Medial Knee Pain

2zanzibar

it seems that after around the 20 mile marke I start to get sharp sporadic pains on the inside of my knee (medial) There doesn't seem to be anything that triggers it, ie. getting out of saddle, going up hill or after a hard effort. It just seems to come on.
The pain is on the down stroke between 4 and 6 o'clock. It starts off as twinges, which become more frequent, mixed in with some sharp pain.
Not quite sure if its tendon, MCL or cartilage

anyone had anything similar?

Grater

It could be the meniscus (cartilage) in the knee.

Here's a little test you can do to find out.

1. First of all, get in a position and squat down.
2. Go down into a frog position and try and walk in that position squatting down.

If you can barely walk or walk with a lot of pain - it's your meniscal cartilage. If it is, it could just be general wear and tear or bruising. I don't think whatever the problem is, that it's serious. A bit of rest and you should be fine I think. But we'll see what happens after that test you do.

I've had 2 full knee reconstructions and I've had a lot of trouble with my medial meniscus and I got half of it removed last year because previously, 2 years ago, it was stitched up but re-tore again on me.

DJA

Ive had trouble with my right knee both inside and outside pain simlar to yours coming on after 30 of riding at different times. Basiclly my problem was "over development" of the tendons on either side of the knee ( or more simple tight tendons). I now stretch regularly and have fixed the problem with this night activety.

2zanzibar

Well it looks like I've ruled that one out. Thanks for your suggestion. I tried and everything seemed OK; it didn't reproduce the pain thank god! Meniscus damage sounds heavy.
I got this pain in late November; so I went to the Physio who couldn't really work out what was wrong but as I'm a long-term sufferer of Patellofemoral pain, he reckoned I was over-compensating for it by shifting pressure medialy; I can't win!! since then I didn't go on the bike until recently, taking it nice and easy. The rest off though hasn't seemed to've made much of a difference.

Grater

Good that it's not mensical damage.

When you ride, are you favouring your bad leg?

2zanzibar

Yes, I think I do. Its certainly stronger than the right leg. Though both seem to track ok, maybe the left (bad) leg deviates slightly, but I've seen other riders with alot worse tracking problems and no pain

peetee

I have had cycling related knee pain for years. It is difficult to describe exactly where but is most painful where the outer quad tendon joins the knee (looking down on the right knee it emerges from the top right hand corner of the patella). When pedalling it does not appear to catch on anything internally. The problem is worsoned by riding my MTB - I believe because of the greater offset of the crank to accomodate a triple set-up (all my bikes have identical SPD's which were a great imporvement over clips and straps - yes I'm that old!). I have a twist in my right leg. My foot points outward by 10-15° in comparison to my left. When I was 9 or so I had supports in my shoes to correct my arches and I have noticed that lifting your foot arch causes your knee to rotate. Perhaps they didn't do a proper job when I was 9?
Physio's have drawn a blank - but then they didn't notice the twist in my leg!
It's sometimes difficult to isolate the pain because I also suffer from very poor circulation in my knees which results in cold knees in all but the hottest weather. I have come back from 30 mile summer rides with sweat poring off me and freezing cold knee caps!
Basically I should be in the pool not riding a bike

Induray

How about the Pes Anserinus tendon (tendinitis). It connects the semimembranous, semitendinosus, and gracilis muscles (hamstrings) below the front of the knee cap. It serves to stabilize the inside of the knee from rotation. It is painful and sometimes induces a burning sensation on the front inside of the knee. The first time it happened to me was during a windy day ride. Then it would flare up everytime I went uphill. I went to therapy and between several exercises, rest and medication, it went away. Plus I installed the Le Wedge shims to my cycling shoes.
Hope this helps
Oh...forgot to mention..if you have pes planus (flatfoot) or tend to pronate (rotate the ball of your foot inward) this could be the cause of medial knee pain. Also if your cleats are rotated externally (toes -in).

OscarC

Try stretching evernight especially after rides. Stretch quads, hamstrings, glutes. Take some advil after your ride to relieve any swelling that may take place. Don't turn over big gears, pedal in a high cadence instead.

