Northern California - Knee Issues

I posted this question in the Training Forum and got an amazing 0 responses. Some of you know me, so maybe you'll be more pressured to share. :p

Like 5 weeks ago on that Montebello/Redwood Gulch/Hwy 9/35 to Woodside ride I started feeling some moderate pain in my knee (3-4/10), on the inside, almost on the surface, top left corner of the patella. The next day it was up from moderate to fairly serious (7/10), very uncomfortable to walk.

It felt better by the next weekend so I attempted a nice flat ride down Canada, but cut that ride short and turned around at the first twinge of pain.

Since then I've done like, 3 .5 mile rides at 0 intensity just to feel if the movement is still uncomfortable; it is.

From everything I've found, my self-diagnosis is patellofemoral pain, and have been treating with stretching (ITB/Ham/Quads) rest, NSAID, and ice.

Has anyone here ever had this before, and if so, how long did it take before you were able to start biking without exacerbating the issue? Even my 7-mile flat commute would kill me right now, and I'm starting to get seriously impatient with not being able to do anything. Jogging/Stairmaster/cycling all seem to irritate the area, and I don't have a pool to swim in, so I feel like my cardio is wasting away.

Any info is appreciated!

Sounds like you are doing all of the right things to heal. Have you had a pro fit? If yes, how long ago? It may be time for another fit.

Curtis Cramblett in San Jose is a pro fitter who is also a PT, so a fitting with him is almost like a PT session as well. I was having a few minor knee issues and he does a good job fitting and giving you stretching/strengthening exercises.

Good luck.

Powwow's suggestion is a good one.

In the meantime, any time I hear someone talk about pain under the patella, two questions pop into my mind:

1. Is your seat too low?
2. Are you grinding too big a gear too much?

Before the advent of clipless pedals, these were the top 2 ways to mess up your knees on a bike. I'd guess they are still both in the top 3. These may not be the cause of your problem (low seats and high gears usually cause the pain under the low center of the patella, IIRC), but it never hurts to double check them.

Good luck. Here's hoping it clears up soon.

Chris, I think you are on the right path with stretching. I imagine, however, it would be helpful to get feedback from therapists out there, especially those that are somewhat versed in the running/cycling world so they have a more intimate idea of what can possibly cause this ailment.

I am feeling less knee pains these days when I supplemented my stretching with strengthening exercises, as suggested by this PT at PAMF. If interested, let me know and I'll dig her name up. Good speed in your recovery!

Thanks for the responses.

To answer a couple of the questions: yes, I had a good fit. I let the bike shop adjust it though when I had one of the fitters recommendations implemented (longer stem). I've since reverted to the fit with which I had no issues, but too late, damage was done.

I've been trying to do some strengthening exercises as I go here, but they are all straight-legged hip things mostly, as any bent-knee exercises will just stress the already-irritated area. I will add those back in once the inflammation is under control.

The one question I can't find an answer for, is how long to expect this to last? Like I mentioned, it's been 4/5 weeks already, with no perceptible improvement since day 3 or 4. Stretching/Strengthening will hopefully prevent recurrence, but this initial incident feels unending.

A friend and (former) co-worker started cycling Spring last year and hit it hard. He lost 40 pounds in like 4 months and was really pushing the intensity. Every ride was hilly; OLH, Kings, you name it. And he was climbing those like he was trying for a PR every time. Toward the end of Summer he started having pain in his knee similar to yours. He backed off but the pain persisted. He's cutting back on the high-intensity super hilly rides to try to keep his knee healthy. (Pelikan knows who I'm talking about.)

I don't know if you just start cycling recently or not but it seems (through the ride reports) that you're doing a lot of hilly rides. Once you get the knee healthy again, you might think about a bike fit (if you haven't had one) and lowering the intensity (lower gearing?) or frequency of the hilly rides.

Also, I'm not sure stretching a damaged or inflamed knee is such a good idea, let it heal first.
But, as with any Internet Advice, check with a doctor (orthopedist) to be sure.

The one question I can't find an answer for, is how long to expect this to last? Like I mentioned, it's been 4/5 weeks already, with no perceptible improvement since day 3 or 4.

Is the pain constant, or only when you're riding?

Two years ago, in late February, I started experiencing pain in both knees on a long ride. For three or four days afterward, the pain was constant, especially going up or down stairs. Then, it was only when I rode, and only in the left knee. It would be fine when I started, then around mile 8 or so, the pain would kick in. That lasted for four weeks. During that time, I took many days off completely, only rode on flat ground, and never rode more than 10 - 12 miles at a time. I also got x-rays taken, and I think an MRI too, but they showed no obvious injury/problem.

I started taking glucosamine chondroitin at the recommendation of my doctor, and did some IT band stretching but not a lot. I also bought a variety of knee brace type things and compression straps (http://www.amazon.com/Pro-Tec-Iliotibial-Band-Compression-Wrap/dp/B000OQLUZ4/ref=pd_sbs_hpc_1) to wear while riding. For at least another month, I mostly stuck to flat routes and didn't do anything longer than 50 miles, and kept my efforts pretty easy. Any time I pushed it, I could kind of feel the pressure building in my knee; it wasn't painful exactly, more like the predecessor to pain. By the end of April, I was able to do a century, but I definitely remember the knee starting to hurt later in the ride. But it wasn't quite as excruciating as the ride where I initially hurt my knees, and looking at my log book entries, it seems it didn't linger.

