Training & Nutrition - getting the run around - shin splints, knee issue or what? agitated : )

Hi,

Last spring I rode a new bike to hard to soon....ever since after 30 mins+ (no matter what load) I get a 'funny feeling' below and to the right of my knee cap (right leg). I have averaged 6k per year for the past 5 years. I am in my thirties ... upper thirties now.

Visit 1: Physio its ' platelar tendonitis (sp?)' solution core strength, stretch, role etc, Physio pushes and prods knee cap with 'hmm' look as he cannot find any painful spots
1 month later no change
Visit 2: Physio its same problem young man do more
Visit 3 Chiro: not sure but whack, bang, no change
Visit 4: Massage 2x full body, felt great, no change
(always ICING knee because thats what I thought it was)

**strange I notice if I wear knee warmers I have zero issues no matter how long or how hard** Guess Sugoi makes a good product : )

So I have been stretching and core strengthening for the past 6 months even took 2 months 'off'.

After 30-40 mins light spin indoors same issue --- frustrated.

Visit 5: Massage guy, says your shin is inflamed/warm...hmmm lets put a small piece of tape around your leg just below the 'fibula' -- not very tight. I can bike on the trainer for 60 mins no problem, tape fell off last night for the last 10 mins - same issue. Now I am starting to ICE my shin. Massage guy says his opinion is its a muscle / tendon issue in the shin pulling something that I feel lower to the right of my knee cap...' seems odd but hey the tape worked'

Super frustrated/agitated because I want/need to ride my bike --- idealy not with a piece of masking tape around my leg -- ideas?? thanks in advance - and yes I know I should check everything with a medical expert : )

wear knee warmers

How far below are you talking about--right by your kneecap or further down the side of the knee?

How far below are you talking about--right by your kneecap or further down the side of the knee?

Hi,

I would say its starts to feel 'warm' or funny directly to the right of the knee cap by an inch and half. The massage person thinks a muscle is pulling the tendon which gives me the feeling. I have had 2 sessions of ultrasound and 1 session of a suction/electric physio thing....tape below the fibula stops any issue.

thanks in advance!!

The general wisdom is that pain to the side of the knee can be related to a saddle that is too high and/or poor cleat alignment. You might try lowering the saddle a few mm and see what happens. Also, note if your most natural pedaling motion puts in you the middle of your float range. If not, adjust your cleat rotation accordingly. Note that properly setup cleats will probably not be exactly symmetrical on both legs since our bodies aren't actually equal on both sides.

If I'm reading you correctly, it doesn't sound like you are in major pain. If so, some minor bike adjustments may be all you need (we can hope!).

What kind of bike fit work have you had done recently? A more medically-oriented bike fit might be a good option.

I've got Patellar Tendonitis along with a few other leg problems at the moment. It's kept me off the bike for four months now, so I know how you feel.

I bought the Stick last week (http://www.the-stick.co.uk/ ..The one at the top). It feels great going over the muscles, just like getting a massage. The initial price is high but it's definately worth it imo, can use it however much I want, unlike a traditional massage. I'll attach it to my bike frame as well so I can use it during the longer rides. I really hope it makes a difference. My problem started in the same circumstances as yours.. new bike.. too much too soon. And your physio appointments are identical to mine.

Here's a similar thread:

http://www.bikeforums.net/showthread.php?607655-Want-to-cry-tendon-injury-mild-bursitis

Some useful info in there.

Do some random searches too, "tendonitis", "knee pain", etc. you can find some good advice in the archives.

The general wisdom is that pain to the side of the knee can be related to a saddle that is too high and/or poor cleat alignment. You might try lowering the saddle a few mm and see what happens. Also, note if your most natural pedaling motion puts in you the middle of your float range. If not, adjust your cleat rotation accordingly. Note that properly setup cleats will probably not be exactly symmetrical on both legs since our bodies aren't actually equal on both sides.

