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Old 10-25-12, 10:39 AM   #1
juggleaddict
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possible causes for knee pain

I recently went on a short overnight tour and have never had issues with my knees before. So to get a few things out of the way:

-I've never done more than a 3 day tour
-I've ridden a unicycle and bicycle over 100 miles within a day or two and have never experienced knee pain before
-I am getting back into cycling after a year of not riding, but have been riding about 5-10 miles a day before this tour
-I have ridden in cold weather with no pain as well

Even on this trip, no problems the first full day, I felt fine until about 30 miles in on the second day. Then I started to feel effects that seem to coincide with the description of Chondromalacia. Knee pain in the front of the kneecap. It quickly began to become pretty intense, but I couldn't stop that day as I was on a time constraint. After a week of not riding I felt fine and got back on the bike....the pain immediately and sharply came back within a mile or two. Now I'm looking up ways to get back to normal through exercises, but I'm concerned because I haven't had any issues with my knees before, even when I was running and rather abusive to them.

I have noted 2 things that were different:

-I was wearing long compression pants (because it was cold)
-It was a hard-pack gravel Trail

According to Sheldon Brown's website this kind of injury can be caused by twisting or lateral forces on the knee. Is it possible that compression wear could put pressure in the wrong spot while cycling? Is it possible that a different terrain may have changed my riding form in a way I wasn't aware of that could have caused this?

Any and all thoughts are welcome. I'm rather frustrated I haven't been able to commute even 2 miles to school over the past week or two. I just want to make sure this kind of thing doesn't happen again, especially if I go on a larger tour.
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Old 10-25-12, 10:43 AM   #2
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Is it possible you simply rode too hard?
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Old 10-25-12, 10:51 AM   #3
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Seat may be to low.
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Old 10-25-12, 10:59 AM   #4
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I recall reading somewhere that if you have pain in the front of your knee, move your seat up and if the pain is in the back of the knee, lower your seat.

I usually adjust my seatpost no more than a quarter inch at a time.

I also wrap electrical tape around the seatpost to mark where I want it.

I have not had any knee pain for several years now that I no longer stand on the pedals to climb hills or accelerate.
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Old 10-25-12, 11:07 AM   #5
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I have my seat as far up as it will go without bobbing. I'll try a quarter of an inch or so.

I don't think I was riding any harder than usual, but it was on gravel so I may have been trying to keep my same pace and worked harder than I thought I was. . . if that makes sense. Still I've pushed all day long before on flat ground with a single speed, maybe I'm getting my gearing wrong. I'm trying to spin more, push less, but I have no reference on what my rpms are.
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Old 10-25-12, 11:45 AM   #6
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I think your first guess is correct: the compression pants changed how your kneecap tracked. Now it's sore. Try doing anything other than cycling for a week or so. Walk, run, anything that doesn't hurt. If it hurts, stop.
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Old 10-25-12, 12:30 PM   #7
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Then I started to feel effects that seem to coincide with the description of Chondromalacia. Knee pain in the front of the kneecap. It quickly began to become pretty intense, but I couldn't stop that day as I was on a time constraint. After a week of not riding I felt fine and got back on the bike....the pain immediately and sharply came back within a mile or two. Now I'm looking up ways to get back to normal through exercises, but I'm concerned because I haven't had any issues with my knees before, even when I was running and rather abusive to them.

I have noted 2 things that were different:

-I was wearing long compression pants (because it was cold)
That'll do it.

I have a terrible time wearing rain pants because within a very short time they cause me all sorts of knee pain. Even some tights cause me problems. The first time I noticed the problem, I was riding a bitterly cold century with several layers over my knees. I ended up with patella-femoral pain syndrome (diagnosed by a sports dr) very badly and it took a couple months of rest and doing leg weights before they felt better again. But now, anything tight over my knees and I have problems.
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Old 10-25-12, 01:03 PM   #8
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Yes, another vote for the compression pants.

Sometimes I find it comes from pulling the cuffs down around my socks, so there are opposing push-pull forces between the fabrics, and the area over the knee remains tight.

Riding the hard-packed trail may also have contributed a little -- I find there is a tendency to coast over rocks and ruts just slightly off the seat, and if you do that with the pedals level (as in standard MTB practice over rough ground), and the affected knee was on the forward knee, you may have strained the ligaments above the patella.

Once you have it, it does take some time to overcome it. Rest, and icing should help some.
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Old 10-25-12, 01:05 PM   #9
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Yes, another vote for the compression pants.

Sometimes I find it comes from pulling the cuffs down around my socks, so there are opposing push-pull forces between the fabrics, and the area over the knee remains tight.

Riding the hard-packed trail may also have contributed a little -- I find there is a tendency to coast over rocks and ruts just slightly off the seat, and if you do that with the pedals level (as in standard MTB practice over rough ground), and the affected knee was on the forward knee, you may have strained the ligaments above the patella.

Finally, there is a slight case that you have an imbalance between your glutes and quads, strengthwise. You may need to do some exercises to strengthen, likely the quads.

