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  1. #1
    Senior Member blaronn's Avatar
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    Different kind of knee pain...

    I've searched and found all kinds of threads about pain below the knee and behind the knee but none like what I'm having. My knee pain is on the top, inside corner of my knee cap - almost like it was bruised by knocking it with a hammer from above while my knee was bent. No pain while riding, only the first couple days after long rides, and the pain is mostly external, like a bruise - sensitive to the touch. Also, when I stand after sitting for a couple hours it gives some pain for the first few seconds of motion.

    I've been riding seriously & racing for about 18 months and haven't experienced anything like this until the past month or so.

    Anybody experience this or know any general rules about this type of knee pain?

  2. #2
    Sultan of Slow ataraxium's Avatar
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    I am going through this at the moment. I raced cross this past season and logged in alot of miles last year. Here lately I have been having horrible knee pains in the same area. I have tried adjusting saddle height and position, adjusting horizontal pedal movement, switching saddles...nothing. I can normally get in about 10-20 miles and then the pain starts. For the next couple of days it is sore to the touch in that area and stiffens a bit if I sit down. Applying in force with my legs makes the pain worse.

    For an answer, I have no clue. I have been trying to figure this out for a month now.

  3. #3
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    Spring knee? Plica syndrome? I'm throwing out close matches from a book I have, Andy Pruitt's medical guide for cyclists.

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    Banned wagathon's Avatar
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    Bowler's knee (runner's knee)? If so, maybe an arch support or orthotic device might help?

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    Rawwrrrrrrrrr! wolfpack's Avatar
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    medial side pain, bruising, tenderness from about 1.5" below joint line to about a 1" above? some pain in the front of knee as well. tendonitis/bursitis for me. overuse injury, tight hamstrings. cure=stretch, stretch, stretch. not sure if same problem exists for y'all, but it's what i've got.
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  6. #6
    Sultan of Slow ataraxium's Avatar
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    Just last week I have found that my knee pain abated after a brief workout with freeweights. Probably just coincidence. Stretching has helped with mine, but it still hurts. Did some drills yesterday and my knees are both sore to the touch today right along the interior edge of the patella. Fun stuff.

  7. #7
    Senior Member kk4df's Avatar
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    Quote Originally Posted by blaronn View Post
    I've searched and found all kinds of threads about pain below the knee and behind the knee but none like what I'm having. My knee pain is on the top, inside corner of my knee cap - almost like it was bruised by knocking it with a hammer from above while my knee was bent. No pain while riding, only the first couple days after long rides, and the pain is mostly external, like a bruise - sensitive to the touch. Also, when I stand after sitting for a couple hours it gives some pain for the first few seconds of motion.

    I've been riding seriously & racing for about 18 months and haven't experienced anything like this until the past month or so.

    Anybody experience this or know any general rules about this type of knee pain?
    I've had similar knee pain after a long ride. It takes a long time to heal. Walking down stairs makes it hurt. Raising the seat seemed to help a bit. I'm also trying some Lemond wedges under my cleats, with the thicker part to the inside.

  8. #8
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    possibly patellofemoral pain syndrome

    I've been fighting with knee pain that is similar to what you and several others describe. After some digging in medical literature, I'm fairly confident I'm suffering from "patellofemoral pain syndrome" or something very similar. There is a pretty decent (clear, concise, relatively comprehensive) article with some treatment recommendations in American Family Physician
    (http://www.aafp.org/afp/991101ap/2012.html) although it is not cycling specific (but then, neither is the injury!). Good luck.

  9. #9
    Senior Member blaronn's Avatar
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    At a glance that looks like good info. Thanks.

    For starters I scheduled a proper bike fitting. Never had one before, which could easily be the problem. Hopefully that will fix it.

  10. #10
    Splicer of Molecules Nickel's Avatar
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    That's a great article. I had thought my problem was related to a quad imbalance but they are almost balanced and I am still having issues. According to that article, I suppose it could be many things.

    Is there a way to tell if your hips are too tight? I imagine that trying to touch my toes tells me about my hamstrings but I didn't know the equivalent for the hips.

  11. #11
    Banned wagathon's Avatar
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    Interesting tie-in as regards the use of Kneesavers--to increase the Q-factor (increasing the distance between the pedals with an extender on one or both pedals)--to decrease the Q-angle (which from the diagram would seem to decrease with a wider riding stance, e.g., alignment of the leg perhaps taking the stress off of a tight iliotibial band).

    From the article:

    Q Angle. Although some investigators believe that a "large" Q angle (Figure 3) is a predisposing factor for patellofemoral pain, others question this claim. One study12 found similar Q angles in symptomatic and nonsymptomatic patients. Another study6 compared the symptomatic and asymptomatic legs in 40 patients with unilateral symptoms and found similar Q angles in each leg. Furthermore, "normal" Q angles vary from 10 to 22 degrees,3 depending on the study, and measurements of the Q angle in the same patient vary from physician to physician.13 Therefore, the physician should be wary of placing too much emphasis on such biomechanical "variants," as this can lead patients to believe that nothing can be done about their pain.

    Last edited by wagathon; 02-05-08 at 03:30 PM.

  12. #12
    Splicer of Molecules Nickel's Avatar
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    I do use Kneesavers on my one bike actually and the one that gives me knee pain I do not have them because 1) I am too lazy to switch between bikes and 2) Haven't coughed up the change for a second set. I noticed my knees never bothered me on my mtb and measured that Q factor and tried to emulate that on my road bike. I hadn't been riding road bike #2 very frequently so didn't think I'd need them but it has become my bad weather bike so I should just invest already.