If I'm reading you correctly, it doesn't sound like you are in major pain. If so, some minor bike adjustments may be all you need (we can hope!).



What kind of bike fit work have you had done recently? A more medically-oriented bike fit might be a good option.

During the summer I spent 150$ at a reputable place (for the first time) and he put my seat up and changed cleat position/ shimmed etc. All this was done after the original injury.

There is no 'searing pain' its starts to feel inflamed or not right after 30 mins of spinning. If I put a piece of tape lightly below the knee cap (below fibula) then there is no pain.

I have 3 different bikes 2 of which have been fitted... all with different shoes but yield the same result. Two more massage, ultrasound treatments and there is no noticeable change.

I just got back from a 6km run and no noticeable sign of injury its just cycling...which is why I run to start with : )

Last spring I rode a new bike to hard to soon....ever since after 30 mins+ (no matter what load) I get a 'funny feeling' below and to the right of my knee cap (right leg). OK, if what you describe is true then at least try a test for self induced inflammation due to poor mechanics.

The simple test is to ride a spin bike with almost "zero load" at about 90 rpm for 30 minutes. If you have the "funny "feeling" then you'll have to modify your fit or shoe/cleat gear to correct the problem. If you have no problem riding a spin bike, then you do indeed have physical limitations due to previous joint/muscle damage.

In any case, the starting point of investigation is determining whether it is "form" or physical imbalances causing the problem. Usually one leads to the other.

OK, if what you describe is true then at least try a test for self induced inflammation due to poor mechanics.

The simple test is to ride a spin bike with almost "zero load" at about 90 rpm for 30 minutes. If you have the "funny "feeling" then you'll have to modify your fit or shoe/cleat gear to correct the problem. If you have no problem riding a spin bike, then you do indeed have physical limitations due to previous joint/muscle damage.

In any case, the starting point of investigation is determining whether it is "form" or physical imbalances causing the problem. Usually one leads to the other.

Thanks for the input! Thats been the MAJOR frustration is after 32-35 mins on the easiest bike gear of my magnetic rim drive trainer then inflammation occurs. I do have Andy Pruitt's Medical Guide for Cyclist which I have been 'reading' on and off since the injury but I 'assumed' the bike fit place (because of reputation) was to be my source. I just reread it and my symptoms sure fit best with lliotibial and friction syndrome (although its a difficult because I have never had 'stabbing pain' as referred to in the book) and the first thing (note the one comment above also mentioned this) is to lower the seat. The 'pain' is worse on the power stroke and it does start with a mild twinge at approx. 33min and builds up. I remember the fit guy raising my seat then I pedaled for a bit and then he raised it again - how much I am not sure - remember that was after the original injury and i was going there to get a 'proper fit'. I did the Andy's guide for height this evening and even with that guide I would say I lowered it 6mm from the shop I went to. Andy's guide says lower 6mm if you think you have the friction syndrome.

It's a muscle imbalance which is causing your patella to track wrong. That's the reason the tape fixed it - it held the patella in the groove. There have been many threads on here about this. Search this forum for "patella", and read everything you can find about it.

Possibly the best advice I've seen is to do straight legged kicks. With the leg held straight, kick it as high as you can. 15 reps, then the other leg. Repeat until tired. Do a couple times/week.

It's a muscle imbalance which is causing your patella to track wrong. That's the reason the tape fixed it - it held the patella in the groove. There have been many threads on here about this. Search this forum for "patella", and read everything you can find about it.

Possibly the best advice I've seen is to do straight legged kicks. With the leg held straight, kick it as high as you can. 15 reps, then the other leg. Repeat until tired. Do a couple times/week.

Thanks - I have read the straight leg kick and started that about a week ago. Is the patella tracking issue called ' patella tendinitis'? -- The tape was about 2inches From the bottom of my patella with a straight leg, it was not tight at all. I have had 2 ultrasounds and 1 electo thing and the massage guy swears its lower leg muscle but he is not a cyclist.

