Commuting - Knee pain -- ride it off?

I had to drive in to work this morning because of knee pain that started last week. I started feeling something weird in my right knee last week, kind of like a clicking while riding and having my knee in the upstroke, but thought nothing of it. Then that night, while I was in bed, I moved my leg and felt this sharp pain, so I bent my knee, trying to see if I could make it go away (probably a bad idea), but it got worse.

After that, whenever my knee is bent walking up and down the stairs, there's a sharp pain inside my knee. I don't think it's the knee cap, but some sort of ligament or tendon. No swelling, so hopefully it's not tendonitis.

I stayed off my bike all weekend and it seemed to be better Monday morning, so I rode in to work. Bad idea. The knee pain returned. Tried to ride it off on the way back, but that just made it worse so I had to get off and do the walk of shame =(

I'm not really sure how I injured myself. I've avoided mashing on the pedals and it seems to be more painful the higher my cadence. My knee feels fine when I walk. It just doesn't seem to like it when I bike. Maybe I need to raise my saddle, but I thought it was pretty high already. Has anyone gone through this? Is this a case of "ride it off?"

When is the last time you got a bike fit? Knee pain isn't something you can just ride off or ignore.

Don't ride it off at all. If the pain feels like it's behind the kneecap it's usually your cleats that need to be adjusted (i'm assuming you're riding with clipless pedals). Saddle height also should be checked.

The cleat should put the ball of your foot directly over the pedal axle when your foot is level and not tilted forwards.

I ride with platform pedals and I never professionally got my bike fitted. I had the seat adjusted by the guy at my LBS to my height while standing on the pedals, if that counts.

How old are you? Ever have an injury there, even years ago? Is the pain worse in the morning? Have you had an x-ray?

Do you mash it up the hills? When I get knee pain it means it's time to start downshifting more often and/or I need to adjust my saddle

My 2 cents. I get knee pain -- a bit of tendonitis -- sometimes when my cleats are out of alignment or for no clear reason (maybe mashing too hard). I use ibuprofen and try not to mash (and fix cleats of course). The pain never gets worse and is usually gone in a few days to a week.

Having said that, my knee pain is just me "overdoing it" a bit. I've never had to get off the bike and walk. The clicking makes me think you might have a torn meniscus (cushions that run around the outside of the knee joint). You should see your doctor.

In the meantime, I would avoid the bike if it is giving you any pain after adjusting the saddle height and saddle fore-aft.

I've had two knee problems in the last two years. One I'm pretty sure was the result of shoe stretch and lots of miles. The other appear to have been the result of too-low saddle. Both sucked, but a new shoe fixed the first problem enough to ride through it as the problem slowly dissipated over the course of the following months. The second problem was much worse, with two months of virtually no riding and I'm only now starting to train for real again after a month or so of riding cautiously. My suggestion? Check your bike fit and see a sports med doc. A regular doc could say "tendonitis, take ibuprofen, chump". Imagine if I'd listened to that and hadn't gotten the PT I clearly needed? Two months off the bike could have been more, much more.

How old are you? Ever have an injury there, even years ago? Is the pain worse in the morning? Have you had an x-ray?

23, no real knee injury ever. There's usually no pain in the morning until I do something like go up/down the stairs or bike. No xray.

I don't mash up hills but the pain seems to be while my leg is going up rather than pushing down, so I don't think it's mashing that did it.

nakedsushi,

You and I are in the same boat right now. I was riding two weeks ago on a 40 mile ride and the knee starting killing me! I had to ride home but barely made it. Stopped at the LBS and the guy noticed that the saddle I switched in was too high and was working my knees over. Problem was it was too late. My knees are jacked my commuting is way down and at this point I'm not sure what to do about it. Stop riding fixed for the time being and try to ride my road bike here and there until my knee starts to feel much better I suppose. I've got a triathlon in two months and RABRAI in 3 so I want to play it careful.

If you come up with any magical remedies, PM me. I need help too!

ICE and Ibuprofen(anti-inflammatory) should help you guys a bit + a lot of stretching + bike fit. Bike fit most likely is the culprit.

I had knee pain just a week ago. Right below the knee. I did my own fitting and is still currently tweaking here and there though most of the pain is now gone. I raised the seat 3mm and set it back 2 mm and it seems to be much better, point is a few mm's here and there makes a world of difference. Or you could go to an LBS and do a professional fitting which will be faster and more convenient.

Check out this site (http://www.cptips.com/knee.htm) for what causes the different types of knee pain and how to fix/prevent them.