  13. #13
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    I think this is the knee pain I have. It hurts at the top of my knee cap (my hamstring has also been tight the last few days). I really feel it when I'm on stairs. I think my panniers made my seat go down just enough to do the damage. I've been off my bike for a week and the pain is still there. Any advice on healing this quickly? The DNC is here in Denver next week and I don't want to have to drive or worry about mass transit.

  14. #14
    Senior Member Ranger63's Avatar
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    Knee Pain

    I'm going to shortcut this thread so I can check daily and see if anyone finds a cause/cure.
    UP till late last season I wasn't having any knee problems.
    Then I started upping the speed ante..going from the mean average of 15mph to 18.
    It's above 18/19 that the problem seems to crop up.
    Extended periods in the 22mph range really bring the pain issue to the forefront.
    Dropping back to 16/17 eleviates the pain entirely (and my riding with the main pack..lol) but extended rides (50-75 miles with some rolling hills)seems to bring it back.
    I'm not pushing big gears and I bring my speed up (the entire group does) gradually.
    For me,it's in the same area described. About an inch above the knee cap and to the inside but still in the front.

  15. #15
    Cat 4 J.Lockdown's Avatar
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    I have been having a similar problem but the cause might be different. From a group ride I did many members mentioned that my legs ten to move inside and out when riding. They do not like to stay straight and this is what has been causing a problem. Its also believe to be from my left leg being a little longer then my right.

    I am currently correcting the issue but I thats how I get a similar pain just not as bad as u described.
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  16. #16
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    what's interesting to me is this started when I added panniers to my bike. Maybe I didn't account for the extra weight or the change in weight distribution. Do you think it's a bad idea to try riding my mountain bike this weekend (very high cadence- low resistance) just to pedal a little? It feels a little better today and I'm dying without riding....

  17. #17
    Rothar
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    Hi All!

    I'm a bit late to this thread (just joined the forum), but since there're still recent postings, I figured I'd add my voice...

    I'm a physical therapist (for what it's worth; and consider this the usual disclaimer that this is not medical or therapeutic advice. If your pain is bad and you suspect something is wrong, by all means see your PCP :0) ) and I see patellofemoral pain syndrome (PFPS) quite frequently. I've not yet looked at the aafp.org article Boutwell included, but here's what the newest research shows: PFPS in closed-kinetic chain activities (such as cycling) is associated with weak hip external abductors and external rotators. If these muscles are weak or excessively fatigued, when we put pressure through our legs into the pedals the femur will internally rotate and the knee will also be driven medially (you've probably seen this in other cycslists: at the highest power generating portion of the pedal stroke, their knees drive in toward the top-tube...) and applies a valgus force to the knee. This valgus force is very stressful for a knee. It's like grossly exaggerating your Q-angle while applying the greatest force through your knee...Ouch!.

    How can you tell if this is what's going on with you? Simple, but you'll need a friend you can trust.
    1) lay on your side with the symptomatic side up.
    2) bend your lower leg (asymptomatic) up so knee and hip are flexed approx. 90 degrees
    3) have your friend left your straightened symptomatic leg (let your friend do all the work!) up and back (the position is not unlike the position you'd be in if you'd finished a skating stride on skis or inline skates).
    4) using the muscles of you hips, you HOLD the leg in that position
    5) here's where the "trust" mentioned earlier comes in: have your friend push down on your leg, trying to return it to its original rest position. Ask your friend not to hammer on you, but to apply the force evenly and steadily.

    If your hip muscles are too weak, you'll not be able to maintain the test position. Either your leg will come forward to take advantage of the powerful little tensor fascia latae muscle in the anterior hip, or your leg will be easily pushed down (in hip abductors/external rotators with "normal" strength, your friend should have to work REALLY hard to push your leg down)

    Okay, so they're weak! What do I do now?

    My favorite exercise for this, and occasionally the only exercise I give my patients, is to take a length of theraband (big rubber band which comes in a variety of resistances), tie it around the thighs just above the knees. Lay on your side with both knees and hip bent, feet together. Keep feet together and lift the top knee away from the lower knee. Go slowly and steadily, and go as wide as you can without excessive accessory contortions. Do 20-50 reps and expect that your butt will be on fire! If you feel any pain (other than lactic acid build-up) stop immediately! Repeat for the other side...

    Simple, eh?

    Let me know if you need further clarification or if you'd like some further info on this (unfortunately, the journals which include this information require affiliation/membership, so a link won't quite work).

    Cheers!

  18. #18
    Meh
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    Wow that is some good info. Thanks!

  19. #19
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    Thanks a lot. My hip-flexor often gives me problems. Who knew they were linked!

  20. #20
    Rothar
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    Quote Originally Posted by NASH View Post
    Wow that is some good info. Thanks!
    Good! I hope it helps!

  21. #21
    Rothar
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    Quote Originally Posted by mhnassi View Post
    Thanks a lot. My hip-flexor often gives me problems. Who knew they were linked!
    The muscles typically involved in PFPS are the hip abductors (lifts your leg out to the side and extends the leg somewhat behind you) and the hip external rotators... the hip flexors are typically their own special problem, though if you're internally rotating your thigh and driving your knee toward the top-tube during the max-power phase of the pedal stroke, it *can* cause trouble in the hip flexors. Either way, strengthening the abductors/external rotators will probably help you out anyway! Good Luck!

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