily I perform 2x5minutes of Ultra Sound therapy, direct on the knee and the Ultra Sound is supposed to break down this "thickening" thus, allowing the tendon to move in its correct plane of movement!

6 days on and my bike was in work and obviously needed it for Sunday, so commuted home today, highish cadence (90-110) low gearing and mainly flat, didn't feel any pain, so good sign, iced knee when got home then stretched.

For the Re-hab sarah suggested trying a 20-mile spin, mainly flat this Sunday then if no pain 2 days off and spin again Wednesday evening for approx 30 miles, she emphasized that I shouldn't be trying to push to make pain, on the contrary, I should be avoiding the pain as much as possible which would suggest healing.

Given that I can perform every 3rd day and gently increasing my mileage, she suggested that once im back up to 50 miles spinning and no pain its time to re-introduce the hills again, this sounds long winded but Sarah stressed that in "real time", if the knee has no (i.e - I get no pain through rehab) I should be back up to 80-100 miles per session within 4-6 weeks!

When I questioned her about what caused the "overload" she said one of a few things:
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)

They were the main ones. On reflection, the pain initially started when out on 96-mile ride back in February in the cold which by coincidence was on very steep hills, so there is satisfactory answer for me- cold, steep hills, too much distance early in season.

Lesson Learnt! Really don't want this aggro again, just hoping and praying that I feel no pain whilst out on Sunday and through the other 3 weeks of rehab.

I admit I am very lucky having a sister-in-law in "the Trade" and who has freely given me free treatment, which I understand some cyclists may not get.... She guestimated the cost of Ultra Sound and her time/advice and it was ailing up towards 500 notes, so it would have been costly to get this done as a punter.

Thanks for all the advice on this, I will however continue to post updates to inform people if this method of treatment was a success in my case for what was officially diagnosed as "Patellar tendonitis".

Jimbo

[zapacoman]

So since you've been at recovery for over a month now... how is your progress? I have this same issue and am looking for some hope!

[madcyclist]

many months later I am doing many fast cycling time trials etc. no pain in knee! so i guess those clicking are just something else!

[LorindaCollins]

Consult with a doctor.