Fatigue can also be a factor. If your quads are tired and you keep mashing/pushing hard the knees will take the stress that your quads/muscles are not supporting. Recovery rides are important especially if you commute every day.

Lastly, you will need to start watching your "form" on the pedals. Since I don't use cycling specific shoes(clipless) I noticed that too much bending at the ankles while pedalling can cause knee pain too.

I have had knee issues before. Pain in front of and below the kneecap is caused by the seat being too low. Pain behind the knee is from the seat being too high.

Icy/hot and advil work the best for me on my knee pain which comes from mashing it too much.

Brain Ratliff, I thought the pain behind the knee was due to my seat being too high, so I tried lowering the seat and I think that just made it worse. I guess to be more specific, the pain feels like it's behind my right kneecap on some type of tendon or ligament, but definitely inside my leg somewhere.

I've been taking ibuprofen, but I'm not sure if it's helping anything, since there's no noticable swelling around my knee. Maybe I'll try the ice tonight.

You may find that it hurts less if you push harder - but that doesn't mean you're making it better. Otherwise, a general +1 on the responses so far. Don't mess with your knees, if there's recurring tetchiness get it checked and get your fit checked.

Brain Ratliff, I thought the pain behind the knee was due to my seat being too high, so I tried lowering the seat and I think that just made it worse. I guess to be more specific, the pain feels like it's behind my right kneecap on some type of tendon or ligament, but definitely inside my leg somewhere.

I've been taking ibuprofen, but I'm not sure if it's helping anything, since there's no noticable swelling around my knee. Maybe I'll try the ice tonight.
To the left or the right of the knee? The tendon from the hip to the knee, on the outside, tends to commonly get too tight among those who cycle and such. There are specific stretches and exercises to fix that. This has been my problem(s). Best to check with a good physio or doctor if it persists.

In my case, it took a good physio to diagnose it specifically - turns out the tight tendon was also pulling the kneecap over to the outside. Stretching that tendon, and working the kneecap back to the left (it was my right leg), fixed my problem.

Check out this site (http://www.cptips.com/knee.htm) for what causes the different types of knee pain and how to fix/prevent them.

useful site, cheers

23, no real knee injury ever. There's usually no pain in the morning until I do something like go up/down the stairs or bike.

Sounds like overuse -- runner's knee. Inflamed tissues that get pinched or pinch nerves. Take it easy until it clears, make sure your saddle is high enough, and try not to use your calfs too much (keep your heels down).

I had to drive in to work this morning because of knee pain that started last week. I started feeling something weird in my right knee last week, kind of like a clicking while riding and having my knee in the upstroke, but thought nothing of it. Then that night, while I was in bed, I moved my leg and felt this sharp pain, so I bent my knee, trying to see if I could make it go away (probably a bad idea), but it got worse.

After that, whenever my knee is bent walking up and down the stairs, there's a sharp pain inside my knee. I don't think it's the knee cap, but some sort of ligament or tendon. No swelling, so hopefully it's not tendonitis.

I stayed off my bike all weekend and it seemed to be better Monday morning, so I rode in to work. Bad idea. The knee pain returned. Tried to ride it off on the way back, but that just made it worse so I had to get off and do the walk of shame =(

I'm not really sure how I injured myself. I've avoided mashing on the pedals and it seems to be more painful the higher my cadence. My knee feels fine when I walk. It just doesn't seem to like it when I bike. Maybe I need to raise my saddle, but I thought it was pretty high already. Has anyone gone through this? Is this a case of "ride it off?"


I'm a sports med doc, so I see a lot of knee problems. It's nearly impossible to diagnose a problem over the internet but you could have something as simple as ITBS (iliotibial band syndrome) or something as bad as an osteochondral loose body that would need surgery to remove. Either way, if your pain is not getting better, have it checked out by a good sports medicine specialist or an orthopedic surgeon (or your family doc if he or she is good with musculoskeletal injuries). Sometimes things that seem simple, aren't.

I'm a sports med doc, so I see a lot of knee problems. It's nearly impossible to diagnose a problem over the internet but you could have something as simple as ITBS (iliotibial band syndrome) or something as bad as an osteochondral loose body that would need surgery to remove. Either way, if your pain is not getting better, have it checked out by a good sports medicine specialist or an orthopedic surgeon (or your family doc if he or she is good with musculoskeletal injuries). Sometimes things that seem simple, aren't.

+1. See a doc.

