knees playing up

jon said:

hi

I was wondering if anyone can offer some advice on my continuing knee
problems. The symptoms are mainly twinges / slight pain at the front and on
the inner side. If i put weight on either knee it is quite uncomfortable. I
sometimes feel it while riding but usually after the ride and the next
couple of days. Knees crunch and click a lot more after ride. Cycling
definitely make them feel worse as i rested up for about a month and they
felt quite a bit better. I ride an mtb on-road and off and have normal
pedals ( ie. no toeclips, cleats etc ). I have tried raising the saddle but
it is now at a point where the seat post is at the limit - i can just about
touch the ground with both toes. ( it's a 19" mtb and i'm 6'0ft - approx 34"
inseam ). I usually ride with a cadence of approx 85 - 95. I don't want to
quit cycling so i'm determined to get a solution to this. Few questions:-

1) The general rule about heel on pedal at 6'0 with straight leg - is that
bare heel or with shoes ?. Would have thought it made much more sense with
shoes.

With shoes, and the knee should be just locked straight - of course,
this will never happen in actual cycling as you're using the ball of
your foot and flexing your ankle. Don't copy the saddle height from
another bike unless the cranks are the same length.

Quoted message said:

2) has anyone found the horizontal position of the saddle affects their
knees.

No. This is a myth (ask recumbent riders).

Quoted message said:

3) Has anyone found that having the saddle too high can cause pain at the
front of the knee.

It's possible to overextend the knee by having the saddle too high, but
IME having it too low is more dangerous as you're then applying a lot of
force when the knee is sharply bent. Stand up on steep hills if they're
short.

This is a good exercise (after you've checked your saddle height and
cleat position, obviously):

Sit on a comfy chair (the sofa in front of the TV will do) with your
hands under your knees. Raise the lower half of your legs so your legs
are straight, and *slowly* let them down again. Repeat 100-200 times
each night for a couple of weeks. Oddly, if this cures the problem
("VMO inhibition" - basically a lazy muscle on the inside of the knee)
you can stop the exercise, as it will look after itself from then on.
If the problem isn't VMO inhibition then this is a low-load, low-impact
exercise that is very unlikely to do any harm.

IANA physiotherapist and YMMV etc etc.

jon said:

Knees crunch and click a lot more after ride.

Everything you've described but this bit in particular sound like the
symptoms of torn meniscus. This is Bad News. You ought to see a doctor
about it - your GP might also be the best person to refer you to a
sports physio.

d.

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

Quoted message said:

1) The general rule about heel on pedal at 6'0 with straight leg - is that
bare heel or with shoes ?. Would have thought it made much more sense with
shoes.

I think it was intended for racing shoes, which have virtually no heel. I
reckon that 0.885 x inside leg (which needs to be measured carefully - broom
between legs, and measure to top of broom handle. Don't let the neighbours
see...) works better. The resulting distance should equate to the
measurement from the centre of the bottom bracket to the point at which a
line through the seat tube crosses the top the saddle.

Quoted message said:

2) has anyone found the horizontal position of the saddle affects their
knees.

Not really, but level is usually best.

Quoted message said:

3) Has anyone found that having the saddle too high can cause pain at the
front of the knee.

YES. Definitely don't put your saddle too high; this is more likely to cause
knee problems than too low.

Quoted message said:

Finally, can anyone recomend a good sports physio in the Herts / Essex /
Cambridgeshire area who has experience of cycling problems.

Sorry, I'm way out of touch now, even though I live in your area. West
Suffolk Hospital used to run a sports injury clinic, but I'm going back
nearly 15 years since I used it. TBH, they weren't that good anyway;
cyclists were not represented in vast numbers among their patients..

One of the commonest causes of knee problems is shoe plate position. A
Belgian doctor eventually repositioned mine - bye, bye knee problem (more or
less, anyway). It's very hard to give very accurate advice on this; I was
pedalling with my foot too far back (i.e., with my toes). The ball of your
foot should be right over the pedal axle. Also, you obviously need to make
very sure that your pedals offer you some movement side-to-side, and that
your foot is able to rest at the correct (???) angle.

Finally, make sure that your shoe plates and pedals are in good condition.
Check for bent axles, especially. Try a completely different pedal system
for a while, if that's possible. I used to find that if my plates / pedals
were getting worn, so that I could rock my shoes from side to side when
viewed from the front, this made my knee problems much worse.

I'm not a physio, but doing some stretching and *LIGHT* weights (bag of
sugar?) can help sometimes. The exercises I found particularly useful were-

1/. Bare feet. Stand a couple of feet from a wall. Slowly lean into the
wall, keeping the feet flat on the floor. DO NOT BOUNCE!!! Should stretch
the muscles in the back of your lower leg, which increases flexibility.