2zanzibar

This is what I'm thinking, though the physio who I saw didn't reckon it was any tendonitis. But from the research I've done its the thing that comes closest. Can you remember what the exercises were that you were given?

peetee

I was advised to stretch and I understand the importance of stretching and good warm up and am careful to do both. I am naturally supple and as an example can easily touch my toes and often my heels without effort. When pedalling my right knee 'orbits' in a figure of eight movement - a slow sweeping 's' on the way down and a a more pronounced, quicker sweep back to alignment on the way up. When walking I have a slight tendancy to step on the outside edge of my right foot anyway so any more support in my instep may correct my knee angle but might create discomfort in my foot or ankle - of which I have never suffered. I am 6 ft and lightly built and because of this my power is limited and I have never had a tendancy to stomp on the pedals. A cadance below 60rpm is pretty ineffective for me.

Induray

Yes . FIrst a warm up on the tread mill 10-15 minutes.
Calf Stretches 3-sets 30 sec each per leg
Quad Stretches 3-sets 30 sec each per leg
Hamstring Stretches-3-sets 30 sec each per leg
Single Leg Extensions 3 sets 15 reps low weight per leg
Single leg Curls 3 Sets 15 reps low weight per leg-tihs one, the therapist said was the crucial one, lift the weights with both legs and then, very slowly, with only one leg supporting the weight, bring it down. Slow is the key.
Then I would receive Iontophoresis? Application of anti-inflammatory via electrical (ionic solution) stimulation.
Other things I did on the side.

To stretch the distal head of the pes anserinus I came up with the following exercise. While standing, spread your legs apart as far as you can. (You must feel just a slight stretch btwn the legs.) Point your toes outward as far as you can.(First time use a chair/bench to stabilze yourself) No with a straight back, rotating fm the hip not back, try to touch the floor with your arms. You should feel the stretch in the medial section of the thigh/hamstring close the knee.If not try to either rotate your feet outward or spread the legs a slight more. Move you upper body closer to the affected knee for additional stretch. Use your arm to stabilize your self since your feet are rotate outwards either using the floor or a low bench. This has worked for me.

Other thing I did was I got the Specialized shoes and Lemond Wedges to compensates for my extremely flat foot condition (Can I say quack?).

Spin at lower gears.

Get a second opinion.

2zanzibar

Thanks everyone for their advice, I've been on a couple of short rides without aggravating it, so will go on a slighlty longer ride in a few days and see what happens.

Increasing the existing stretching regime will hopefully help

peanutjar

I began experiencing similar knee pain a month and a half ago, on mile 21 of my first ride after returning from a ski trip during which I "tweaked" my knee on one occasion (though skied several more days and visited several cities and walked around with no problems or pain).

Dr was not able to see anything on X-ray or MRI, though manipulation did produce some odd noises and sensations.

Original pain was on the pedal upstroke; inner portion of knee - quite sharp, and I essentially had to pedal home one one leg. After several weeks essentially "off" (rest 1 week, ride = pain, rest another week, try again... etc) and 2 Dr visits, I have resumed riding for the past week. Now the trouble is characterized by the knee feeling "weak" most of the time, and a bit of occasional pain while riding. Dr diagnosed it as "tendinitis" of hamstring tendon in one or more of 3 places where it connects to lower leg. Recommended thorough warmup, stretching, icing, and 2 Aleve tabs. morning and night as an anti-inflammatory. I am able to ride well enough, around 120mi/week, but trying to "push" a bit yesterday brought me closer to pain than I've been in a while.

I generally try to spin 95-100 rpm on level, 85-90 on hills (particularly while trying to baby my knee, but would like to continue high cadence and build in power). I can stay pretty smooth with my pedalstroke unless I try to push, then my uninjured leg does more of the work.

I am 6'3", lightly built (160lbs) - bike setup seems to be good in terms of seat height, etc. I have the red Look cleats which allow a bit of rotational float. I do have flat feet and use orthotics in my shoes, which just have to get used to pedaling again (along with my nether regions) to be much more comfortable.

May look at the exercises posted above for further strengthening..

Hope this experience helps, any suggestions you have for me are welcome as well.

Thanks!