I have terrible knees, was a catcher for our High School and College baseball team and my knees really paid for it. I had a lot of trouble until I switched to pedals with a lot of float. Are you using clipless? If so there are many pedal systems out there that have a lot of float, which has saved my knees.

I'm not using clipless. Just regular platforms. I don't think I know what pedal float is.

edit: Been off the bike a day and babying my knee. It feels much better this morning. No pain. I was tempted to ride to work again, but decided to give it another day and just walk to work.

Oh well, there goes that theory! A lot of clipless pedals lock you into one position in the pedal, not allowing your leg to move. That is hard on the knees, pedals with float allow you foot to rotate 15 degrees or so, makes it much easier on your knees.

But if you are on platforms you are exempt from that issue. :)

Glad the knee is feeling better.

I currently am approaching three months of being off the bike because of pain in the right knee. It started with a feeling of discomfort with no event (injury, etc.) that I could recall, and got worse over a period of two weeks. I quit riding to give it a rest, and it did not get better. It would hurt to walk up or down stairs. It would hurt sometimes when I just moved it the right way. The pain seemed to be near the ten o'clock position at the edge of the kneecap, as viewed by bending over at the waist and looking at the kneecap.

I went to the doctor, and he gave me a month's worth of prescription anti-inflammatory drugs ("naproxen" or something like that) and a sheet of exercises, and said to go back if it didn't get better. It has been getting better at an EXTREMELY slow rate, and the only reason I haven't gone back to the doctor is that it HAS been getting better, although slowly. I figure that if I go to the doctor and say that my knee hurts but it is getting better, he won't be able to recommend much besides waiting. It would make sense to do something only if it doesn't resolve all the way or if it comes back when I get back on the bike.

After it started to get better, the pain would occur in a more reproducible manner. One of the prescribed exercises was a leg extension, that is, sit on a chair with the feet on the floor and then extend the lower leg out parallel to the floor, and then lower it. I noticed that I would get a little stab of pain at the point where the leg was almost horizontal, and then another little stab of pain on the lowering motion when the lower leg was almost vertical. However, if I had the kid move my leg for me, so that it was going through the full range of motion without any muscular contraction on my part, it would not hurt.

Now, after almost three months, I can walk almost at full speed and have no pain under normal circumstances, but if I jar it or twist it just so, it still will hurt. When I walk, it doesn't hurt, but I still can feel that somthing is not quite right.

My sister-in-law the licensed physical therapist says that pain on the inside of the knee by the kneecap can be related to tight muscles in the backs of the legs, and said I should stretch those. She recommended sitting on the edge of a chair with one leg extended and the other bent with the foot on the floor (for support). On the extended leg, pull the toes back and sit up straight. That puts a nice stretch on the back of the leg.

I also have access to a weight room, so I have been doing leg presses, leg curls, and leg extensions on weight machines, starting light. I can go through the full range of motion with light weights, so that gives me hope that things will heal up. I figure that if it were bones rubbing together or something like that, it would hurt all the time.

Consulting the amateur diagnostician's best friend, the internet, suggests that thing like this can take MONTHS to heal, so I have resigned myself to riding the bus for a while. If when I try the bike again the problem comes right back, or if it stays at its current point of "almost completely better," I will get myself back to the doctor, or maybe find some sports-medicine doctor who might know a bit more about the mechanics of the knee in relation to various physical activities.

Good luck. Everyone should be able to get around under one's own power.

Yeah, I'd err on the side of caution - get a proper bike fit, don't be scared to spin in the lower gears instead of mashing it out when you do get back in the saddle (don't be scared of taking another day or two off). Above all, go to a Doc and make sure you're not making a mess of your knee, they're pretty darn important! :)

Sounds like it's time to see a knee specialist...

After 2 days of not biking and babying the knee, it felt back to normal this morning, so I thought I'd be able to ride my bike into work as long as I kept the gears fairly low. The pain returned halfway through the ride but it wasn't as bad and I didn't push it as hard. I think I'll give it more of a break over the weekend and if it's not 100% better, time to call the doctor.

My recommendation would be: next time don't ride TO WORK to test it out. Ride in a big circle around your neighborhood, so if it comes back your "go home and rest" distance is fairly short. That way you don't have to keep working it (much) after the pain starts.

Is it odd that it is only the right knee? If it was something like saddle height, wouldn't it be both knees? Just asking for my own education... Of course, I guess you could be pushing harder with your right leg?

Yeah I thought it was weird that it's only one knee though. I think I must have tweaked it sometime off bike and made it worse, but I don't see how.