I read a lot of Bike Forums threads during that time about knee pain, and it seems like people's experiences are all over the map. Some people weren't able to ride for six months or more after the initial injury. Others, like me, were lucky to have quicker recovery times. But even though I was able to ride, I'd say there was at least six months where how my knee was feeling was the major preoccupation of every ride I took.

Eventually, my knee began to feel less and less iffy, and I stopped taking the glucosamine chondroitin and stopped wearing the knee braces and compression straps, and I haven't had any major recurrences of the kind of pain I initially suffered. Not sure if those things actually helped, or if it was more just the passage of time, but probably can't hurt to try them. You can get glucosamine chondroitin pretty cheap at Trader Joe's, and any sporting goods store probably has the compression straps.

I've had knee pain on the tops of my knees from upping my mileage and/or climbing too quickly.

Everything everone else said, and I'll toss in: Have someone good look at your shoes and cleat placement. Some folks are helped by shims, of foot beds, depending on what their issues are.

There was a big ol thread in 50+ about a pricy, but totally full body, video fitting system. They seem to have offices in Sacto and elsewhere. The person writing was very much helped by shims.

My 6th double century did my right knee (actually hamstring) in. It took me months to finally found out what was wrong. I'm not as flexible on my right side and my bike was set up perfectly for my left leg. Eventually the hamstring decided it was tired of overextending and became irritated. The power of the centimeter is amazing. :) I did all the things you are doing. The pain would go away for a ride and then be back. Anyway, don't give up. Maybe go to a PT or get another bike fit. I felt better after having an X ray and an ultrasound because it showed no permanent damage.

Certain things still bother my hamstring and it's been more than a year. I never could get my commute bike to have the right set up. So now I have a lovely MB 1 sitting in my garage doing nothing. I use to be able ride my husband's bike in the trainer with no problem. We now have two trainers. :D Funny, running doesn't bother it at all.

Good luck.

Veronica

You mentioned you "thought" you had an MRI. You would know. Your knee is placed inside a very large doughnut shaped imaging machine and the images are taken. It probably took you 20 minutes to have it done. If there is no meniscus/MCL injuries, it is probably some kind of an overuse injury. If you have not had an MRI, you should get one. You need to rule out any major injury.

In addition to the suggestions mentioned aove, you can use an Interferential Unit (IF 4000), along with ice to help alleviate the pain and speed healing. You should work with a Physical Therapist to set it correctly according to your injury and an Rx for how often to use it. (3x/day - 20 minutes each time). You will also need extra electrical contact pads. The links are below.
I must warn you (and your PT will tell you the same thing). IF will make you feel better, but you need to allow the healing to take place and not go out and ride hard just because you feel better. Your PT will tell you how long to lay off.
Err on the side of rest, rather than immediate exercise. I will share with you what my PT told me.
PT/Q - how long do you want to keep riding?
Me/A - 25 years
PT/A - Then 1-2 months of recovery is not a long time, given how many more years you want to keep riding

http://www.dme-direct.com/if-4000-chatanooga-intelect-interferential-unit/
http://www.dme-direct.com/coldone-cold-one-knee-wrap/
http://www.dme-direct.com/tens-electrodes-unit-electrode-reusable/

Best of luck. I had knee surgery last July and was pain free by September. I worked closely with a PT and did exactly what she told me to do.

Might as well re-tell my story here as it touches on a lot of the above advice.

I developed dull knee pain/ache above my right patella approx 4 months after getting my first road bike last year (first switch to clipless). It became a regular annoyance and would occasionally give me a sharp pain while climbing stairs. Eventually got it through my skull that I should seek advice, so this caused me to do two things.

1) Got refit. Sure enough my saddle was too low, combined with my new found desire to climb this was bad. I saw a BG fit specialist at my LBS (no charge, I'd bought my bike there - Jeff at The Pedaler in El Sobrante fwiw) and he also diagnosed that my right cleat alignment was poor and also that I needed a wedge in the right shoe. So he took care of three things which were improperly setup on my bike.

2) I went to the doc and saw a PT. She confirmed that I had injured my knee - this was key as I had already had my bike fit adjusted but wasn't getting back to normal in quite the way I had hoped. This was because I had originally injured my knee and wasn't allowing it to heal - I honestly hadn't appreciated that fact; I thought that after my fit was correct, then the pain would just vanish. So irrespective of bike fit, I needed to let my knee recover. The PT recommended that I ice the knee for 20mins each night, with my knee elevated. She also found that my right leg was somewhat out of alignment when I walked (also picked up by the bike-fit) and noted that I had disproportionately increased strength in my quads through cycling, but not other areas in my legs, so prescribed strengthening exercises to help both posture and alignment.

Bottom line for me - I needed to get my bike fit sorted to address the underlying cause of my knee injury and also needed to get the knee properly rehab'd before I could get back to normal.