knees again

Quoted message said:

From: "DH" <[email hidden]> Organization: @Home Benelux Newsgroups: alt.rec.bicycles.recumbent
Date: Sun, 7 Dec 2003 23:53:15 +0100 Subject: knees again

Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure something is
damaged or irritated. I just want to know if I could damage myself. Thanks, DH

I think you should see a doctor, one of the reasons I only ride recumbent is because my left knee
has been reconstructed and riding recumbent is one of the few things that does not hurt it, if you
are getting pain then it sounds like you have damaged something.

--
Ian

catrike.co.ukcatrike.co.ukOpen ↗

No I'm not a medical person nor do I portray one, however I do know that if you push too hard too
soon when you are riding a recumbent you probably will have knee problems. Go easy until you built
up the miles. Spinning for several hundred miles should probably do it. Spinning is a good thing no
matter what you ride. When you've been off the bike for a few weeks it maybe necessary to get
reconditioned. Newbies often get on a bent and push too hard climbing even small hills. This puts
lots of pressure on the knees, since you are pushing back in the seat. One of the advantages of a
conventional bike, you naturally raise off the saddle, this relieves the knee pressure. Almost all
of us have gone thru this learning curve. This being said if you are experiencing extreme knee pain
time to take a rest and see a doc. Recumbents are a great riding experience, but there are new
muscle groups that need to be conditioned. Go easy, learn to spin, get your bike adjusted to your
riding style, and you'll probably do fine. Denny in Sayre, Pa "Bent but not Broken"

"DH" <[email hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure something is
damaged or irritated. I just want to know if I could damage myself. Thanks, DH

DH said:

Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure something is
damaged or irritated. I just want to know if I could damage myself. Thanks, DH

No medical background here, but no knee pain either. I've only owned my Tour Easy a couple of
months, and my rides are anywhere from 5 to 50 miles. I've been careful to stay in gears that allow
me to spin around 85-90 rpm's without pushing hard. Early advice here told me to look out for
developing knee pain if using a 'mash-y' pedaling style on a bent.

I rode the Hilly Hundred here in Indiana with only three weeks experience and had no knee pain. I
was very slow going up those hills, and walked up several of the worst ones (well, more than several
on the second day). I do still have pain in the hand I sprained (or broke?) that weekend, but it's
not riding related, and getting much better these days.

Mike Rice

It is either force strain, or repetitive strain injury.

If it is force strain, you are probably pushing too hard and need to spin.

If it is repetitive strain injury, you are either overextending the joint or over compressing it and
the repetitive motion strains the tendon.

For the repetitive strain injury, you have to check two parameters on the recumbent. 1) Leg
extension, neither too short nor too long and 2) the crank length -- too short is okay but you lose
power. If the crank length is too long, even though your seat distance is correct, and your extended
leg is in the proper position, your other leg, the compressed leg is too compressed.

If the crank is too short, you won't have the repetitive strain injury problem, you will just not
get an effective leverage as a longer crank.

"DH" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure something is
damaged or irritated. I just want to know if I could damage myself. Thanks, DH

No medical advice here, but if the pain goes away after you've been off the bike, it might just be
your "getting used to" period. Someone gave me that advice when I started on my recumbent and had
some slight discomfort whereas I had none on my DF. In my case I was a "spinner" on both bikes. Pain
went away after awhile.

Good Luck

Joe

"DH" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure something is
damaged or irritated. I just want to know if I could damage myself. Thanks, DH

"Ian" <[email hidden]> wrote in message "]news:[email hidden]...

Quoted message said:

Quoted message said:

From: "DH" <[email hidden]> Organization: @Home Benelux Newsgroups: alt.rec.bicycles.recumbent
Date: Sun, 7 Dec 2003 23:53:15 +0100 Subject: knees again

Could someone, preferably someone with a medical background, please explain why riding a
recumbent causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure
something is damaged or irritated. I just want to know if I could damage myself. Thanks, DH

I think you should see a doctor, one of the reasons I only ride recumbent

is

Quoted message said:

because my left knee has been reconstructed and riding recumbent is one of the few things that
does not hurt it, if you are getting pain then it

sounds

Quoted message said:

like you have damaged something.

