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  1. #1
    Ca-na-da? krazyderek's Avatar
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    Slight pain above knee cap

    I just recently switched to SL pedals and yes they are a bit more constricting then my old SPD-R pedals which had plenty of float. I set up my shoes so my feet are in the exact same position though.

    Now a week and a half later i'm starting to get some mild pain right above and around my knee cap, not sure it it's muscular or joint related. It generaly only happens days when i push it pretty hard, sprint quite a bit, or do hills, so mostly out of saddle stuff.

    I know behind the knee pain is the saddle height, and side knee pain is cleat alignment, but what bout above the knee pain? Any takers?

    I'm thinking it could just be where i'm used to trainning on rollers for the past 2 months, my legs aren't used to being out of the saddle and it'll just take some getting used to and take it easy for the next week or two.

    If it gets worse though i may pay a visit to my favorite physio&message place.

    Just a side note, my knee's have always cracked (think cracking your knuckles) when i bend my knees sitting on my legs or squatting down for excersize or picking something up. The cracking often feels quite releiving.
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  2. #2
    214/13 PedalMasher's Avatar
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    Perhaps it's patellar tendinitis? Try some inner quad exercises next time you're at the gym. I'm no stranger to knee pain, and had quite a bit a year ago, with patellar tendinitis right above the knee cap the main culprit. Could also be quad overuse injury putting stress on your tendons. Nothing a little PT or gym time can't fix!

  3. #3
    Ca-na-da? krazyderek's Avatar
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    Well i checked at local chapters store to try and find a book someone recommended "Save Your Knee's" but it wasn't in stock, good news it's only 20$cdn. Also looks like they carry another book i want, "Trainning and Racing With Power" so maybe i'll order them both in.
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  4. #4
    Dopamine Junkie dglevy's Avatar
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    i have some sort of condition that is similar to that. i've been told by medical professionals that it's chondromalacia patella (cp; kneecap off its track) or cp plus tendinitis. the cp is from having overdeveloped quads. a physical therapist i met on the bike trail said it's very common for cyclists to have muscles that are pulling the kneecap sideways.

    physical therapy is supposedly the cure but i haven't tried it. warming up slowly and carefully on the bike (~20 min. before hard efforts) seems to help avoid tenderness the next day. also, this may seem strange, but walking downstairs (not upstairs) with 50 lbs in a backpack helps tremendously. i assume that's b/c it's strengthening muscles around the knee that are not used in cycling and are pulling the kneecap back closer to its track. i'm not sure what the 'inner quad' work mentioned by pedalmasher means specifically. but i assume you could do your own do-it-yourself version of physical therapy in a gym.

    you may not have a mild case of cp, but the 'cracking' sound is what i have too. so that's why i'm giving you this information. in any event, try different things to relieve it: slow, careful warm-ups; ice on the knee for 15-20 mins after the work-out; etc. if nothing works, see a sports doctor. chances are they will recommend physical therapy. i think phys. therapy is a pain b/c of the travelling involved. but, if you go once or twice, you can probably re-create the exercises in a gym.

    hope this helps, and let us know what works, eventually, if you find a solution. it may be helpful for those of us who are having similar problems.
    Last edited by dglevy; 04-14-06 at 09:17 AM.

  5. #5
    Dopamine Junkie dglevy's Avatar
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    just found this link in the usenet faq:

    http://draco.acs.uci.edu/rbfaq/FAQ/9.39.html

    it repeats some of the info listed above but that's good, sort of confirms what people have been saying, and it adds some more info too.

  6. #6
    Senior Member DannoXYZ's Avatar
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    Quote Originally Posted by krazyderek
    I know behind the knee pain is the saddle height, and side knee pain is cleat alignment, but what bout above the knee pain? Any takers?
    Actually too-low or too-high of a seat will cause knee pain:

    TOO HIGH/FORWARD = pain on the back of the knee
    TOO LOW/REARWARD = pain on the front/top of the knee
    CLEAT ROTATION/FLOAT = pain on the inside/outside of knee

    Something obviously changed with the shoes. The sole+cleat may be thicker or thinner than your last shoe, along with the difference in float you noticed. If your old shoes and cleat had more float, perhaps that made up for some mis-alignment. Check the cleat to see if the wear is exactly in the center of the range. A lot of times, float hides problems where you're actually rotated to one extreme end of the range. Then when you restrict that float with new shoes/pedals, you end up not being able to rotate to the same position as before.