Is there a name other than patella tracking to search around on ? thanks again

Sports medicine doctor visit today - he diagnosed IT Band friction sydrome...he said dont run or bike for 6 weeks...I said WHAT - -- then he said maybe you could try in 2 weeks...

How long should one take off? ice? NAID? etc. he said my 'knee' is fine its a tendon issue...

That seems an odd place for ITBS to manifest but what do I know. AFAIK the main fix for ITBS is stretching and don't do what makes it hurt. But you've been doing that. Maybe different stretches? My guess is that ibuprofen would help a bit. The bike fit fix is to lower your saddle, maybe .5 cm to start. Another guess is that ice won't help because you've been doing that.

But I dunno. The tape thing is a puzzler. I don't see why that would help ITBS.

There are a number of people on here who have had severe ITBS. Maybe one of them will come on. I've only had it minor and easily fixed.

If you google itb stretches, there are many sites like this:
http://www.itbs.info/html/body_stretches.html
which also have other information.

I am nervous after 6 weeks it wont be any better...hard pill to swallow. The sports med guy said my knee seemed fine ie the structure. He did book an xray and mri which both take time and he sort of thought it was better to book now 'incase'.

I am getting orthotics tomorrow (I do have flat feet) and going to a specialist for active release (www.montgomerymassage.com/aboutus.html). I watched a few more videos and I was 'rolling' with the roller and not stopping along the band. So I will now take more time on the roller --- 10 mins per day.

The tape thing bothers me as well. It doesnt even have to be very tight... so I have resigned myself to 'roll' and do straight leg lifts and ICE and Vit I for at least 2 weeks.

Dr. Pruit also says .06 mm lower seat but when I paid 150$ for my setup after the original injury the person raised my seat a good 10 mms.

Anybody ever give this guy $20 bucks for this advice http://saveyourself.ca/tutorials/iliotibial-band-syndrome.php??

thanks

Should you take ibuprofen for the 6 weeks or just a week? Dr. Pruitt doesnt say in his book... I found reference to 1 week online. I dont need it for the pain at all....

Having worked in a PT place, that does not sound like ITB syndrome, but more of a patellar tracking problem. If the patella is maltracking, that causes chondromalacia (irritation of the "groove" the patella tracks on), and eventually the patellar tendon gets irritated as well. I too have knee pains to the side of my left (and right, to a lesser degree) kneecap. I have tibial torsion, which causes my lower legs to "bow" outwards and the patella to maltrack due to the deformation caused by the torsion. Also, the kneecaps point outward and it also forces my feet to point outward, causing a duck footed walking style. I got fit a month ago by a chiro in my cycling club, and the thing that has made the difference is adding spacers to my left pedal (i have 3mm now, as much as I can get away with) to move my left foot more under my knee, and allow me to place my cleats to allow for a more duck-footed position. This and a weakness and tightness in my gluteus medius were giving me both knee and lower back pain. I have been doing whats call a clamshell exercise every day. Since they weren't working very well, the glutes were tightening up and pulling on lower back structures, and forcing my quads to do a lot more work than they should. This was causing my knee to be pulled on in ways it shouldn't be.

To sum up, I moved my pedal out on my left 3mm, and am doing exercises to strengthen the gluteus medius so that my glutes do some of the work they are supposed to and not put so much strain on my knees.

So what would you say about the 6 weeks off? I find it quite bizarre that after 33mins (I have tried about 6x) over the last 6 weeks the inflammation starts. I did already take many weeks off cycling in Dec although I ran 3x a week and didnt do that much stretching or muscle building.

The sports med guy said (after I baulked at 6 weeks) maybe you could try again in 2 weeks... 6 weeks vs 2 weeks vs is my setup messing me up. I am less than convinced.

Dr. Pruitt also says for IT band issue to move the pedals out to make a wider stance.

