I suddenly developed quite an intense pain in one knee. My milage and effort have been fairly stable over the past 2yrs. Bike is properly fit (seat height, etc.), no changes made to it for over 1yr.. I tend to be a high cadence (100+) rider, although I'll stand up for sprints, etc.
It started in early Jan. I had done a 99mi ride and it started quickly about several days later (in the interim I had been riding 20-45mi each day with no pain) but during a 25mi ride 5 days later I really noted it - I really don't know if the long ride was the trigger or something else. I had before done 75-85 mi rides with no issue during or post. I had never had knee pain of any sort before. Pain is typical of Chondromalacia - front of knee, increases with squatting, up stairs. Was quite painful day after riding.
I stopped cycling almost as soon as pain started and scheduled Dr. appt. After two weeks of rest, icing, antiinflamatories, I tried gently cycling again (3mi, 10-12mph) and pain came back very quickly. Finally the appt. with knee specialist. X-rays found no bone damage or obvious issue, but found my knee cap to be rotated slightly outward (thicker cartlidge on inside of leg vs. outside). MRIs are planned, but not yet occured to see if any cartlidge damage.
Perscription is to see PT 2x/wk for 6wks for "knee patelofemoral pain/lateral complex, Evaluate and Treat" Dr. explained it will entail strengthening inside quad. muscles near full extention and stretching of outside knee. She said light/short cycling (i.e. round the neighborhood) is OK and wont cause futher damage. I know rest and PT is key.
Here is the point of my posting: Can anyone who has gone thru this share your experiences? Any tips (beyond following Dr.)? Any ways of coping with not cycling for so long? (I can't run due to back injury - compressed disc) It now been almost 4wks with virtural no cycling and I still get quite a bit of pain in my knee when squatting/going up stairs. I also know MRI is key to understanding if there is a more serious issues. But what I don't understand is why after 2yrs of cyling why this would come on so suddenly and so strong?
Al
wagathon
02-07-06, 01:40 PM
That's a bummer. What's your lowest gear? Just curious. I have a bad knee but no medical background so I can't be of any help, although my guess is that you'll have to stop pushing hard for a while or maybe as a riding lifestyle to protect against that happening again. I have some low gears to be on the the "safe" side. Good luck. :)
noisebeam
02-07-06, 07:20 PM
That's a bummer. What's your lowest gear? Just curious. I have a bad knee but no medical background so I can't be of any help, although my guess is that you'll have to stop pushing hard for a while or maybe as a riding lifestyle to protect against that happening again. I have some low gears to be on the the "safe" side. Good luck. :)
My lowest gear is 38/26. I tried to use it for a very easy neighborhood ride it but it was too low so I shifted up a few cogs. Oddly the knee pain hurts more when spinning 80-90 that when pushing a slightly higher gear (even at 10mph) at 50-60.
I just gotta be patient. The MRI will be telling of how serious I problem I got. Part of what is pushing my patience is waiting for Dr. appts. and test. Like I said its been 3.5wks since I first got the problem and about 3 since I first called Dr., but each appt. and test has a several day wait. PT wont start for another 2wks and until then I feel like I am doing nothing to start rehab. (except of course the non-use rest which is certainy a very important part)
Al
kim kohen
02-08-06, 03:06 AM
Like the previous poster I'm not a medico but I have had a knee reconstruction and some problems with knee pain. During my recover from the reco I had a few issues and the physio immediately started taping my kneecap to relieve the pain. Worked fine and was only necessary for about 2 weeks.
Any time I've ever had similar knee pain I've been able to tape my knee and get good relief. Ask the physiotherapist when you see them and see what they think. You could also check out http://www.physiotherapy.co.za/images/selection%20of%20taping%20tech%20article.pdf or http://www.hughston.com/hha/a_13_4_5.htm
FWIW, this taping technique (McConnell technique) was developed in Australia so it must be good:)
cheers
kim
pearcem
02-08-06, 12:07 PM
i had the exact same problem for about 6 months. I went to the docotrs, no help, but then i went to my team mate who is a PT, and the most effective thing he showed me was stretching my IT band. it fixed the problem well enough to ride in a matter of weeks. obviousy, this may not work as well for you, but it's just stretching, so it's worth a shot. here ya go: http://www.rice.edu/~jenky/sports/itband.html
531Aussie
02-08-06, 12:51 PM
I had some chondromalacia about 15 years ago, and after 2 physiotherapists misdiagnosed it as patella tendonitis, the subsequent rest, stretching and icing for a month did nothing. A 3rd physiotherapist diagnosed chondromalacia, and it was gone in about 4 days after doing straight-legged kicking exercises with light weights.
http://vmartin.bigpondhosting.com/photos/chondro.jpg
Only 5 or 10lbs was enough for me.