    Also annoying to me is some shoes don't allow you to select the fore-aft position of the cleat sufficiently to get the ball of the foot over the pedal-spindle. I say go back to the old shoes and take some really precise measurements of seat-height, KOPS, cleat location & rotation.
    Last edited by DannoXYZ; 04-03-07 at 02:42 PM.

  7. #7
    Dopamine Junkie dglevy's Avatar
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    anyone ever had chondromalacia patella? if so, were you able to cure it?

    i've been able to ride this past year (thank god!), but the knee is not in perfect shape. i still have to be very careful to not stress it if i'm not warmed up.

    any feedback from cyclists or medical professionals on this would be greatly appreciated. (see my post above for more details.)

    --david

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    My vote is that your saddle height and fore/aft will have to be adjusted to take into consideration the difference in the shoes/cleats. I don't think you developed any physical ailments. You just need to make the proper adjustment and all will probably be well. If everything else were the same, then I would have been more concerned about the pain.
    What is better than getting your heart rate up and saddle time?

  9. #9
    Aluminium Crusader :-)
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    I'm no Doctor Butt,

    do a search on 'jumpers knee"

    these are good general tips:
    http://www.cptips.com/knee.htm

  10. #10
    Senior Member badger_biker's Avatar
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    Try doing some quad and hanstring stretches before you ride. I experienced what sounds like similar pain earlier in the year and was concerned heading into a weeklong trip. I did the stretches each day and it helped significantly. Obviously this won't resolve a fit problem that may be causing it, but it shouldn't hurt and may ease your riding discomfort.

  11. #11
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    Quote Originally Posted by dglevy
    anyone ever had chondromalacia patella? if so, were you able to cure it?

    i've been able to ride this past year (thank god!), but the knee is not in perfect shape. i still have to be very careful to not stress it if i'm not warmed up.

    any feedback from cyclists or medical professionals on this would be greatly appreciated. (see my post above for more details.)

    --david
    Hi

    cp (not to be confused with cerebral palsy ) is not a misallignment of the patella as you suggested in the previous post. However a misalligned patella could be the cause of the cp. CP i it's self is the breakdown of the cartilage "under" the patella.

    I would have to disagree that the misallignment of the patella (if that's the cause of your cp) is caused by overdeveloped quads. I would rather say it could be because of "misdeveloped" quads - the different parts of the quads are not in balance either by pure strenght or by muscle control or (probably) both. If your vastus medialis is weak, and the lateralis in comparasion is stronger, the result would be a patella moving slightly lateral off it's track. I imagine this could be activity specific so it's important to assess the knee's function in the activity believed to cause the problem.

    You really should consult a PT so he or she can do a physical assessment to try to discover why there is a problem. However, assuming the problem is caused by a "off it's track"-patella, this is how I, as a physical therapist, would guide a patient with this condition:

    So - first of all - if your knee is painfull and swollen you should rest for as long as it takes. This could be weeks. With rest I mean avoiding all painfull activites. A little discomfort is OK, but the knee should not hurt more or be more swollen after the activity. You should continue exercising within this limitation, and the exercise should include some kind of movement of the kne. Cycling is (more than) fine if you can limit you effort so that you do not irritate the patella further. Other activities could be walking, swimming water-running etc. You should also start doing some exercises to develop better conrol over your quads, this should probably be supervised by a PT. In my experience a big part of the problem is often du to lack of control/strenght of the vastus medialis. Then as the pain is under controll and the irritation minimal you should GRADUALLY start to develop more strenght adding more resistance to your training. However it will be important to include the knee control issue also in this fase, so that you don't fall back to those old and bad movement patterns. And remember that developing hamstring controll and strenght, not only the quads, is also a very important part of a healthy knee.

    And the prognosis should be good. But take tour time. As last way out there is surgical treatment available.

    Good luck

    chubakabra

  12. #12
    Senior Member Terex's Avatar
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    Occam's Razor : "when given two equally valid explanations for a phenomenon, one should embrace the less complicated formulation"

    Adjust your seat, per other posters. Fiddle with it, a little at a time, and you should find a position in which your knee doesn't bother you. I had exactly the same problem when I first started riding. All the other "kneecapulitis" theories are much less likely.