2. Lay on your back. Tie sugar (or similar if other half objects) to foot.
Keep knee straight - lift. Repeat lots. Strengthens muscles in from of upper
leg, which can increase support to the kneecap during activity.

Best of luck - I know how painful and frustrating knees can be.

I said:

This is Bad News.

Sorry, just realised this sounds a bit scary. It's not really that
scary, but it's definitely a good idea to get it looked at by a doctor.

d.

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

Quoted message said:

I said:

This is Bad News.

Sorry, just realised this sounds a bit scary. It's not really that scary,
but it's definitely a good idea to get it looked at by a doctor.

I agree. However, IME NHS doctors aren't that helpful; you tell them you've
got a bad knee, and they listen. They ask you when it's sore, and you tell
them something like, "it's worst after about 120 miles, especially if it's
below freezing." Whereupon they open the door for you and tell you to stop
cycling 120 miles... :o(

in message <[email hidden]>, jon

(') said:

I was wondering if anyone can offer some advice on my continuing knee
problems. The symptoms are mainly twinges / slight pain at the front
and on the inner side. If i put weight on either knee it is quite
uncomfortable. I sometimes feel it while riding but usually after the
ride and the next couple of days. Knees crunch and click a lot more
after ride. Cycling definitely make them feel worse as i rested up for
about a month and they
felt quite a bit better. I ride an mtb on-road and off and have
normal pedals ( ie. no toeclips, cleats etc ). I have tried raising
the saddle but it is now at a point where the seat post is at the
limit - i can just about touch the ground with both toes. ( it's a 19"
mtb and i'm 6'0ft - approx 34"
inseam ).

FWIW I also have a 34 inch inseam. The tops of the saddles of all my
bikes are 31.5 inches from the centre of the bottom bracket bearing,
measured along the line of the seat tube.

Quoted message said:

I usually ride with a cadence of approx 85 - 95. I don't
want to quit cycling so i'm determined to get a solution to this. Few
questions:-

1) The general rule about heel on pedal at 6'0 with straight leg - is
that bare heel or with shoes ?. Would have thought it made much more
sense with shoes.

I've always done it with shoes.

Quoted message said:

2) has anyone found the horizontal position of the saddle affects
their knees.
3) Has anyone found that having the saddle too high can cause pain at
the front of the knee.

Your saddle isn't too high. I'm pretty sure it's too low. On a mountain
bike which typically has a high bottom bracket you're unlikely to be
high enough to get a good leg movement if you can get both toes down at
the same time. The more bent your knee is the more strain you're
putting on it (think about the angles and forces). You don't want it to
quite straighten when actually cycling but you want to get pretty close
to that.

Get a new seatpost. Is the bike itself big enough for you? (Yes, I know
a 19" MTB frame should be, but is it?).

Having said all that you really ought to see a physio.

--
[email hidden] (Simon Brooke) http://www.jasmine.org.uk/~simon/

;; my other religion is Emacs

On Tue, 17 Aug 2004 20:35:04 GMT, Simon Brooke <[email hidden]>

Quoted message said:

FWIW I also have a 34 inch inseam. The tops of the saddles of all my
bikes are 31.5 inches from the centre of the bottom bracket bearing,
measured along the line of the seat tube.

Wouldn't the crank length be important here?
--

Cheers,

Al

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

Quoted message said:

hi

I was wondering if anyone can offer some advice on my continuing knee
problems. The symptoms are mainly twinges / slight pain at the front and

on

Quoted message said:

the inner side. If i put weight on either knee it is quite uncomfortable.

I

Quoted message said:

sometimes feel it while riding but usually after the ride and the next
couple of days. Knees crunch and click a lot more after ride. Cycling
definitely make them feel worse as i rested up for about a month and they
felt quite a bit better. I ride an mtb on-road and off and have normal
pedals ( ie. no toeclips, cleats etc ). I have tried raising the saddle

but

Quoted message said:

it is now at a point where the seat post is at the limit - i can just

about

Quoted message said:

touch the ground with both toes. ( it's a 19" mtb and i'm 6'0ft - approx

34"

This is the bit thats bothering me. You should not be able to touch the
ground with both feet if you are sat on the saddle. Sit on the saddle and
turn the peddle with your foot. Your leg should be almost but not quite
straight at the bottom of the peddle stroke.

Quoted message said:

inseam ). I usually ride with a cadence of approx 85 - 95. I don't want

to

Quoted message said:

quit cycling so i'm determined to get a solution to this. Few questions:-

1) The general rule about heel on pedal at 6'0 with straight leg - is that
bare heel or with shoes ?. Would have thought it made much more sense with
shoes.
2) has anyone found the horizontal position of the saddle affects their
knees.
3) Has anyone found that having the saddle too high can cause pain at the
front of the knee.