As for riding to work. It's only a 1 mile ride so I didn't think it would be too bad. And it's easier than riding around the block b/c the streets around my house has more bumps on it than Edward James Olmos's face in BSG.

""Riding it off" is probably a bad idea. 5 years ago I had to have surgery on my left knee. "Riding it off" would not have helped. Actually, "walking it off" wouldn't have worked either :) Go see a sports med guy or another Dr. who's good with sports injuries so you can find out what it will take to get your knee to heal without making things worse. Then find someone who can help you with bike fit. If you're not sure or can't figure out if your seat is in the right position then you should get some help from someone who will do more than take a quick look at you while standing on the pedals. The link below has some pretty good info on bike fit FWIW.

http://www.ultracycling.com/equipment/bikefit.html

Try this. Wait a week, give your knee some rest. Now, when you get back to riding, raise your saddle up about, say, 5mm. I've had this problem before, and that was the solution. Yes, it was only in one leg, probably because of a combination of sitting slightly off-center on the saddle and having one leg slightly longer than the other. The problem crept up when I started riding with bigger gears. It went away when I raised the saddle up higher. If the knee pain starts up again, stop on the road, raise your saddle up a few more millimeters. Keep doing that until the knee pain stops flairing up.

If the knee problems have only come up recently, you haven't done permanant damage to your knee yet. Just experiment with your saddle position and you'll soon get it right. You should feel exactly no pain in your knees when you ride. If you do, your saddle is too low.

I should say that if you start getting pain at the back of your knee, your saddle is too high. Lower your saddle 5mm and keep it there.

I can relate a little
I'm 22 and rode happily for a while but abruptly developed knee pain predominately in my right knee. Doctors have diagnosed it as quadriceps tendonitis but I have had no real treatment. One sports medicine doctor simply told me that I was young and it would get better so long as I took it easy. A second sports medicine doctor told me last week now that no, it won't get better with just taking it easy, I need physical therapy and tissue massage. Now I have to work it out with insurance to get that without paying a boatload.

Things have improved by making full use of my gearing system. I've learned to shift like a madman, you can always hear me clicking up, clicking down, down, clicking up. Once you get the hang of it its great. I cant imagine now how I always use to mash it from a stop, feels much better to downshift fully when at a stop and then upshift when necessary again.

+1. See a doc.

great advice for the lucky few living in advanced 1st world countries..., actually most 3rd world countries have better public health systems than the good ol' usa

Here, try this:

AMERICAN MEDICAL SOCIETY FOR SPORTS MEDICINE FIND-A-DOC:

http://www.newamssm.org/FADquery.html

I had pain behind my knee that I "rode off" for several years. I thought it was related to bicycling. I did bring it up with my doctor but I dismissed it as being minor. It turned out that I had a nerve sheath tumor on my sciatic nerve, which is potentially deadly if it is malignant. I just had it removed surgically and I am still sweating out the uncertainty about whether it is benign or malignant.

Moral: Don´t "ride it off".

Your pain sounds very similar to mine. I've been experiencing pain, every time I ride, in my right knee.

I can lay off biking for a few days and it feels a lot better, to the point that I question whether anything is really wrong. Even though I can still feel something not quite right inside my knee, walking or going up stairs doesn't feel that bad unless it's inflamed. However, the shortest little ride causes my knee to flare up. I can ride through it. The pain starts almost immediately but feels better after riding a little more. It's very hard to pin-point the actual location of the pain, but basically it's inside my knee on the medial side.

I went to the local sports med and they did X-rays and put me on physical therapy. After a few weeks of this I'm wasn't really seeing any real improvement. Some of the exercises seemed to inflame the knee a little. A couple of weeks ago, I went in for an MRI and had begun to believe it was something called plica syndrome. Unfortunately it was a torn medial meniscus.

I'm scheduled for arthroscopic surgery next week. Since they are just cleaning it out, the recovery time should be fairly quick.

Hopefully, you don't have anything like a torn meniscus, but I'd definitely get it checked. An MRI is the only way to tell, I think, other than arthroscopic surgery.

Good luck!

Thanks for all the advice. I was off the bike for a couple of days to give the knee a rest and it felt MUCH better. I could go up/down the stairs without any pain. Got on the bike again today, raised my seat a bit and everything went smoothly until halfway up a hill. I also noticed the other day that riding with my right foot turned in (toes pointing slightly left) made it more painful, but with the toes turned a bit out, it felt fine. I'm wondering if all this is due to my foot being in the wrong position.