To sum up:
- it doesnt even really 'hurt' its just a warm funny feeling that gets warmer and funnier as time progresses...
- 6 weeks or
- should I just experiment with setup and muscle building and let pain guide my cycling cause I can tape and bike without pain
- i really want to bike a lot - ie a 7 day race this summer...

right knee shot with marker where the inflamation starts at about 32min --- from the blackberry...http://sites.google.com/site/eeberhar/ (sorry about the hairy legs : )

right knee shot with marker where the inflamation starts at about 32min --- from the blackberry...http://sites.google.com/site/eeberhar/ (sorry about the hairy legs : )

Link no work

try again - new to google sites...

to carbonfibreboy what was your fix? the straight leg kicks? how long did you do them? did you take any time off cycling? thanks

Hi - This is not really what you want to hear - but here it goes.

Sept 09 - got a TT bike, road it hard up some hills.
i got Patella Femoral Pain Syndrome ( PFPS )

Started riding 2 months after it - after a little bit of riding i was getting sore on the medial ( inside ) aspect of my left knee - just below the joint.

Physio told me to take it ( 1 piece of tape accross the knee )

this worked like magic.

Skip forward to now. i go about 30 mins with out tape until it feels "funny, and "not right"
not pain, just feels weird.

Or, i can tape it and ride up hills all day with no problems at all.

I have been told the same as you - strenghen VMO, stretch, etc etc.

so far i would say it has gotten ever so slightly better in a few months - but not much.

Invest in some good tape and use it when ever you ride

for what its worth - i can tape my knee and race on it with out issues.
its just a pain having to tape it all the time

well it at least makes me feel better that somebody else is running into this taping thing... : )

went to an experienced sports massage person (recommended person) and she said she didnt know what it was but was 98% sure it was NOT IT band syndrome. she didnt think it was ptfs either but wasnt as sure on that one. she did ART.

my funny spot felt funny before even starting this time but i biked 60 mins and it never got any worse ie the friction didnt seem to increase.

for fun a put a 6 inch piece of electrical tape (all i could find) above the fibula if the funny spot started to aggravate even a little and it took the feeling away. so the tape doesnt even half to go although way around my leg... could i have a torn muscle/tendon in my lower leg that inflames by me knee....

ordered sports orthotics today as well...

Thanks for the knee pic

to carbonfibreboy what was your fix? the straight leg kicks? how long did you do them? did you take any time off cycling? thanksThe time I had chrondomalacia, I just raised my saddle and eased off the effort for a while. I didn't take time off or do anything special. The time I had ITBS, I just stretched. Nothing special, just the standard supine and sitting leg stretches, a couple times a day, or whenever I felt pain. I took a couple days off. It was gone in a week or less. Except for a torn meniscus and a ruptured Achilles, I've been lucky with my legs.

I have a call in to a buddy who might have had something similar and is riding again. That pic rang a bell. I'll post anything new.

What exactly do you do with the tape? Just tape across the site, or do you try to pull something one way or another?

Hey,

The massage lady said 'I dont know and weird spot' which was great because she was honest. She did say sometimes miniscus can get stuck...she did say the pain was right at the joint line. Just another option I guess.

That being said she couldnt explain the tape thing.

here is an image with the tape. https://sites.google.com/site/eeberhartest2/home the tape is about 5 inches long just below the fibula with low tension but enough to keep that area of the leg (ie the tendons etc not moving as much)

I have been digging around again on 'shin splints', seems like its a catch all for lower leg and maybe i have damaged my lower leg mucscles/tendons maybe ripped something off the bone...ok I am reaching...

thanks for asking around

2 physio appts.
1 prof bike fit (which I have now changed)
5 massage appts with 3 different people
1 regular dr and 1 sports dr
and now a sport orthotics guy who seemed pretty knowledgeable


ps - both the sports orthotics and sports massage were unhappy that the bike fit guy shimmed my right leg as they said there isnt any noticeable difference if you loosen the muscles a bit.