--
Ian

catrike.co.ukcatrike.co.ukOpen ↗

Are you sure the bike has been properly fitted to you? I get knee pain on both uprights and
recumbents when my leg extension is too short. Even being off by a small amount causes pain after a
certain point. It's the first thing I check and adding a tad more extension has always cured my knee
pain. Other than that spin don't mash. See a physician with experienced in this area if the pain
continues.

skip

I appreciate all the responses, but am really interested in knowing (mechanically/biologically) what
causes the pain when riding a bit too hard or a bit too long.

I believe the bike fits me well. I have a slight to moderate break in my leg when biking and it
feels natural.

I really try to use the gears to keep things spinning, but sometimes you just need that extra burst
of power and that's probably the wrong thing for me to do. I'll take you word for it that things
will improve with time; _and_ if I have severe pain or chronic pain, I will see a doctor.

Edward, thanks for the info. Your answer was closest to the kind of info I was looking for.

Quoted post said:

Originally posted by Dh
Could someone, preferably someone with a medical background, please explain why riding a recumbent
causes knee pain.

It is fairly easy to incur knee pain on a recumbent. It depends greatly on how you ride. A pedal masher may find it easy because there is no real stress on the body as on an upright bike. Thus the legs feel more confident to hammer the pedals. Some use their seat back to push off of giving the knees maybe too much confidence.

I would however say that you should contact your primary care physician.

Edward Ing scribed with passion and wit:

Quoted message said:

If the crank is too short, you won't have the repetitive strain injury problem, you will just not
get an effective leverage as a longer crank.

"DH" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

Could someone, preferably someone with a medical background, please explain why riding a
recumbent causes knee pain. What exactly is going on? When I feel pain or stiffness, I figure
something is damaged or irritated. I just want to know if I could damage myself. Thanks, DH

Thinking more on this, there is also the question of "float" if you are using clipless pedals.

--
Ian

catrike.co.ukcatrike.co.ukOpen ↗

"DH" <[email hidden]> wrote in message news:<[email hidden]>...

Quoted message said:

I appreciate all the responses, but am really interested in knowing (mechanically/biologically)
what causes the pain when riding a bit too hard or a bit too long.

I believe the bike fits me well. I have a slight to moderate break in my leg when biking and it
feels natural.

Lawrence Preble, D.C. gave a great analysis on knee pain on this list in the past. Let me
quote it here:

Quoted message said:

Quoted message said:

Here are a few basic suggestions concerning cycling-related knee

pain which you may find helpful. I posted something similar to this on this NG, some time ago;
however, this might be a good time to review some basics in assessing and preventing knee injuries.
Just a second while I take off my helmet and put on my lab coat...There, that's better. The
following information should not be construed as a diagnosis or prescription for anyone's particular
injury and is meant as informational, only. Also, this information did not originate with me but is
widely available from multiple sources.

The knee is the most commonly injured joint in cycling. As injury is generally a problem of overuse,
it is often seen in the cyclist just beginning a training program or early in the training season
when the temptation is to do too much too fast. The most common causes are:

1.) For a wedgie rider, faulty saddle height or for recumbent rider, faulty seat distance.
2.) Pushing excessively high gears
3.) Slow cadence in cold weather
4.) Too much leg work in the gym. (Yes, some of us cyclists do some cross-training, and some
do way too much. I'm guessing this is not your main problem.)

One way to classify knee pain (and identify possible solutions) is to look at the location
of the pain.

Anterior (i.e., front of knee.) Reasons patellar tendonitis patellofemoral syndrome Causes pushing
BIG gears - cadence too low saddle too low or too far forward foot too far forward on the pedal
crank arms too long leg length discrepancy with seat set for shorter leg Possible solutions ride at
75 rpm or higher raise seat (in small increments of less than 5mm) or move seat back move cleat
forward 1 to 2 mm shorten crank arms by 2.5 cm set seat for longer, not shorter, leg with correction
for the shorter leg

Posterior (back of knee) Reasons hamstring/gastrocnemius neurovascular bundle Causes saddle too high
or recumbent seat too far back too much pedal float leg length discrepancy with no correction for
shorter leg Possible solutions lower seat (in small increments) or move seat forward limit float to
6 - 8 degrees set seat for longer, not shorter, leg with correction for the shorter leg

Medial (inner side) Reasons medial collateral ligament pes anserenus Causes cleat position too wide
- foot held internally rotated excessive knee frontal plane motion too little pedal float Possible
solutions narrow foot position by moving cleat outwards orthotic or wedge to correct foot alignment
pedal float should be 6 - 8 degrees

Lateral (outside of knee) Reasons iliotibial band degenerative lateral meniscus Causes cleat
position too narrow - foot held internally rotated too little pedal float excessive knee frontal
plane motion Possible solutions widen foot position by moving cleat towards the bike pedal float
should be 6 - 8 degrees orthotic or wedge to correct foot alignment

Treatment General Issues

These are usually conditions that develop slowly over a number of days and are not emergencies.
Likewise immediate evaluation by an orthopedic specialist is overkill. Immediate care is always
available at a walk in clinics, but it is more productive to see your primary care physician or a
sports medicine physician as the first step.