The knee was still a bit painful after the ride in to work today, but not as bad as before. I stretched out my calves afterward and now it's fine. Hopefully this means it's getting better *crosses fingers*

Either way, I'm seeing a doc later this week for an unrelated issue, so I'll bring it up with him.

I'm thinking of raising my seat some more, but I'm paranoid of falling over at stop signs and intersections. At the height it's at right now, I can *barely* touch my toe to the ground while leaning the bike slightly over while I stop. I know I'm supposed to get off saddle when I stop, but I haven't figured out how to actually get of the seat while the bike's coming to a stop!

Knee pain can be caused by a seat that is too high which will cause pain in the back of the knee. A seat that is too low or too far forward may cause pain in the front of the knee. Improper foot position on the pedal (or improper cleat alignment) can cause pain on the inside or outside of your knees. Another cause of knee pain is using too high a gear. Try to use a gear that allows you to pedal quickly, from 70 to 100 strokes per minute. Individual anatomy may also result in knee pain. Cyclists with slight differences in leg length may have knee pain because the seat height is only adjusted for one side. Shoe inserts or orthotics can help correct this problem.

hey,

as a physio, id say:
go see a physio. or a _sports_ doc.
most normal docs are next to useless for this kind of thing (sorry...)

it's impossible (an in fact, profesionally negligent) to try and diagnose over the internet. it takes 20-45 minutes of detailed talk and tests to even start getting a feel of what your problem is unless its a commonly identified problem or you're seeing a really good practitioner!

connective tissue injuries (ligaments, tendons etc) take AGES to heal, at least from the normal 'it'll be right in a few days' mentality. you're often looking at 3months or more for healing to approximate full strength, and thats assuming you dont go constantly reinjuring yourself (soooo soooo soooo common!!!) which from the OP you have already done... that doesnt mean you have to have 3 months off the bike, but it does mean you should GO AND SEE SOMEONE!


you're 23, so it might seem like a lot of money to fork out for some guy who does some tests and gives you 3 stupid exercises and tells you not to do stuff you want to do BUT ITS YOUR KNEE! it's gotta last you another 70 odd years down there, and the chances of setting yourself up in an incomplete-healing and reinjury cycle was too big to risk it really.

dont want to scare you or anything!

lance

Sloppy pedalling in a lower gear can mess up knees too. As you're spinning at higher RPMS, watch that knee position over the spindle.

I rode to the market yesterday and in to work today and no knee pain! Yaaaaaay. Thanks for all the advice in the thread. I went to the doctor last week and as I predicted, he said nothing helpful. Barely glanced at my knee and told me I should make an appointment for the x-ray tech. I've been putting that off because I don't think there's anything wrong with the bone.

I think it's probably IBS. I did a bunch of stretches dailiy, which seemed to help and took it easy on the bike -- stopping to stretch if I felt any pain. Now, when I'm on the bike and the pain feels like it's about to come back, I remind myself to keep my toes from pointing down and point them out a little (pointing my right foot slightly to the right) and the pain disappears. I'm guessing the pain was from me having my foot in some position it didn't like.

Good to see you're knee's feeling better. I've noticed too that foot positioning, angle, and where you're toes are pointed does make a big difference with knee pain. Everybody is different though. My knee pain goes away when I point my toes down and slightly forward through the whole pedal revolution.

Edit: Oh yeah, the ball of my foot has to be right over or slightly behind the pedal's center bar.

I've got this weird thing going on with my right knee as well. I don't feel pain so much as "pressure" or tightness. I'll call it pressure but that's not really right but as close to describing it as possible. Anyway, when I feel this, I can crack my knee like cracking my knuckles and the pressure goes away. This goes on all day except for when I'm on my bike. My left knee doesn't do this.

Anyone have any ideas? I'm going to ask my doctor but I'm curious as to what bike forums folk think.

Thanks much.

So, it doesn't crack when you're on the bike, but you still feel the pressure? Has this always happened, or has it started since biking?

I'm thinking of raising my seat some more, but I'm paranoid of falling over at stop signs and intersections. At the height it's at right now, I can *barely* touch my toe to the ground while leaning the bike slightly over while I stop. I know I'm supposed to get off saddle when I stop, but I haven't figured out how to actually get of the seat while the bike's coming to a stop!

you need to raise your seat more.

chances are your knee started to hurt because the seat started to slip down into the tube, thus lowering the seat. there is absolutely no way your knee should hurt on a short 1 mile ride, given that you haven't had knee probs before and are young.

and just for the record, you should never "ride off" your knee pain. if it's there, u need to rest it.

sd