  13. #13
    370H-SSV-0773H linux_author's Avatar
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    Quote Originally Posted by DannoXYZ
    Actually too-low or too-high of a seat will cause knee pain:

    TOO HIGH/FORWARD = pain on the back of the knee
    TOO LOW/REARWARD = pain on the front/top of the knee
    CLEAT ROTATION/FLOAT = pain on the inside/outside of knee
    +1

    - had sudden pain on front/top of knee on one bike after a few rides... measured against my other well-fitted rides (top of seat to pedal) and found out the seatpost had slipped down!

    - raised the seatpost to equal height of the other comfy bikes... result: knee pain gone!

    (i hope your fix is just as simple)

  14. #14
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    Quote Originally Posted by Terex
    Occam's Razor : "when given two equally valid explanations for a phenomenon, one should embrace the less complicated formulation"

    Adjust your seat, per other posters. Fiddle with it, a little at a time, and you should find a position in which your knee doesn't bother you. I had exactly the same problem when I first started riding. All the other "kneecapulitis" theories are much less likely.
    All though I agree with the conclusion (try adjusting the seat), I do not agree that "kneecapulitis" theories are less likely. Actually I think there is most likely that they are the same animal; some kind of inflammatory response ("kneecapulitis") to over stressed body tissue, which could or could not be relieved by adjusting the seat.

  15. #15
    Dirt-riding heretic DrPete's Avatar
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    Quote Originally Posted by badger_biker
    Try doing some quad and hanstring stretches before you ride. I experienced what sounds like similar pain earlier in the year and was concerned heading into a weeklong trip. I did the stretches each day and it helped significantly. Obviously this won't resolve a fit problem that may be causing it, but it shouldn't hurt and may ease your riding discomfort.
    +1. It sounds like you're describing patellofemoral syndrome, which is a less severe deal than chondromalacia. It does have to do with the way the kneecap tracks over the femur, and it can usually be corrected with quad strengthening exercises, particularly in the last 15 degrees of the range of motion, i.e. try some leg bends where you only bend the leg about 15 degrees.

    I'm no orthopedic surgeon, but that's what it sounds like. Definitely see a doc if it doesn't get better soon. No point messing around with your knees.
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  16. #16
    Michigan Rider lesdunham's Avatar
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    Knee Pain

    A couple of other factors that may be helpful to know are after how many miles of riding does it take to increase the pain? Does time or rpms change it? Maybe change back to the SPD's and see if it changes. If an anti imflamatory changes the pain than it is not skeletal (CP). If pedals, self medication, and use/rest don't change it than it must be position or skeletal dependent. Just a process of elimination until you figure out what works. Don't worry when you get old it all hurts about the same.
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  17. #17
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    I had similar issues with one knee. Raising the saddle and tweaking the cleat position solved it for me. Focusing on spinning and keeping my cadence in the low 90s also played a part as well, I believe.

  18. #18
    Dopamine Junkie dglevy's Avatar
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    man, this thread woke up since i last checked it! thanks for all the input.

    i don't think my problem has to do with bike fit. my kneecap is always a bit off its track. cycling can make it worse, but so can a lot of things, like climbing stairs, running, walking fast, lifting heavy objects.

    thanks, cbkb, for your thoughtful posts. you are right. somewhere along the line, either a doctor or a fellow cyclist told me it was chondromalacia patella, but that is probably incorrect. i had an orthopedist take an x-ray of it and he said there was no discernible deterioration of cartilage. he also warned that an x-ray is not good at showing soft tissue, so it was not definitive. nevertheless, my sense is that my cartilege is in good shape. i never have outright pain. my knee has never been 'swollen and painful'. i just get discomfort and tightness. the kneecap pops more loudly. i have always been careful to ease up at that point. at worst, maybe two or three times, there has been slight inflammation, probably of the tendon or tendons at the top of the kneecap and i would get a slight throbbing sensation. (tendinitis has been the other diagnosis i have heard. but i think the tendinitis is just a by-product of the kneecap being off track.)

    you are probably right that the quadriceps are mis-developed. the discomfort all started because i was sprinting on my bike, without warm-up on cold autumn days, to catch the staten island ferry in new york city. the discomfort was in both knees, but it went away for one of them and stayed for the other. this was after a long season of racing and training, so my legs were quite strong.

    dr. pete's comment about the 15 degree leg bends makes some sense to me because it resembles what i found by accident. as i mentioned above, walking downstairs (not upstairs) with 50 lbs in a backpack helps tremendously. it's the only thing that has lessened the discomfort and 'popping' sound and feeling at the kneecap when i extend my leg. cbkb, would this be consistent with your sense that the vastus medialis is too weak, relative to the lateralis?

