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Old 03-09-09, 06:54 AM   #1
Daerkon
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Pain behind kneecap

I have been training consistently for over 2 months now and have added a lot of climbing more recently as the road conditions have been improving. Most of my rides are between 1.5-2.5 hours in duration. I ride 5-6 days a week currently to include some recovery rides. I have some previous knee surgeries (meniscus) but so far have had no issues with either knee.

Yesterday I rode a long flat ride of about 4 hours and during the ride developed a dull pain behind my right kneecap. The only difference between this ride and my usual training was that I spent the majority of the time on the drops as it was flat and windy. It was also a fast group ride that was significantly high in terms of effort. Is it possible that this change in position could have caused the knee pain? It seems different than I have previously experienced, it hurts if I kneel on it but is not a sharp pain and has caused no swelling or fluid build up.

I will possibly take it easy today either spinning or totally off the bike to see how it feels. Anyone experience anything similar? Any thoughts?
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Old 03-09-09, 07:44 AM   #2
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This is probably not the response you were looking for, but since this is a sub-forum about nutrition, I thought I would reply with my experience about joint pain.
Besides riding my bicycle on a regular basis, I do a lot of hard work on my property.
I used to have a lot of problems with my joints; knee, hip, shoulder, elbow.
There were times when I could barely walk, it hurt so much and other times when I could not use an arm for any lifting.
I tried wearing those elastic braces when I did any exercises or hard work.
I even tried those joint multivitamins.
Then, someone told me about how weight lifters use flaxseed oil to protect their joints.
So, I decided to give it a try.
That was about 3-4 years ago.
Everyday I take a tablespoon of flaxseed oil.
It still amazes me that since I started taking flaxseed oil, I have not had any joint problems.
I'm certainly no expert on nutition.
I just wanted to share my experience with joint pain.
Best of luck to you.
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Old 03-09-09, 08:14 AM   #3
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Go easy on it. It sounds like when I had "prepatellar bursitis" (inflamed bursa behind the kneecap). IF you go easy now, it should heal up OK in a fairly short time. If you're stupid like me, it will continue to give you trouble for months.
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Old 03-09-09, 08:58 AM   #4
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Stretching out on the drops puts more strain on the hamstring, so that could be the issue. I have had similar issues from time to time, particularly recently in fitting a new road bike after months of mountain biking. An identical saddle height and fore-aft position led to inside-knee pain pretty quickly on the road bike, the only difference being the less upright position.

I found that moving the seat forward a couple of centimeters helped a great deal, as well as working on flexibility.

on edit - looking at the post upthread, I'll give flaxseed oil a try too.

Last edited by daxr; 03-09-09 at 09:03 AM.
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Old 03-09-09, 10:36 AM   #5
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could be lots of things -
- simple over-did-it syndrome
- tight hammies
- seat too low
- gears too big
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Old 03-09-09, 11:08 AM   #6
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Thanks for the responses. I can certainly try the flaxseed oil, how long was it until you experienced a change using this product? I have been using Glucosamine for quite a long time now after my doctor recommended giving it a shot following my last surgery. My doctor said some people benefit greatly from it and others report no real improvement, unfortunately I think I fall in to the latter category.