To low definately can.

Quoted message said:

Finally, can anyone recomend a good sports physio in the Herts / Essex /
Cambridgeshire area who has experience of cycling problems.

Sorry. Live in Scotland

Quoted message said:

Any help would be much appreciated

Jon

"Al C-F" <[email hidden]> wrote in
message news:[email hidden]...

Quoted message said:

On Tue, 17 Aug 2004 20:35:04 GMT, Simon Brooke <[email hidden]>

Quoted message said:

FWIW I also have a 34 inch inseam. The tops of the saddles of all my
bikes are 31.5 inches from the centre of the bottom bracket bearing,
measured along the line of the seat tube.

Wouldn't the crank length be important here?
--

(Hope Simon doesn't mind me butting in) Funnily enough, no. I thought the
same as you when I first came across Genzling's method (which is what I've
described in my post, and which gives a BB - saddle measurement). However, I
found that it does indeed work better; I rode 165mm cranks on the track
(unsurprisingly), and 170s on the road, and found that my position
corresponded when measuring from the BB. I presume it's the centre of the
pedal circle that counts.

in message <[email hidden]>, Al C-F

(') said:

On Tue, 17 Aug 2004 20:35:04 GMT, Simon Brooke <[email hidden]>

Quoted message said:

FWIW I also have a 34 inch inseam. The tops of the saddles of all my
bikes are 31.5 inches from the centre of the bottom bracket bearing,
measured along the line of the seat tube.

Wouldn't the crank length be important here?

Yeah, probably would but <mumble tone="ashamed">I've never actually
tried anything but 172.5, so I don't really know what difference it
would make</mumble>

--
[email hidden] (Simon Brooke) http://www.jasmine.org.uk/~simon/

Do not sail on uphill water.
- Bill Lee

in message <[email hidden]>, Simon D

(') said:

One of the commonest causes of knee problems is shoe plate position. A
Belgian doctor eventually repositioned mine - bye, bye knee problem
(more or less, anyway). It's very hard to give very accurate advice on
this; I was pedalling with my foot too far back (i.e., with my toes).
The ball of your foot should be right over the pedal axle. Also, you
obviously need to make very sure that your pedals offer you some
movement side-to-side, and that your foot is able to rest at the
correct (???) angle.

Jon said (top of thread) that he rides on flats. One thing which might
help the knees is a clipless pedal with a lot of lateral float, e.g.
Speedplay Frogs. Not cheap though.

--
[email hidden] (Simon Brooke) http://www.jasmine.org.uk/~simon/

'there are no solutions, only precipitates'

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

Quoted message said:

Jon said (top of thread) that he rides on flats. One thing which might
help the knees is a clipless pedal with a lot of lateral float, e.g.
Speedplay Frogs. Not cheap though.

Thanks for that, Simon. I agree with what you say, and would add the thought
that almost *any* clipless pedal with float (which I think they all have
nowadays?) might help. One of the things that helped me was switching to
clipless in the late 80s; I think it was the lack of rocking motion (to
which I referred in my post) that reduced my problems. Could also have been
that my foot's position over the pedal was determined by the plate
position - although, as I said, I actually had them in the wrong place!

bob watkinson said:

This is the bit thats bothering me. You should not be able to touch the
ground with both feet if you are sat on the saddle.

This depends on the bike even for a given "rule of thumb" setup: some
have the crank lower than others. My cargo bike has a fairly low crank
specifically so it's easy to get both feet down if you've got a big load
on the back that needs stabilising at stops.

Quoted message said:

Sit on the saddle and
turn the peddle with your foot. Your leg should be almost but not quite
straight at the bottom of the peddle stroke.

I use that one, but note it is a rule of thumb for road use, not gospel
for everyone and everything. Off road you might (but might not) want
things a little lower. But people and their bodies, and their bikes,
are different. Start with something like the above and fiddle
empirically until you've seen how changes affect you.

Pete.
--
Peter Clinch Medical Physics IT Officer
Tel 44 1382 660111 ext. 33637 Univ. of Dundee, Ninewells Hospital
Fax 44 1382 640177 Dundee DD1 9SY Scotland UK
net [email hidden] http://www.dundee.ac.uk/~pjclinch/

in message <[email hidden]>, Peter Clinch

(') said:

bob watkinson said:

This is the bit thats bothering me. You should not be able to touch
the ground with both feet if you are sat on the saddle.

This depends on the bike even for a given "rule of thumb" setup: some
have the crank lower than others. My cargo bike has a fairly low
crank specifically so it's easy to get both feet down if you've got a
big load on the back that needs stabilising at stops.