Dealing with yourself will be the biggest issue. Competitive athletes and overzealous newbies have a
"fear of rest" - and rest is probably the single most effective treatment. Peer pressure to continue
to ride doesn't help.

First Aid Ice, elevation, and resting the knee are all helpful.

Rehabilitation Take a few days off and then begin a limited riding program - cut back mileage by 20
- 30 % and spin at a high rpm and in a low gear for a week or two. And the same goes for leg work
in the gym. Remember, if you push too hard, you just get to start over again. Mild stretching
before and after the ride keep the muscles loose, and icing the knee after the ride may be
beneficial as well.

Drugs Tylenol or NSAIDs such as motrin are a good start. Motrin can be taken up to 800 mg 3 times a
day for a few days, but then drop back to the recommended dose on the bottle. If you have a history
of ulcer problems or develop GI side effects, either switch to tylenol (it helps pain but is not as
good an antiinflamatory) or see your physician for one of the newer Cox-2 medications (Vioxx,
Celebrex) which are much easier on the stomach.

Prevention

a.. Correct biomechanics - follow suggestions above
b.. Consider a complete bike fit
c.. Choose gears that allow a cadence of at least 75 - 80 RPM
d.. Don't make big changes in your training program - increasing mileage by more than 10% a week
is a risk factor for injury as is over zealous interval training.
e.. Keep your legs covered in cold temperatures

Quoted message said:

Thinking more on this, there is also the question of "float" if you are using clipless pedals.

Ian, I am using clipless pedals.

Gary, thank you so much for that post! I will copy that and study it.

Thank you, Dave Horne

Anyone have experience with the various gizmos (HostelShoppe has 2 types) that let one experiment
with different pedal positions to simulate shorter crank lengths. I'm not sure I'm ready to shell
out for a new shorter crank, but have been thinking about getting a set of these adapters to see if
it's an improvement.

Edward Ing said:

2)the crank length -- too short is okay but you lose power. If the crank length is too long, even
though your seat distance is correct, and your extended leg is in the proper position, your
other leg, the compressed leg is too compressed.

If the crank is too short, you won't have the repetitive strain injury problem, you will just not
get an effective leverage as a longer crank.

DH scribed with passion and wit:

Quoted message said:

Quoted message said:

Thinking more on this, there is also the question of "float" if you are using clipless pedals.

Ian, I am using clipless pedals.

Which pedals are they? How much float do they give?

--
Ian

catrike.co.ukcatrike.co.ukOpen ↗

These are just regular pedals with a large surface area, no clips. I don't understand your use of
the word 'float' in this context. What does that mean?

Gary posted below a good summary of some advice on knee pain from an earlier posting by Lawrence
Preble. Much of this and more is available in a book that was recently mentioned in Bicycling called
"The Knee Crisis Handbook" by Brian Halpern.

I've read a lot on this subject, and while I didn't learn much new, the book did cover just about
everything I've seen. In particular it mentioned the problem of knee cap alignment from muscle
imbalance that is frequently overlooked (its not mentioned below for example.)

For anyone new to the subject this book would provide a great review on this painful subject.

Steve Christensen Midland, MI

Quoted message said:

The knee is the most commonly injured joint in cycling. As injury is generally a problem of
overuse, it is often seen in the cyclist just beginning a training program or early in the training
season when the temptation is to do too much too fast. The most common causes are:

1.) For a wedgie rider, faulty saddle height or for recumbent rider, faulty seat distance.
2.) Pushing excessively high gears
3.) Slow cadence in cold weather
4.) Too much leg work in the gym. (Yes, some of us cyclists do some cross-training, and
some do way too much. I'm guessing this is not your main problem.)

One way to classify knee pain (and identify possible solutions) is to look at the location of
the pain.