The way my physiotherapist explained it to me is that during normal quad contraction the rectus femoris pulls the knee cap up and out of the way of the end on the femur, but when fatigue, overuse, or imabalances develop -- or whatever -- the firing order of the quads stuffs up, and the rectus femoris doesn't pull the knee cap up quick enough, therefore causing the grinding on the femur and the subsequent pain.
The straight-leg exercise somewhat islolates the middle quads (rectus femoris and vastus intermedius) and corrects the tone imbalance. The leg doesn't have to be dead straight, just so long as the dominant movement is hip flexion, and not knee extension.
noisebeam
02-08-06, 02:30 PM
Thanks for the advice to everyone. What 531Aussie describes seems 'right.' - that picture is great!
But to be cautious, I will want to first meet with PT and see what they say before I undergo any self-directed treatment. But perhaps there is promise that this won't be too long term. It's been hurting the past two days with no cycling in quite a while, mostly when stepping out of drivers seat in car and lifting my self up with leg, Also after sitting for 3hrs in airplane it get stiff and hurts until I walk a bit.
Al
kster
02-08-06, 07:56 PM
I've also been diagnosed with chondromalacia. Mine started about 6 months ago, it's a lot better now but I have to keep it under control with regular maintenance. For me, biking doesn't really bother it, but high impact exercise along with long sitting causes discomfort.
My PT said I was "out of alignment" due to being flat footed and my hip muscles not firing. My fix was the following:
1. always wearing (custom) othodics
2. doing hip exercises like leg raises when laying on the stomach
3. rolling on a foam roller & tennis ball on the upper leg and hip to help remove knots
4. flexibilty in the quads & hamstrings
5. ice on the knee after a hard workout
It's really important to find a good PT, otherwise you will be wasting your time and money.
531Aussie
02-08-06, 08:37 PM
But to be cautious, I will want to first meet with PT it's obviously wise to be cautious, but the kicking exercise can be done with a very light weight. The movement is unfamiliar to most people, so it doesn't take much to generate a training response. The last time I did them I used an old boot with a 2.5lb weight taped to it! :)
Richard Cranium
02-09-06, 08:11 AM
Generally, joint rehab focuses on movements without stress. But every situation is different, and where there's money to be made, often the scope and detail of medical treatment can vary.
My own perspective suggests a spin-trainer or rollers and aspirin until swelling and pain subsides.
noisebeam
02-09-06, 09:21 AM
My own perspective suggests a spin-trainer or rollers and aspirin until swelling and pain subsides.
It is spinning over 90rpm that brings out the pain the quickest when on a bike. Of course that doesn't mean that it is what causes the problem. I've been observed by a bike fitter when spinning and told I have a very smooth stroke with no lateral knee hitches. There is also zero swelling as confirmed by knee specialist.
Al
noisebeam
03-01-06, 05:11 PM
Update: My first visit with the PT was today (yes, it takes time to get on their schedule).
After the battery of prodding and tests the PT also confirmed I had all the classic signs of Chondromalacia. So I have a set of strengthening (inner) and stretching (outer) exercises. My left leg had some weakness in some muscles relative to right.
Even after the 6wks of rest my knee still hurts quite a bit walking upstairs/hills or cycling (which I've done more in last week)
Most interesting tidbits:
-My left leg (one with bad knee) is 5mm longer, due to a 5mm longer femur. This possibly suggests putting spacer under right cleat and raising seat 5mm.
-The PT said that high cadence can be bad for the condition, that slow and firm is better to keep legs in full control and not get any muscles pulled by momentum. This makes me wonder if riding fixed at high cadence (which I did a lot) contributed. I wonder if the implication is that if one rides high cadence ones form may degrade, or perhaps there is more to it than that.
My MRI is today at 5pm.
Al
FCastigl
03-01-06, 10:43 PM
i have that too, it kind of comes and goes, but sometimes the pain is really intense. doing straight leg raises helps a lot. extend one leg, point your foot towards your body, and lift the leg straight to a 45 degree angle.
