What should i do about this knee?

wh0areume

The red dot describes where my pain is.... (feels like it's sort of under my knee cap)


It started hurting 50 miles into a 75 mile ride last sunday.
I've tried to stay off it all week, but i went out again today and the pain is still there.
Only hurts when I'm biking - mostly when climbing or in bigger gears.


How do i fix this?
How long should i stay off my bike?
Should i see a doctor?
Do i need surgery?


I'm fairly new to biking, and i've always had a tendency to "muscle" the bigger gears rather than keep a high cadence.
(Which might have been the cause of all of this)


My road bike was fitted to me when i first bought it (by some olympic silver medalist) so i dont think it's seat position.

bikerboy59

go and see a Doctor. i had injured my knee in a ride last august and i stayed off the bike till December at which time i was on the trainer adn guess what, the pain was right back so i went to the doctor and in march had it scoped. now riding is pain free. Just my opinion though.

nath1

Do you have any history with regards to a knee injury? For example have you ever torn any ligaments if so then you may have a cartilage problem. If not then it may well be that you are pushing to hard too soon in too bigger gears. Im a sports injury therapist and see this injury quite frequently. I would ice regulary, check you seat position, perhaps it does need a little more height maybe only a few mil. Then check you saddle position for example is it too far back or forward. Finally, check your pedals make sure that you have plenty of float especially if you have active movement in your feet (moving position alot when pedaling). There are some good pedals out there today that can acomodate lots of diffrent styles of pedaling, i would recommend time RXS, or speedplay they have lots of float. With regards to what to do now, ice as often as poss, when applying the ice do so with a bent knee so that it open up the knee joint to allow the ice to do ,its magic. Do this as i say 20 mins every hour that you can. I would still ride but only after you have checked all of the above. But this time change your style of riding SPIN as much as poss, dont be tempted to mash . To me it sounds as if you have a touch of bursities, they are small sacks that help to lube the knee but when pushing too bigger gear or bike position is slightly out they are irratated and become inflamed giving the rider a burning sensation or nipping sensation when pedaling. However it could be the onset of tendinities of the patelliar under the knee cap which is probably unlikly because normally the rider also gets pain in the rear os the knee. So hope that helps, PM me if you need any more help or you have anyother symptoms that might help . nath

wh0areume

No history of knee injuries.
I use speed-play pedals so i don't think the float is the problem.
I moved my seat backwards about 1cm two months ago. Could this have caused the injury?


Yesterday after my ride, my knee hurt every time i sat down/got up in a chair, etc. for the entire day.
I'm considering raising my seat a bit like you suggested, but I'm somewhat hesitant because of who fit me to my bike when i bought it.


If this is what you think it is, will it go away eventually?
I will of course keep working to spin as much as i can, but when in a standing position that's not too much of an option - and that's when it starts hurting.


Should i avoid climbing for a while?
Should i ice the knee even when it's not hurting?
Will the ice eventually fix it?



Thanks for all your help so far.

nath1

Hi, yes definatly ice even if you arer not riding for a few days, it will help to take down any imflamation people do not realise how much iceing is important. So if you are using speedplay then you can do no better for pedals. I would definatly raise your saddle by three mm for a start, dont fell that because you have had your bike set up at the shop that it is bound to be exact we all tweak after intial setup. What this will do is change the angle of the pedal stroke on your knee, and this works wonders for all kinds of knee issues. For instance i have a softening of the cartilage behind the knee cap and since i have alterd the saddle the pain has diminished. How i recommend people to adjust their saddle when they have knee issues is, put your shoes on and sit evenly on the saddle next put the heal end of your shoe on the pedal ( the pedal should be in the six o clock position) finally adjust your saddle until there is about three to five mm gap from your heal to the pedal, for really thin soled shoes add another three mm. But you must make sure that you are sitting square on the saddle and not dropping your hip when doing the measurement. This will give you a really nice position just allowing a slight bend in the knee. Alternatively, raise your saddle until your hips rock when pedaling then slightly lower the saddle by a few mm at a time until your hips stop rocking, this gives you the same position as above. The angle that your knees are pedaling now could be contributing to the irratation in your knee so the above will definatly help if not cure it. So i would ice as often as poss, avoid any hill work if poss, if you cannot avoid spin up. Dont be tempted to use ibuprofen gels on the area as they actually shrink tendons slightly, ice is the best. For the seat adjust sit on the saddle and drop a plumb line down just behind your knee cap , you should be clipped in and the pedal needs to be at three o clock , so with the plumb line behind the knee cap and the pedal in the right position , the plumb line should now be in the centre of the pedal axle, if not adjust until it is. hope this helps, cheers

wh0areume

Update...

I raised my seat almost 1 full cm, and it felt amazing!
Not in my knee though, unfortunatly, but everywhere else.
My knee was still killing me, no matter how low of a gear I was in.
I even wore a knee brace.
I've been iceing constantly, and that didnt seem to help matters either, but i'm still going to keep doing it.


I made a doctor appointment for Wednesday.

nath1

Yes it will probably take a bit of time to settle down, its difficult but be persistent and give it time. Im almost sure it will heal. cheers

wh0areume

It's killing me not to ride, though...
Every day away from it is torture.

Not to mention i'm worried because i'm not sure how it happened in the first place, and if it could easily happen again, etc...