Yup, but the OP was talking about a mountain bike, and on mountain bikes
the bottom bracket is typically quite high.

--
[email hidden] (Simon Brooke) http://www.jasmine.org.uk/~simon/

;; lovely alternative to rice.

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

Quoted message said:

Finally, can anyone recomend a good sports physio in the Herts / Essex /
Cambridgeshire area who has experience of cycling problems.

Not a personal recommendation, but there's a physio who leaves his
cards in Baker's Cycles in Bishops Stortford (number should be on
Yell.co.uk). The owner says quite a few of his customers use him.

Toby

Simon D said:

I agree. However, IME NHS doctors aren't that helpful; you tell them you've
got a bad knee, and they listen. They ask you when it's sore, and you tell
them something like, "it's worst after about 120 miles, especially if it's
below freezing." Whereupon they open the door for you and tell you to stop
cycling 120 miles... :o(

I'm sure that's true, but they have no right to do that. If you have an
injury, they have a duty to treat it, surely? Or at least refer you to
someone who can treat it. I want Helen DV's opinion on this matter.

If my doctor treated me like that, I would retort with: Cycling keeps me
fit. If I stop doing this exercise, I will become unfit and will
ultimately take up more of your time and become a greater drain on NHS
resources than if you treat my injury seriously. You [censored].

If doctors are prepared to treat lung cancer victims rather than just
send them packing and telling them to stop smoking, then they bloody
well ought to be more sympathetic to a cyclist's knee complaints.

d.

davek said:

If doctors are prepared to treat lung cancer victims rather than just
send them packing and telling them to stop smoking, then they bloody
well ought to be more sympathetic to a cyclist's knee complaints.

I know someone who had suffered from high blood pressure. He lost a modest
amount of weight and his blood pressure dropped so he commented on this to
the doc. The doc's response was 'we know that, we just don't tell people cos
they never manage to lose weight anyway'. There's nowt as strange as real
life..

...d

davek said:

Simon D said:

I agree. However, IME NHS doctors aren't that helpful; you tell them
you've got a bad knee, and they listen. They ask you when it's sore,
and you tell them something like, "it's worst after about 120 miles,
especially if it's below freezing." Whereupon they open the door for
you and tell you to stop cycling 120 miles... :o(

I'm sure that's true, but they have no right to do that. If you have an
injury, they have a duty to treat it, surely? Or at least refer you to
someone who can treat it. I want Helen DV's opinion on this matter.

If my doctor treated me like that, I would retort with: Cycling keeps me
fit. If I stop doing this exercise, I will become unfit and will
ultimately take up more of your time and become a greater drain on NHS
resources than if you treat my injury seriously. You [censored].

If doctors are prepared to treat lung cancer victims rather than just
send them packing and telling them to stop smoking, then they bloody
well ought to be more sympathetic to a cyclist's knee complaints.

d.

I went to see mine about odd heart things that happened occasionally
whilst out cycling (ok, the parents were more worried about it than I
was, but hey, I was about to do my longest hilliest ever ride).

I was checked out, asked questions, and told in no uncertain terms to
get out there and not to give up cycling!

In the case of a knee, where it really can stop you cycling, if you get
told to stop doing whatever aggravates it, I agree, go get a second
opinion. Though I've been told similar with a nerve problem in my arm, it:

a) is more likely that there is nothing they can do,
b) it'll get better eventually, even though it's already been a year
c) isn't aggravated by cycling unless the road surface is [censored] for a
long distance

What's annoying is that d) I did it while sailing, and sailing will make
it much worse again, so I can't do that till it's properly healed.

But sailing is something I do far less frequently than cycling - while I
miss it, it doesn't thus contribute quite as much to my fitness levels
as the bike does (and MUST get back on the bike tonight, things have
conspired against me of late/since the L2C ride, and I'm planning doing
my first 100km in 4 weeks or so!)

I think a lot of the time people can view cycling etc as a leisure
activity and thus a luxury that's not necessary to survive on a day to
day basis. In some respects they are right - it's not like it stops you
working, unless you couldn't get to work using bus/train/car/taxi etc -
and it's not likely to kill you if you can't cycle - but it *does* make
you healthier in the long run.

--

Velvet

David Martin said:

I know someone who had suffered from high blood pressure. He lost a modest
amount of weight and his blood pressure dropped so he commented on this to
the doc. The doc's response was 'we know that, we just don't tell people cos
they never manage to lose weight anyway'. There's nowt as strange as real
life..

Sounds like my (overweight) father, who takes medication to bring his high
blood pressure down, and cheerfully told that the gp had said that the
efficacy of things like losing weight or eating less salt wasn't clear so
he isn't doing that, and thinks he is healthy because the pills do work.

Roos