  19. #19
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    Quote Originally Posted by dglevy
    man, this thread woke up since i last checked it! thanks for all the input.

    i don't think my problem has to do with bike fit. my kneecap is always a bit off its track. cycling can make it worse, but so can a lot of things, like climbing stairs, running, walking fast, lifting heavy objects.

    thanks, cbkb, for your thoughtful posts. you are right. somewhere along the line, either a doctor or a fellow cyclist told me it was chondromalacia patella, but that is probably incorrect. i had an orthopedist take an x-ray of it and he said there was no discernible deterioration of cartilage. he also warned that an x-ray is not good at showing soft tissue, so it was not definitive. nevertheless, my sense is that my cartilege is in good shape. i never have outright pain. my knee has never been 'swollen and painful'. i just get discomfort and tightness. the kneecap pops more loudly. i have always been careful to ease up at that point. at worst, maybe two or three times, there has been slight inflammation, probably of the tendon or tendons at the top of the kneecap and i would get a slight throbbing sensation. (tendinitis has been the other diagnosis i have heard. but i think the tendinitis is just a by-product of the kneecap being off track.)

    you are probably right that the quadriceps are mis-developed. the discomfort all started because i was sprinting on my bike, without warm-up on cold autumn days, to catch the staten island ferry in new york city. the discomfort was in both knees, but it went away for one of them and stayed for the other. this was after a long season of racing and training, so my legs were quite strong.

    dr. pete's comment about the 15 degree leg bends makes some sense to me because it resembles what i found by accident. as i mentioned above, walking downstairs (not upstairs) with 50 lbs in a backpack helps tremendously. it's the only thing that has lessened the discomfort and 'popping' sound and feeling at the kneecap when i extend my leg. cbkb, would this be consistent with your sense that the vastus medialis is too weak, relative to the lateralis?
    Hi, and sorry for the late reply...

    First of all I'm happy to hear that you are probably not suffering from chondromalacia patellae. All though it is treatable it is not the easiest thing in the world to deal with...

    I guess dr. Pete's comment on the 15 degree leg bend makes some sense in that the vastus medialis is often said to be active in the last phase of extending the knee. I cannot quite see how this relates to walking downstairs, I guess I would actually have to see how you are solving that task... However, to my knowledge, this (the 15 degree thing) is the case for an open chain movement of the leg. In a closed chain movement the vastus medialis will (or at least should) be very active earlier. You can try this on your self: Sit on a chair and straighten your knee 100% (lifting your heel from the floor etc). At the same time put a couple of fingers on your vastus medialis (the medial part of your quads, right medial and above the patella). You can actually feel the vastus medialis come into play in the last degrees of extension and even more som in the hyper-extension (this is a open chain movement). Now (after putting the leg down) try to palpate your vatsus m while you are slowly standing up. You can feel the vastus immediatly getting "rock hard". So which of these to activities resembles cycling the most? The latter of course, and I thing som kind of strengthening/knee control exercise that requires some of the same movement is the best way to go. One easy exersise which could be effective is stepping up an down on a box (or chair or whatever). This should be done with your body, your knee and your toes pointing straight forward. And it should be done SLOWLY, both up and down. Do not allow your self to slam the knee back in a locked posistion (hyper extended) on you way up, and dont let your self "fall" down on your way down. Think control and slow! You can start with only 15-20cm height and increase the height as you get more balance/control/strenght. 3x20 2-3 times a week should be OK.

    Well these are just my thoughts, and these are exrecises which every cyclist could benefit from form time to time. It wil not only strenghten the vastus medialis, but it will increase the control of the kne an may be a factor in decreasing the risk for injury. However use it on your own risk, and I will still urge you to see a professional. There could be other reasons for your problems (hip, ankle etc), so if you do not get better you really should get it sorted out.

