The Knee Saga Continues
 

So a year or so ago I started to have some knee pain associated with riding. It got worse with my new Focus in August. I went through all the adjustments, seat up, down, forward, back, etc, but it just got worse, so I called the doc. My PCP gave me a ringing endorsement for a guy. I look him up, and he had gone to good US medical schools, good fellowship, spoke English, team ortho for NHL team, big college team, blah,blah, blah.

First visit. I had very carefully noted those conditions that made it hurt, where it hurt, lots of good sharp observations, I'm a scientific type so I felt pretty prepared. I sit down and the PA comes in. Short buff muscular weight lifter kind of guy. "So your knee hurts, eh?" I told him my observations, he cuts me off says talk to the doc. Doc comes in, slightly taller buff muscular weight lifter. "So your knee hurts, eh?" Told him my observations, half way through he says need an MRI and splits.

Couple weeks go by, get the MRI, back to the office. PA comes in and gives me a lengthy reading of the MRI. Hems and haws, message is, "Can't see anything." Doc comes in, hems, haws, scratches chin (he is an MD after all) doesn't see anything much. Says things like,"Well we could give you this injection, or that injection, or PT, or exercise, or heat, or you could buy a brace at CVS, or something..."

So my take away is that if your knee isn't a train wreck or doesn't have an actual small caliber bullet lodged in it they don't have any ideas. So I'm just going to run it 'till it collapses and they can see my quivering pink body lying on a stretcher. At least they have some nice "before" MRIs to compare it with.

It should go without saying that you need to see a different doc.

You may want a different Doc but it sounds like good news and is probably a strain. I had one when I first went to clipless pedals and used the "0" float cleats. All went well for months but I did several 25 mi. climbs at 5 -8% grades and my right knee started hurting. I had an HMO and they would only pay for x-rays which usually show nothing for 6 mo. Then they sent me to an orthopaedic surgeon who did an MRI which came back negative. He at least told me I probably strained a ligament. I decided to start using 3 degrees of float cleats and in about 4 more mo. the pain went away. Perhaps you need a professional bike fitting? If it is just a strain it can take a long time to heal. At least you don't need surgery.

Have you been fitted to your bike?

Fixed it for you.

It's a bummer when you're trying to do things the right way and the results are poor. One thing you didn't mention in your original post when discussing adjustments was foot position on the pedals. I don't know what pedal and shoe combination(s) you use, but the problem may lie there. From my own experience, I found that when the cleat on my right shoe was out of alignment just 2 or 3mm I had knee pain. I hope you get to the bottom of it soon and the saga becomes a distant memory.

Thanks!!!!!

One perfectly reasonable theory is that my bike is doing it intentionally because I have embarrassed it. It is a pretty spiffy high performance bike I have modified with steering extender, raised adjustable stem, and flat pedals. the bike resents being in the hands of a 70+ yo amateur. The local high zoot riders have had no end of comment and asking why I bought such a high end bike for my modest needs. The answer is because I can and I wanted it. Period.

I don't use clipless because I'm too old to start now and I break easily. My feet assume the angle they need. I do notice that my right foot is angled out a little more than my left when I walk, and I don't force it to point straight ahead when I pedal. I am using MKS pedals, BMX type. I had Ergon pedals on it for a while. The Ergons tend to push my feet to a more straight ahead position, the MKS allow the foot to assume any angle.

Yes, I was fitted by the guy that owns the shop. He was a pro rider in South America and is well reputed. He used a system of computer program and measurements taken with various wooden devices that looked very competent.

My strategy now is to ride out until the knee starts to hurt, and then turn around and go home. It is pretty painful when I get home so I take an Aleve and do it again the next day. I figure I will either cure it or break it so bad the Dr. will be able to see it in the MRI, then he can fix it.:)

There are so many structures involved with the knee that it could be anything. It could be a muscle imbalance, or your patella could be offset a little. You didn't give a lot of information of what kind of pain, where, when it hurts, etc. so I can't really make any kind of an educated opinion. See if you have a local college that has a bicycling team and find out the ortho they use, or the physical therapist (PT). If they are nice, maybe the schools Athletic Trainer (AT,C)can evaluate you. The Athletic Trainer is the first and last one to see an injured athlete, so usually has a better grasp on what is going on with an active person than some doctor who sees sedentary people all day long and doesn't have a clue as to what you want to do.

Normally, a good stretching and strengthening program will help. Ice your knee at the end of the day, 20 minutes on, and at least 40 minutes off to allow it to warm. If the pain is under the kneecap, then go for 30 on and 40+ off as bone doesn't transmit cold very well. A good knee brace, a neoprene one with a hole at the patella (kneecap) is probably the best, but a good PT or AT,C can give you a better idea of what you need. You may just need orthotic inserts in your shoes to put your foot at the correct angle, so it could be many things. Don't give up, just keep looking until you find the right person. Someone in medicine with a cycling background is the best, so check with the local bike shops and clubs to see if they know of a Doc, PT, AT,C, who also rides.

Last, but not least, you're not 19 anymore, so the body does wear out, but if you had arthritis or any other significant bone problems I would imagine the MRI would have shown it, so maybe they saw an older person and just figured that you don't really do anything so just said for you to take it easy. We have a guy who rides with our group who is 95. He got into a big argument with his doctor because he wanted to ride 60+ miles a ride and the doc said no, so you have to let the medical people know that you are active and what type of exercises you are doing so they will understand.

Shorter cranks!
It worked like a miracle for me. (One knee doesn't have full range of motion)
175mm Constant knee pain. Cadence wouldn't go over 62 RPM
170mm Occasional knee pain. Cadence 80 RPM
165mm No pain. Cadence 85 RPM
160mm. No pain. Cadence 82 RPM. That was getting too short.

IF you are 70, your knees probably just don't bend like they used to.

Get a referral to a physical therapist. You'd be surprised what a few specific exercises can do.

edit: to add a little text, a good doc won't put you under the knife unless it's necessary. If he didn't find anything obvious, a little exploratory surgery is just going to make things worse. AND, you'll need PT after any surgery anyway. So go the least-invasive route first, you may be pleasantly surprised.

Run don't walk to find a better otho doctor 'cause the one you've got is only interested in your money.

I have a slightly troublesome knee. When it acts up and begins to express some discomfort, I step up knee exercises. My theory is that there is some imbalance and the knee joint needs to be a bit stronger. I'm 75y.o. and I do not think there is a procedure, a pill or ointment that will chance that. Being stronger is always good.

68 agrees. Squats, leg sled, hiking, stepmill. Stretches help a lot, too:
http://www.bikeforums.net/showthread...1#post15372967

I think clipless helps, too: enables one to push forward at the top of the stroke which helps prevent or correct imbalances.