Hey yerself,

I talked with my buddy at great length about this a few weeks ago, but I'd forgotten all about it. Typical. I classify him as a very strong rider. One of the best climbers I've ever ridden with, you know, club level, 3, that kind of thing. Anyway, he's strong and in his 40's. He had this thing go wrong with his knee last fall. He tried all sorts of things, went to doctors, got refitted by a physiologist, off his bike for a month, etc., etc. Someone finally figured out that the tip of his fibula and the stuff attached to it was the issue. Here's his response today:

"It looks about the same. It's hard to tell if that's the tib-fib joint from the picture. For me it was the tib-fib joint and associated muscles. Focusing on Gluteous (Tensor Fasciae Latae). The joint, apparently was out of whack causing muscle pain too.

"Root cause seems to be related to 3 items.
1. My muscles thigh muscles are so strong that they pull up so hard on the fibula that they cause the fibula to get stuck in the joint.
2. Lack of flexibility exacerbates the first problem because when the muscle is relaxed it's actually still drawing up on the fibula. I've been working on Gluteus, Quad and IT band stretches.
3. Poor pedaling technique - not pedaling circles. "

IMHO #3 might be very important and something you can change now. Be sure you don't push down on the downstroke until the last 45° of the downstroke and then smooth that into the pull-back and lift-up at the start of the upstroke. Try to keep a feeling of air between the bottom of your foot and the shoe. And spin at least 90 rpm on the flat and 80 climbing.

Good luck!

hey,

thanks so much.

now that make sense to me. i have been telling everyone its like where 'something' attaches to my tibia. that also makes sense for the taping as it calms that area down when your in the first part of the pedal stroke down...hmmm this is making even more sense.

climbing is my thing as well.... not saying to much but when i did this injury i was pretty strong : ). Just saying my muscles were pretty developed as well...

i have been saying for a few years it sometimes feel like my muscles were so strong i could wrip away my tendons. it was sort of a saying but felt really true.

super helpful! thanks for your time

thank your friend and if he/she was ok with an email let them know my account

ask your friend if he ever got somebody to 'yank' on his 'sore leg' to pull them apart and if that relieved pressure? i have had that done a few times but sort of forgot about it --- isnt the mind wonderful. is there something he had done to 'unstuck' the fibula or is it just stretching and strengthening as mentioned above.

thks

If that is indeed your issue, than it would make sense to start working on strengthening your glutes post-haste so that your quads don't continue to be overly strong and do all the work. Stretching would also be called for so that your tendons/ligaments can do their part without being either stretched too far, or end up "stuck" because they aren't flexible enough.

I noticed that if I pushed down later in the stroke when climbing, my knee would not hurt (or as much). I guess if you push too soon, you jam the knee, which likely causes the pain an irritation.

I seriously doubt it's shin splints. Having had those, you would know that you have those, as your entire shin hurts. Ay yay yay that is very painful, and nothing to be done about it except quit doing what you doing for awhile and allow the muscles to re-attach to the bone properly.

I sent to my friend and included your tape pic, your question, and your addy.

Update after this week

- 1 ART with sports massage session
- 1 week of NAID 400mg per day
- 1 week if ICE 2x a day
- 1 week of 2x per day leg 15 leg reps (various) with downhill ski boot on and stretching
- 1 week of IT band rolling (stopping for 15 seconds then moving along about an inch)
- 1 week of 2-4x per day Traumeel external

Something is changing --- still sensitive but feels different. Its almost like I can feel it all the time a bit but biking doesnt seem to aggrevate it as much. Still early days but there has been more progress in the past week vs the past 6 months...

thanks for the sounding board - will update soon

thanks

3 days of 60 min light spin, tape for the first 30 mins then no tape.

All the work on the area might getting more bloodflow to it, which means things will feel different, but it is a good sign that the area is starting to recover. Keep up the good work!

just to throw in something differnt
i have to tape accross the top of my knee cap.

its amazing how 1 piece of tape, not even applyed that tightly can mean the difference between 2 hours pain free riding and 30 mins then sore knee......