I am thinking I pushed it a little hard and am going to look into the position a bit more when I am in the drops as I think this must be a factor. I am very hesitant to adjust my position as it is such a science and it took a long time to sort out my current position. Prior to being professionally fitted I had experienced knee pain regularly and after much work and adjustment all that went away - I guess my body could be changing and I need to go back for a refit!
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Old 03-10-09, 10:08 AM   #7
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sounds like a fit problem. have you ever been fit?
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Old 03-10-09, 04:02 PM   #8
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Quote:
Originally Posted by Kotts View Post
Go easy on it. It sounds like when I had "prepatellar bursitis" (inflamed bursa behind the kneecap). IF you go easy now, it should heal up OK in a fairly short time. If you're stupid like me, it will continue to give you trouble for months.
Doesn't sound like pre-patellar bursitis to me (I'm a PT). The prepatellar bursa is located in front of the kneecap and is usually irritated in kneeling activities. Pain behind the kneecap in cyclists would more likely be due to chondromalacia patella-- irritation of the cartilage (not a bursa) behind the kneecap. Relative rest, cross-training, and attention to the tracking of the kneecap through balance of the quadriceps and hamstring groups are important. The fit of you bike also affects the tracking of your patella, so have someone check that out. If the problem persists beyond a few days with rest, see a PT or orthopedic doc who treats athletes for a diagnosis and treatment plan. I have had this condition from time to time, and it can be resistant to treatment, especially when longstanding. I have found the position of my foot on the pedal critical to not aggravating this problem.
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Old 03-11-09, 08:35 AM   #9
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Doesn't sound like pre-patellar bursitis to me (I'm a PT). The prepatellar bursa is located in front of the kneecap and is usually irritated in kneeling activities. Pain behind the kneecap in cyclists would more likely be due to chondromalacia patella-- irritation of the cartilage (not a bursa) behind the kneecap. Relative rest, cross-training, and attention to the tracking of the kneecap through balance of the quadriceps and hamstring groups are important. The fit of you bike also affects the tracking of your patella, so have someone check that out. If the problem persists beyond a few days with rest, see a PT or orthopedic doc who treats athletes for a diagnosis and treatment plan. I have had this condition from time to time, and it can be resistant to treatment, especially when longstanding. I have found the position of my foot on the pedal critical to not aggravating this problem.
I completely agree, with a few additions. Prepatellar bursitis would also have your knee very swollen, a symptom you did not mention. Due to the stated change in position on the bike, chondromalacia is very much a possibility. I would definitely recommend a sports medicine clinic for an evaluation if the pain persists. The right brace and possibly a few specific stretching and strengthening exercises could clear this up in no time.

D
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Old 03-11-09, 09:08 AM   #10
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It sounds more like a patella mistracking problem to me.
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Old 03-11-09, 03:17 PM   #11
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For chondromalacia patella, raise your saddle. Try setting your saddle so that there's a 4mm gap between your fully extended heel and the pedal. Then go easier for a while.
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Old 03-12-09, 06:02 AM   #12
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For chondromalacia patella, raise your saddle. Try setting your saddle so that there's a 4mm gap between your fully extended heel and the pedal. Then go easier for a while.
Good advice, but address the reason for the patella symptons also. Ie if it is a mistracking issue then work on the controll and alingament of the knee. if its a strength issue look to strengthen specifically, if the patella needs to be more mobile then mobilise it passively. Else the problem may return.
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Old 03-12-09, 09:56 PM   #13
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Well, I got this I think my second year of serious training. I went to an orthopod who told me my legs are deformed, I had "loose patella" and I am in inferior being who should give up cycling and wait until it is my time to start using a walker. I already realized I was an inferior being, but the heck with that!

Of course I completely ignored him, raised my saddle as above, stopped doing leg extensions and knee curls at the gym, switching to just leg sled and barbell squats, 3 sets of 30 of each, and sure enough, it got better, then went away and never returned. Also I took 2000mg/day of glucosamine (still use 1000 mg). I might have taken ibuprofen, too, but I don't remember.

Oh, and make sure your seated climbing cadence is at least 80, and 90+ on the flat.
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Old 03-13-09, 04:40 AM   #14
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"loose patellas" are fine ,poorly controlled or mistracking ones need targeted exercise. Seems like your targetting was good enought.
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Old 03-13-09, 07:55 PM   #15
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So I took Monday and Tuesday of this week off to give my knee and body some time to recover. My knee was a little stiff on Monday but much improved by Tuesday, no swelling either day. I decided to start back on Wednesday on the rollers so that if there was pain at any point I could simply jump off. I rode the rollers for an hour on Wednesday and one and a half hours on Thursday at high cadence and felt nothing unusual. Today I went out for an hour and a half on the road climbing 2500' and again maintained a fairly high cadence the ride was relaxed and no issues with the knee. I definitely feel the issue was related to being in the drops for an extended period of time and/or the level of exertion.

I have been professionally fitted and my bike was custom built for me (although it was originally built 10 years ago when I was racing some and an aggressive rider, titanium and carbon - Seven Odonata). I rebuilt it 18 months ago with dura ace 10 and all new components which changed the geometry a little. I had a refit following the bike rebuild. I am thinking of taking it a little easier on the current training and going to look into reviewing position when I can schedule an appointment. I am getting older and maybe need to be more gradual in increasing my efforts particularly given the previous knee surgeries.

Thanks again for all the information!
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