Anyway, thanks for all the help!

nath1

On the other hand you could perhaps do some active recovery, like swimming its the best next option. Because you are an athelete, you think like an athelete so it is at thyese times when we are injured that are the hardest. I would spend the time also looking towards the future like putting together a really effective training plan. This way your mind will also be active, by the time you have healed you will be on another level. cheers

OscarC

First I would double check (becuase everyone make mistakes) your fitting. Starting from making sure your cleats are angled and set in the right position. The Lemon fitting method is great. You should learn a little about this too. See this link.

http://www.bikenow.com.au/u-fit/saddle_height.htm

Second, if you're just starting out as you say, pushing big gears for that many miles is hard on your knees. Especially if you have not built up a milage base. A milage base is for at low efforts and higher cadence is for preparing your body to ride the hard miles. It allows for your butt, back, neck, knees joints, muscles, etc. to gain some strength in the saddle before going out and training hard.

As it seems you probably already have some inflamation. If you take a whole week off (7 days), it really shouldn't have much of negative impact on your fitness level. Do "RICE". Rest Ice Compress and Elevate. Aside from that, becuase we really so much on our knees in cycling, besides my vitamins, I take larger doses of Glucosamine, Chondroitin and MSM. These supplements are expensive but well worth the money. Costco carries this now with out the MSN. You should read about these. They help rebuild the material around your joints, ligaments etc. and keep them flexible. The MSM is more of an anti-inflamitory and pain reliever. You will notice a difference in as little as few weeks. I'm sure this also depends on the individual.

Also you should make sure you have a stretching program as part of your cycling. We are only talking about a 15 minute a day or every other day investment. Stretching will make a huge difference. What does stretching have to do with your knees you say? Well...when you cycle, because we don't fully extend our legs, the effect is negative in that it tightens our hamstring, quads etc. This tightening put extra strain on the ligaments and attaching joints. In and around you knee, tightness can cause pulling around your knee in any one direction causing an inbalance or your knee to not track correctly.

Lastly, I would say that when you ride, try to keep your cadence up to around the customary 90. Try to be at about 75 to 80 on climbs if possible (for your knees sake). Start slow though and pay close attention to how you knee feels. I'm guessing you should be able to ride again and slowly increase your efforts while still healing. Knee problems are a pain becuase they do take so long to heal fully.

My final thougths are, I've been riding along time and most of us have experienced knee problems. Take what I say with a grain of salt as I'm not a doctor, but do ride more than some doctors out there. Do your own research and see what works for you. Sorry for the long winded response but I don't want to give you a half of a response which would be counter productive.

Best of luck.

wh0areume

Update: Saw a doctor.

The guy seemed incompetent, but he said that my adductor muscles were weak, which was letting my knee slightly slide to the outside part of my leg when at the top of my pedal stroke. This caused it to wear down on my cartilage, causing the pain. He prescribed me antiinflammitories, told me to strengthen my adductors, and ice it.

What surprised me is, there's a adductor weight machine at the gym (kind of like a thigh-master motion). I got on it and kept increasing the weight. i did 10 reps at 305 lbs, which was as high as it went. are these different adductors? they don't seem weak to me.

I haven't ridden since Monday (6/12) and I'm going to keep off my bike until 6/21.
I'm also taking Glucosamine, Chondroitin and MSM (3 pills/day), and icing it every chance i get.

I feel like this is a permanent injury, and it's going to worry me everytime i get on the bike.

discobean7

Based on reps of 305lbs I wouldn't classify your adductors as "weak" either. Perhaps he was referring to the VMO (vastus medialis oblique). This muscle is active during terminal extension (last 10 degrees) and is also important for proper tracking of the patella (keeps patella from deviating laterally). The VMO tends to be the first muscle to atrophy following an injury and is usually the last muscle to return to full function after recovery. Although based on the pics I would say your VMO isn't underdeveloped either. I think you're on the right track though. Keep doing what your doing, take some rest, and when you do come back, take it easy at first.

__________________
"if at first you don't succeed, redefine success"

Archibald

know the feeling!
i'm at week 6 of 6-8week recovery for a PCL injury, so i feel your pain.
mine was a small niggling pain in the side of my knee that i ignored and "pushed through"...
in the same boat as you in that i have no idea of what caused it, but at least the physio knows about preventing reoccuring through the way we're fixing it.
there'll be an additional month of excercises to help strengthen the specific muscles around the joint as this will take some of the load of the ligaments and the joint.
It's this strengthening that seems to really be doing the trick.
Two days ago I got to do my first ride in 6weeks! on my MTB (for the lower gears) along a bike path that follows a local creek. i've never ridden so carefully in my life!! but man, it was good to do!!
so hang in there and take the time needed to heal properly. work closely with a trusted phsyio (or whatever other physician you prefer) and the results will be worth it all...

wh0areume

What exercises are you doing?
The doc never told me what exercises that would strengthen the muscles by my knee.


Yesterday I went for a short 5 mile ride.
It felt a little different than my other knee, but it didnt hurt, even going up hills.
I didnt want to push my luck, so i turned around and went back to work.
I'm going to try to go a little further tomorrow, taking today off.

Sometimes I swear I can feel it healing...
Kind of how you can feel a cut heal when it's sort of an itching pain..
I'm taking about 5-6 "Glucosamine/Chondroitin/MSN" pills per day, and icing about 3 times per day.