Training & Nutrition - Need Advice on Knee Problem
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After some aggressive riding for about a month in April, I developed what I could best describe as a burning sensation or irritation in the general area of the patellar tendons in both knees. Only cycling brings this on -- I can run with no problems. I saw an ortho and he though it was patellar tendonitis. I am seeing a PT who is starting to think patello-femoral syndrome (and not tendonitis), which appears to be a technical term for "your knee hurts and we don't exactly know why." I took 5 weeks off from cycling, had a professional fit to the bike, and followed the stretches and exercises prescribed by the PT.
Today I got on the trainer and pedaled for 20 minutes about as easy as I could -- I was basically just going through the motion of cycling. About four hours later the burning sensation started again. The doc and PT are somewhat puzzled by all of this because it is brought on by rather gentle cycling and not things like a 12-mile run. This is quite the opposite of their usual experience with these sorts of problems. I would appreciate any ideas or personal experiences you have that might help us identify and eventually solve my problem.
07-06-05, 05:09 PM
For myself, it was a combination of cleat angles, seat height, and seat position that solved my problem. The combination of those virtually eliminated my knee pain. I occassionally feel some stress on the left knee when I do big gear strength training while seated.
How much adjustment was performed on your setup? Are you using clipless pedals?
The original fit was wrong in practically every respect: the seat was too high and too far back and the pedals (SPD-SL) were centered straight ahead whereas they should be centered slightly toe-out. The interesting thing is that the original fit was a "quickie" done by the shop that sold me the bike. Anyway, I am confident that the fit is now correct. I have high hopes that once my knees calm down I will be in good shape.
I am trying to figure out what I did to my knees so that I can pick (with the help of my PT) the best route for rehab. For example, should I find some lenght of time I can get on the trainer every day (like 10 min easy) without pissing off my knees or should I just stay off completely for three months?
After completing a 200+ mile, 4 day trip along the C&O Canal, I started experiencing loud clicking and mild pain in my left knee. Seems to be coming from the side of my knee cap. I took nearly a week off of the bike to allow for some recovery but am back on it now for my daily commute (riding very gently). It's only slightly tender when I'm on the bike, however, walking can hurt. Ice and Ibuprofin don't seem to help much. I ride with SPD's too, can you confirm the toe-out orientation? I haven't heard of this. I'm slightly worried since this seems to be a chronic problem, lasting longer than other joint pain I've had in the past.
I am not sure of your question. The SPD-SL is a roadbike pedal that is somewhat similar in design to a Look pedal. I think the SPD is a mountainbike pedal that is nothing like a SPD-SL. Which pedal are you using?
07-16-05, 06:41 PM
I used to have a LOT of problems with my knees (one knee in particular). I try not to point my toes down, warm up slowly (no hills the first 10-15 minutes or high gears), make sure my seat is adjusted at the right height (not too low, not too high), and I do not wear cleats because I find when my feet are constrained in any one position, I can't make natural adjustments that I have learned to make over time depending on my flexibility and fitness level to avoid knee pain. When I was exercising over the winter in the gym on the stationary bike and treadmill, I started having a lot of knee pain - but stretching and thoroughly warming up with 15 of low intensity exercise totally eliminated the problem.
Good luck finding what works for you. I believe a lot of knee problems are due to a combination of:
1) Lack of warm-up and going too hard or too fast too soon
2) Fitness levels and flexibility - what stage you're in when the problem occurs (early season, mid season, etc.) - and the need to make proper adjustments.
Go see a sports orthopedist, preferably one who is experienced with cycling related injuries.
People on forums have no way of identifying your problem. All they can do is throw out various possible knee problems. you can do that yourself with a simple google search, but it still won't tell you what your problem is. You need to take copies of your x-rays and MRIs to another doctor.
Ideally, it would be nice if I could just go see someone like Andy Pruitt, who must have dealt with thousands of cyclists with bum knees in his career. That not being feasible, I am seeing a local orthopedic surgeon and physical therapist who are most likely the best I am going to get. Although they have a sports orientation, they may only see a few cyclists a year.
The PT said that successfully treating problems like mine is often a process of trial and error that requires the active participation of the patient. Part of my active participation is to ask other cyclists if they have experienced similar problems and if they ever found a successful approach to dealing with the problems. I seriously doubt I am experiencing a new and unique syndrome and the collective experience of the members of this forum is a valuable resource.
Hopefully this clarified the motives behind my original post.
I am experiencing a very similar situation as yours. I have been racing and put on 4000 miles the past 12 mos. and have done a very steady slow increase in duration/intensity without problem until recently. I have patellofemoral syndrome as well. It is an imbalance among the components of the quadriceps muscle which causes the patella to slide in a way other than how it should over the femur. Usually, the vastus lateralis is a little stronger than the medialis which causes the imbalance. Very frustrating being able to run, but not to bike. Please keep us posted as to what helps!
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