    Good luck!

    chubakabra

  20. #20
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    Quote Originally Posted by krazyderek
    Just a side note, my knee's have always cracked (think cracking your knuckles) when i bend my knees sitting on my legs or squatting down for excersize or picking something up. The cracking often feels quite releiving.
    ironic timing.

    that's creepy. i JUST noticed that my left knee is 'cracking' when i bend it, not sure if it sounds like your knuckles, more like stepping on broken glass.

    this is new to me (i felt something tweak in my knee on sunday). no real pain, just doesn't feel 'solid'. currently paranoid, doubting whether i'll do my last race of the season, or not, on saturday.

    like dglevy i don't feel any 'out right pain', although at the end of an 1:30 on the bike, just doing a short jump to kake a light, i felt some pain when i pulled the pedal up (on the backstroke). hmmm...
    Last edited by botto; 10-06-06 at 04:30 AM.

  21. #21
    Senior Member VT Biker's Avatar
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    I too have had a problem with the tracking of my knee cap. Again - you should see a specialist, however, this is a knee problem which can be cured.

    I started cycling this year, and before that, rarely worked out my legs before. I always worked out the upper body in college. The pain (and subsequent tracking issues) happened on the first long ride into the front range here in Denver. I went to PT and they determined that I had a mis-aligned knee. They quickly explained that what probably happened was that I was already mis-aligned, and when I started hammering up the hills, it exascerbated the already mis-aligned knee. They said this is a common problem, because typically people who are just starting out in cycling are getting into it either from having not excercised at all or having rarely used the muscles in the way you push them when riding.


    They recommended a combination of leg excercises and stretches with only flat rides in the plains with a higher cadence. I slowly worked up to now, where I can routinely do 60 mile hill rides in the mountains. I hope this winter to continue to work on my leg strength to ensure that I never have to worry about this problem again.

  22. #22
    Dopamine Junkie dglevy's Avatar
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    So, i finally saw a physical therapist. He says the problem is in my hips! He says i have restricted mobility in my hips and that's why my knee cap is sore. Go figure.

    Now i don't know what to think. But one thing's for sure: i'm not going to do 30 minutes of exercises a day for 30 days just based on his say-so.

  23. #23
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    Quote Originally Posted by krazyderek
    I just recently switched to SL pedals and yes they are a bit more constricting then my old SPD-R pedals which had plenty of float. I set up my shoes so my feet are in the exact same position though.
    Now a week and a half later i'm starting to get some mild pain right above and around my knee cap, not sure it it's muscular or joint related.
    If it were happening to me
    I'd go back to the prior/original setup. Give myself a few days of real easy spin stuff until the pain has completely subsided, then 'workout' with the same type and level of ride. If after a few days of that and no reappearance of the symptoms, I've isolated the cause to some relationship in the 'new' setup.
    If the symptoms reappear as before and persist, look to your current riding methods.
    Going back outdoors after a long period of trainer stuff will change your pedaling method; even though it may not seem to.
    Standing rarely causes the issues you mention. If your quads aren't up to it, they'd be complaining...
    as for knee pain and where - the knee is the locus of all things cycling. not the only place but all paths lead to the knee. often issues in other places, like the feet get magnified and zero in on the knee.
    rotation, saddle and foot fore/aft, leg extension and leg length anomalies, supination, pronation, hip and torso position.
    The general 'statments' about location of pain are good start points, but often just that.
    Restricting the natural leg movement can also be an issue. My right leg wobbles like a 'mother' when I'm really under heavy effort (lotsa reasons). If I were to use a pedal system without float or one very restricted, my legs and knees would feel it. Float doesn't make my attachment to the pedal and crank any less secure or less powerful, it allows my leg to follow its natural movement without requiring further mechanical/structural intervention. If it was about skiing or skating where edgecontrol is an issue, I;d say more 'control' is important. But cycling is all about delvering the best and smoothest power stroke you can, and that often means letting the body do its little 'adjustment' things to make that happen.
    Short clips of a Pro rider from the day, Michel Pollentier, would Hi-light that adage. His pedaling style was god-awful. A really nice guy from what stories tell, but his style would remind me of a butcher hackin huge hunks of bone and meat. But it didn;t seem to slow him down much...
    Best of luck in getting it sorted.
    EDIT - thinking about Michel (cause he was one of those "leave it all out on the road guys" - Hincapie's recent stage ride in T of C with a broken wrist reminded me of him) the only image i could root up was this ebay sale of a poster of him http://cgi.ebay.com/Cycling-Action-P...QQcmdZViewItem
    very cool
    Last edited by cyclezen; 04-03-07 at 12:05 PM.

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