Knee pain-again!

gmdave2002 said:

........... but surely pain would manifest in both knees in these cases? ............

I only get a problem in the right knee from time to time, & never in the left.

Sounds like pain I experience when climbing or pushing a huge gear when sprinting. Only in my right knee. Doctor diagnosed patella tendinitis. First day of physical therapy was today...the PTist did a bunch of movement tests on both legs and immediately noticed that my quads on my right leg were significantly tighter and that my calves, quads, and hamstring were weaker on my right leg. Thus, lots of right knee pain whereas left knee is OK so far.

3 weeks of stretching, followed by several weeks of strength training, and hopefully I can start training hard again.

Mark

Thanks Mark,

Sounds very similar to my problem. I am continuing to get acupucture in the kneecap and once that's over, my PT is giving me a weights programme to build up both legs but specifically the quad in my right leg which is slightly weaker. I think I will start stretching a bit more after a training session as well as before.

Dave

gmdave2002 said:

Hi all,

I was wondering if anybody had any useful tips for me. I increased my climbing volume 2 months ago to prepare for a 200km ride over very mountainous terrain and almost immediately I had quite bad pain in my right knee. It initally felt like the pain was around the kneecap but lately seems to be localised under the kneecap.

I see from previous threads that this type of pain can be attributed to big gear climbing, incorrect saddle height etc but surely pain would manifest in both knees in these cases? I don't push big gears, my saddle height hasn't changed and I don't seem to tick any of the boxes that typically contribute to knee pain.

I have been getting acupuncture treatment but this doesn't seem to be helping. If anyone has any ideas it would be greaty appreciated!

your problem sounds like chondromalacia - which is basically the cartilage under the knee cap is being irritated by repeatedly rubbing the kneecap against the femur (simple explanation). there is a v groove behind the knee cap and this "v" fits into a groove in the femur. if the alignment is not "perfect" meaning that you only have a few degrees of error you will eventually feel pain under the kneecap. typically exacerbated when greater force applied per revolution as in climbing. a couple of things to look at:

1) do your knees excessively internally rotate during the pedal stroke e.g. do your knees touch or cross over the top tube at the top of the stroke? if so you may be a candidate for shims or othotics - but specialized body geometry shoes can help significantly to minimize this knee travel.

2) stretch your quads for 3x1' three times a day and take oral anti-inflammatories as prescribed on the bottle. also, incorporate stretches for the ITB, hamstrings, adductors (inner thigh), hips and hip flexors. any stretch book will help you with these stretches. think long duration, over a minute per stretch at a tolerable level.

3) get deep, deep tissue massage for the quads, ITB, adductors, glutes

4) this is part of a bigger problem, called poor neuromuscular coordination, meaning your some of your muscles are being used more than they should and others are being under used than they should, after the season is over look into hiring a qualified trainer who can put you on a strength training program to correct this.

that is a start, any more questions or guidance, i will be glad to help

mmerchant

Hi mmerchant,

Thanks for your detailed reply, a few of your points certainly rang true. I occasionally touch the top tube (the odd scrape appears on the inside of my leg but I dont consciously notice it happening) with my quads but I am told this is normal enough because of the muscle mass on the quadricep.

In your opinion should I discontinue the acupuncture as my PT thinks there is tendon inflammation around the kneecap but im not convinced? Do you think specific gym work to strengten my quads is advisable after the symptoms clear up?

I switched to Time pedals last year after previously using shimano pedals. Would you recommend switching back to the shimano pedals or just adjust the float on the Time ones?

Thanks.

Blessed relief!!

Yesterday evening I decided to change a few things on my bike to see whether I could eliminate what was giving me the knee pain. I raised the saddle by 5mm and changed back to my old pair of shimano pedals and cleats.

After 10 miles my knee felt better than ever and I even managed to complete 60 pain free miles! It was definitely worth the 5 minute pre and post cycle stretching, something I would recommend to everyone with knee trouble.

Thanks to all who offered their advice.

gmdave2002 said:

Blessed relief!!

Yesterday evening I decided to change a few things on my bike to see whether I could eliminate what was giving me the knee pain. I raised the saddle by 5mm and changed back to my old pair of shimano pedals and cleats.

After 10 miles my knee felt better than ever and I even managed to complete 60 pain free miles! It was definitely worth the 5 minute pre and post cycle stretching, something I would recommend to everyone with knee trouble.

Thanks to all who offered their advice.

So was it the stretching or the pedals?
The pedals sounds more likely as Ive found stretching usually takes a couple of week to loosen you up properly. Have had similar complaint with right knee and regular stretch as a result.

Hi DJA,

Hard to say whether it was the saddle adjustment, the pedals or the stretching. I suppose I should have done the 3 things separately if I wanted to see which worked. Maybe it was a combination of all 3. I don't imagine it was the stretching alone, but most probably the saddle adjustment and change of pedals. I feel that I am now getting an almost full extension of the knee compared to feeling a bit cramped before the adjustment.

I think the pedals helped a lot as well. I immediately felt that my pedalling stroke was different than before, but hard to explain how. I suppose I can describe it best as feeling less restricted in my stroke. I guess the previous pedals (or cleats) just didn't suit me and going back to my old ones felt a lot more "natural".

For what it's worth, my advice would be to look at what changes you have made to your bike/setup immediately before your problem started. After that change one thing at a time and hopefully you will find where the problem lies. Plus, continue the stretching before and after you cycle. I do about 5 minutes of each.

Hope you can solve the problem!

[font=Times New Roman]A similar thing happened to me, it drove me crazy. I tried acupuncture, physiotherapy, stretching the whole nine yards. It turned out to be my shoe plate! Don’t assume your feet/legs/pelvis are symmetrical and therefore set your shoe plates symmetrical, I learned a big lesson. If you have just changed pedals then this may be the problem. Also the deck/stack height of the Time pedal may be different than what you are used to.[/font]

[font=Times New Roman]Good luck,[/font]

[font=Times New Roman]Bill. [/font]