Anterior (i.e., front of knee.) Reasons patellar tendonitis patellofemoral syndrome Causes pushing
BIG gears - cadence too low saddle too low or too far forward foot too far forward on the pedal
crank arms too long leg length discrepancy with seat set for shorter leg Possible solutions ride at
75 rpm or higher raise seat (in small increments of less than 5mm) or move seat back move cleat
forward 1 to 2 mm shorten crank arms by 2.5 cm set seat for longer, not shorter, leg with
correction for the shorter leg

Posterior (back of knee) Reasons hamstring/gastrocnemius neurovascular bundle Causes saddle too
high or recumbent seat too far back too much pedal float leg length discrepancy with no correction
for shorter leg Possible solutions lower seat (in small increments) or move seat forward limit
float to 6 - 8 degrees set seat for longer, not shorter, leg with correction for the shorter leg

Medial (inner side) Reasons medial collateral ligament pes anserenus Causes cleat position too wide
- foot held internally rotated excessive knee frontal plane motion too little pedal float Possible
solutions narrow foot position by moving cleat outwards orthotic or wedge to correct foot alignment
pedal float should be 6 - 8 degrees

Lateral (outside of knee) Reasons iliotibial band degenerative lateral meniscus Causes cleat
position too narrow - foot held internally rotated too little pedal float excessive knee frontal
plane motion Possible solutions widen foot position by moving cleat towards the bike pedal float
should be 6 - 8 degrees orthotic or wedge to correct foot alignment

Treatment General Issues

These are usually conditions that develop slowly over a number of days and are not emergencies.
Likewise immediate evaluation by an orthopedic specialist is overkill. Immediate care is always
available at a walk in clinics, but it is more productive to see your primary care physician or a
sports medicine physician as the first step.

Dealing with yourself will be the biggest issue. Competitive athletes and overzealous newbies have
a "fear of rest" - and rest is probably the single most effective treatment. Peer pressure to
continue to ride doesn't help.

First Aid Ice, elevation, and resting the knee are all helpful.

Rehabilitation Take a few days off and then begin a limited riding program - cut back mileage by 20
- 30 % and spin at a high rpm and in a low gear for a week or two. And the same goes for leg work
in the gym. Remember, if you push too hard, you just get to start over again. Mild stretching
before and after the ride keep the muscles loose, and icing the knee after the ride may be
beneficial as well.

Drugs Tylenol or NSAIDs such as motrin are a good start. Motrin can be taken up to 800 mg 3 times a
day for a few days, but then drop back to the recommended dose on the bottle. If you have a history
of ulcer problems or develop GI side effects, either switch to tylenol (it helps pain but is not as
good an antiinflamatory) or see your physician for one of the newer Cox-2 medications (Vioxx,
Celebrex) which are much easier on the stomach.

Prevention

a.. Correct biomechanics - follow suggestions above
b.. Consider a complete bike fit
c.. Choose gears that allow a cadence of at least 75 - 80 RPM
d.. Don't make big changes in your training program - increasing mileage by more than 10% a week
is a risk factor for injury as is over zealous interval training.
e.. Keep your legs covered in cold temperatures

DH scribed with passion and wit:

Quoted message said:

These are just regular pedals with a large surface area, no clips. I don't understand your use of
the word 'float' in this context. What does that mean?

Clipless refers to pedals that have cleats to attach to the shoes, float is the ability for the feet
to move in the cleats while you are pedaling to mirror the natural movement of the joints, if your
feet are rigid on the pedals then extra stress is placed on the knees, but I'm not sure how this
works with platform pedals, which are what you have, comments anyone?

--
Ian

catrike.co.ukcatrike.co.ukOpen ↗

"Edward Ing" <[email hidden]> wrote in message
"]news:[email hidden]...

Quoted message said:

It is either force strain, or repetitive strain injury.

If it is force strain, you are probably pushing too hard and need to spin.

If it is repetitive strain injury, you are either overextending the joint or over compressing it
and the repetitive motion strains the tendon.

For the repetitive strain injury, you have to check two parameters on the recumbent. 1) Leg
extension, neither too short nor too long and 2) the crank length -- too short is okay but you
lose power. If the crank length is too long, even though your seat distance is correct, and your
extended leg is in the proper position, your other leg, the compressed leg is too compressed.

If the crank is too short, you won't have the repetitive strain injury problem, you will just not
get an effective leverage as a longer crank.

I'm 5.7" on a Trice Micro and have recently switched from 170 to 152m cranks. I should have done
this long ago, it only took a short while to adapt to, and cost me only $30 to try. Worth it to find
out if it helps, IMHO.

SteveC