Once you have it, it does take some time to overcome it. Rest, and icing should help some.
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Old 10-25-12, 01:06 PM   #10
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Yes, another vote for the compression pants.

Sometimes I find it comes from pulling the cuffs down around my socks, so there are opposing push-pull forces between the fabrics, and the area over the knee remains tight.

Riding the hard-packed trail may also have contributed a little -- I find there is a tendency to coast over rocks and ruts just slightly off the seat, and if you do that with the pedals level (as in standard MTB practice over rough ground), and the affected knee was on the forward knee, you may have strained the ligaments above the patella.

Finally, there is a slight case that you have an imbalance between the muscles that make up your quads, strengthwise. You may need to do some exercises to strengthen, likely the inner quad muscles.

Once you have it, it does take some time to overcome it. Rest, and icing should help some.
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Old 10-25-12, 01:54 PM   #11
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Yes, another vote for the compression pants.
Well that's good to hear. It does make sense too, I wasn't wearing them the first day except for the first 2 or 3 miles, then it was too warm. Wore them all day the second day.

Dang, I will have to go back and get the short version of them, I liked them better than my cycling shorts because they don't have any padding to bunch up.

Thanks all : ) Sad that I learned this lesson the hard way, but good to hear that the solution is easy.
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Old 10-25-12, 01:57 PM   #12
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My current rain pants do get quite tight over the knees, but Rowan has a pair of rain pants which have articulated knees (the knee area is baggier), and I would like to get a pair of those to see if they will work for me.

As far as cycling in cooler weather, leg warmers can be quite good because I can loosen them off over the knees.
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Old 10-26-12, 06:50 AM   #13
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If the padding in your bike shorts is bunching up, then they are the wrong size too (too big). Shorts should be snug.
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Old 10-26-12, 06:58 AM   #14
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If the padding in your bike shorts is bunching up, then they are the wrong size too (too big). Shorts should be snug.
oh they are certainly snug enough. Bunching probably wasn't the right word. Padding tends to get squashed and then it's just useless and putting pressure in places it shouldn't. With the brooks there's really no need for padded shorts anyway, it's always fit me even when it was hard as a rock. . . still comfy. I have only pair of padded shorts for this reason, I've always ridden in boxers and gym shorts, even the 100 mile runs and been fine as long as I have the brooks under me. The compression pants were extremely comfy on the saddle.
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Old 10-26-12, 09:22 AM   #15
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I haven't been able to commute even 2 miles to school over the past week or two.
teacher or student? this is kind of an how old are you question,
have any history of other knee trauma?

and have you discussed any of this, in person, with your MD?
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Old 10-26-12, 10:02 AM   #16
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I'm a graduate student at Georgia Tech. : )

No history of any injuries at all. No knee pain that I can ever remember. That's sort of why I was perplexed.

I'm 23, and haven't been to a doctor but once or twice in those years. The only one I can remember was for the flu. I wouldn't even know where to go to see a doctor other than the heath center on campus, which I considered. After reading up, it sounds like some exercises and rest will be the ticket, but I did contemplate getting xrays or something because of the level of pain I was in when i got back. Probably too late to get them now.
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Old 10-26-12, 10:57 AM   #17
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I'm a graduate student at Georgia Tech. : )

No history of any injuries at all. No knee pain that I can ever remember. That's sort of why I was perplexed.

I'm 23, and haven't been to a doctor but once or twice in those years. The only one I can remember was for the flu. I wouldn't even know where to go to see a doctor other than the heath center on campus, which I considered. After reading up, it sounds like some exercises and rest will be the ticket, but I did contemplate getting xrays or something because of the level of pain I was in when i got back. Probably too late to get them now.
If it gets bad, consult a physician, but my experience with doctors at university health centers has been they just want to get you out the door as fast as possible. They'll give you a pamphlet on whatever your ailment is and send you on your way.
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Old 10-26-12, 11:14 AM   #18
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yea, that's where I went for the flu and they basically said "yup, you have the flu, here's a load of meds, go home and rest...wash your hands." . . . I guess I got some free ibuprophen out of the deal. Rather I paid an exorbitant fee to have health services and got a few pills out of the deal.

by "in those years" I mean "in 5 or so years" . . . not all 23 : P
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Old 10-26-12, 12:41 PM   #19
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oh they are certainly snug enough. Bunching probably wasn't the right word. Padding tends to get squashed and then it's just useless and putting pressure in places it shouldn't. With the brooks there's really no need for padded shorts anyway, it's always fit me even when it was hard as a rock. . . still comfy. I have only pair of padded shorts for this reason, I've always ridden in boxers and gym shorts, even the 100 mile runs and been fine as long as I have the brooks under me. The compression pants were extremely comfy on the saddle.
I made a conscious decision not to bring padded bike shorts with me on this tour. Our days haven't been terribly long, and I've been OK on the Brooks B17. It wasn't really broken in when I left, so it's actually getting more and more comfortable as I go. I'd probably baulk at doing a century, however.

Patella tendonitis can be very painful. Rest is the primary treatment -- that is, avoiding riding the bike for a while.
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