Logistics
03-02-06, 12:32 PM
I have a similar problem too, except mine is the earlier stage known as Patellafemoral Syndrome (PFS). I have to do similar excercises and stretches, if I don't I was told the cartilage would shred and look like crab meat (Chondromalacia Patellae) and I would have to see a physical therapist. I will also mention that massaging the muscles around the knee cap also helps by relaxing the muscles and allowing the knee cap to slide back into position instead of popping the knee back into place.
mtnroads
03-02-06, 08:03 PM
Having same problem with rt knee for a couple of months and also discovered slight leg length discrepancy (longer on rt side), probably exacerbated by my purchase last Fall of a mtn bike with longer crank arms (175) than my normal road bike (170), and using it on the street for long rides. Because that increases flexion at top of pedal stroke, it adds to stress on the knee, and I even discovered that my rt knee was kicking out slightly at the top of the pedal stroke. So I stopped riding the long arm bike, started doing the leg kick exercises and have been avoiding all high-gear pushing for a month. Just easy rides, and almost back to normal, thank God.
iamthetas
03-12-06, 06:17 PM
531Aussie, thank you for that. I saw this thread a week or so ago and have been doing that excersise because even though I was diagnosed as a slight tear of the acl, the injury was word for word with noisebeam as far as where, when and how it hurts. even had the same p.t., etc.. well after doing that 1 set of 10 with NO weights the day I read it I felt so much less stiffnes it was an answered prayer. I am doing 3 sets of 10 twice a day on top of my other excersises and have almost 0 pain and have lateral movement for the first time since early last spring. my p.t. let me get back on the bike again as long as its flat and 3 miles or less( Im a mt.biker). I cancelled last weeks appointment to p.t. because Im just doing the same thing there and its costing me $135 a visit out of my pocket. I have an appointment with the sports med dr. on Apr 3 that I am keeping as this is a follow up to see if surgery will be needed.
Im thinking this has saved me from having to get cut open!!!!. I am going to share it with him.
thank you again. btw I work on concrete all day and I got some Newbalance shoes that fit right and that has also not hurt anything.
531Aussie
03-12-06, 08:44 PM
ah, good to hear http://www.musicianforums.com/forums/images/smilies/thumb.gif
As I may have said above, I once got up to doing the movement with very heavy weights at the gym with a wall-pulley, but I think I over did it. So, a light seems to be best, for some reason.
WarrenG
03-12-06, 11:20 PM
Lots of good advice so far so I'll just add a few things. My wife has been through all this and had arthoscopic surgery 4 days ago by some guy named Dr. Eric Heiden. Shorter crank arms will reduce the amount of bend in your knee at the top of the pedal stroke. Saddle can probably be raised a little (less than 1 cm) to help.
Leg extension exercises using ony the last 30 degrees of movement and with toes pointed out to aim at the inner quads. Tighten this area to counteract the tight outer quad/IT band. Use 3-4 sets of 20 reps. When you can do 4 sets, increase the weight and do about 15 reps each set. Add reps each week or so until you're up to 20 again and then add more weight.
Don't sit cross-legged because this puts high pressure against that damaged cartilage you have under your kneecap. The video we got of her surgery shows the "crabmeat" of cartilage in that area, due mainly to a lifetime of running. Scraping it smooth would not leave enough good stuff behind so leaving the crabmeat is better.
Getting 'scoped isn't really a big deal and it's the best, and sometimes the only way to really know what's going on. My wife was riding her bike on the trainer the day after the procedure. The 'scope procedure also includes a lot of flushing out of the loose bits in there (in the sinovial fluid) and provides some extra relief for awhile. During the procedure they can do a better assesment of tracking issues because the muscles are relaxed.
Some people respond well with Glucosamine and Chondroitin. Costco has good prices. These act as a lubricant against the damaged cartilage.
For significant problems with patella tracking you may end up with a procedure called a "Lateral Release". It's usually effective, but still only a last resort.
salsabike
03-12-06, 11:38 PM
Haven't heard anyone mention pedal systems yet. I have had this kind of knee pain with SPDs, and it went away when I switched to Frogs. I shortened my crank arm length, also. Recently tried SPDs again, and the pain came right back. So you may also need to consider a pedal system that allows some float, like Speedplays of various kinds.
WarrenG
03-13-06, 11:14 AM
Haven't heard anyone mention pedal systems yet. I have had this kind of knee pain with SPDs, and it went away when I switched to Frogs. I shortened my crank arm length, also. Recently tried SPDs again, and the pain came right back. So you may also need to consider a pedal system that allows some float, like Speedplays of various kinds.
A fixed cleat in the proper position can help hold the knee in its best alignment. This is why my wife prefers fixed cleats over those that float. BTW, SPD's can float too.