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Old 11-18-09, 10:16 AM   #1
enfilade
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Bad knees for cycling? (Pictures)

I've been having pain in my knees for seven weeks now. after doing a lot of reading, and seeing my physiotherapist, we can't pinpoint a specific problem.. just patella-femoral pain syndrome (PFPS), which really could be anything.


(see the surfer)
\ /
\/



(feet are facing forward in this photo)

Does it look like the knees are misaligned?




Again here, doesn't it look like the tibia is connected to the knee joint at a weird angle.. very lateral?

Will stretching and strengthening the muscles actually change the shape and mechanics of the joint? or does it just improve the quality of the muscle?

I'm hoping that strengthening muscles on the medial side will cause a greater medial pull on the tibia, bringing it back into alignment, but i don't know whether that's possible now. I'm 21 by the way.

I am worried about this. I want to be cycling strong when i'm seventy!


Any input and advice is very appreciated.
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Old 11-18-09, 10:32 AM   #2
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Try some IT band stretches.
http://www.youtube.com/watch?v=t2uCy7lb9XU
Look up other ones. Go easy. Keep cadence high while riding.

Last edited by Metzinger; 11-18-09 at 11:26 AM.
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Old 11-18-09, 11:25 AM   #3
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Apologies. Fixed bad link above.
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Old 11-18-09, 12:12 PM   #4
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My legs look about like yours, except for being powerfully muscled of course. I was having knee pain when I started serious training, many years ago. So I went to an orthopedic doc. He measured and examined and told me that my knees were congenitally deformed, misaligned, I had "loose patella," and I should just accept that I would be couch potato forever. Instead, I kept going to the gym, lifting weights, and doing pedalling drills on the bike. All was fine in just a few months of that treatment. Now I can hump 75 lbs. on the trail and ride 100s of miles in a day.

Try squats, leg sled, and one-legged pedalling. Don't go real deep, not beyond a 90 knee angle, on the squats or sled. Also, and this is important, be sure to push your foot forward at the top of the pedal stroke. You should feel your foot push forward in the shoe. This will help your patella track better.
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Old 11-18-09, 03:06 PM   #5
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Originally Posted by Carbonfiberboy View Post
Try squats, leg sled, and one-legged pedalling. Don't go real deep, not beyond a 90 knee angle, on the squats or sled. Also, and this is important, be sure to push your foot forward at the top of the pedal stroke. You should feel your foot push forward in the shoe. This will help your patella track better.
Never thought of the foot movement before. When I was a masher I'd just put all my weight on one leg, the leg with the foot at the top. That one would slowly go down then I'd shift all my weight across onto the other side.

Ah, I'm going to miss mashing.

I'll need a few bigger gears when I get back on the bike. There's no way I could climb some of the hills around here seated, in the big gear alone. The reason I mashed was to give the quads a break. Guess it's gonna take me a lot longer to climb in future..

Thanks for the link Metzinger. I haven't done any ITB stretches but I am using a foam roller on it.
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Old 11-19-09, 06:18 AM   #6
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enfilade, my partner in pfps crime - no itb stretches? shame on you.
tight lateral structures and weak/loose medial ones can play a big factor in pfps.

Im not sure my knees/legs look like yours
( i will PM you a photo, for comparison sake )

Trust me on whole "spinning is better for your knees than mashing"
bad knees might not ever cause you a problem if you spin all day long.
or, you might have decent knees - that get thrown out of whack by doing something silly ( lets just say that i now know that a high geared P2C and a day of hill climbing do not go hand in hand )
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Old 11-19-09, 06:28 AM   #7
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I have the same problem and had to take 6 weeks off when it first appeared. Various knee wraps and straps and I've tried them all, seem to help a bit. Presently I wear Mueller sleeves on both knees.
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Old 11-19-09, 03:19 PM   #8
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I have the same problem and had to take 6 weeks off when it first appeared. Various knee wraps and straps and I've tried them all, seem to help a bit. Presently I wear Mueller sleeves on both knees.

6 weeks? Lucky.
Im at 2 months in a few days time.
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Old 11-19-09, 04:29 PM   #9
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I'd see a pro not just any random doc or therapist but one who knows about cycling and who can set up your bike to fit your body. I'm lucky because I have an amazing bike fitting shop just down the street. Question them about flexibility--in my case, any added flexibility is a detriment (I have way too much mobility in my knees).
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Old 11-19-09, 05:31 PM   #10
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My knees look more or less like yours. With the help of a trained bike fitter (BG specialized shop fitter), I have yet to have any problems related to the way I was built. Overtraining on the other hand....
The best thing you can do for yourself until you get a pro fitter to look at you is make sure the muscles that support posture are fit. This includes the muscles around your ankles, knees, hips. Weakness in these parts, for me, most definitely affects my posture on and off the bike. Cycling wont do much to help your body support itself to avoid injuries.
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Old 11-19-09, 07:31 PM   #11
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It is easy to look for something to nitpick when you're looking for the cause of something. Something you wouldn't find before pain will be there after. Sometimes it's the cause. More likely, it's just an artifact.

You don't look like you're put together weird. Just slightly knock-kneed., which can cause a whole lot of problems if your shoe isn't fit right and your cleats aren't placed correctly. Under a lot of force, I'd guess your knees track toward the tube. Fit, stretching, using smaller ratios, and maybe a little muscle development, should help.
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Old 11-19-09, 11:43 PM   #12
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Originally Posted by enfilade View Post
Never thought of the foot movement before. When I was a masher I'd just put all my weight on one leg, the leg with the foot at the top. That one would slowly go down then I'd shift all my weight across onto the other side.

Ah, I'm going to miss mashing.

I'll need a few bigger gears when I get back on the bike. There's no way I could climb some of the hills around here seated, in the big gear alone. The reason I mashed was to give the quads a break. Guess it's gonna take me a lot longer to climb in future..

Thanks for the link Metzinger. I haven't done any ITB stretches but I am using a foam roller on it.
Nuh, nuh, nuh, nuh, nuh! Smaller gears will probably get you climbing faster. You want to use all the muscles in your legs, more or less evenly, when you climb. The more you spread out the load, the more total load your legs can absorb. Your heart rate should be your limiter, not your legs or lungs. Your legs should actually be fairly comfortable at maximum 10 minute duration climbing load. They'll hurt after and hour and a half of that, sure, but they should hurt all over, not just one part. If you can't climb your local hills seated, you need smaller gears. You should be able to climb up to 18% seated using normal road gearing, say 30 X 25. Concentrate on putting power to the pedals all around the circle. You won't be able to do much more than unweight the pedal on the upper part of the backstroke, but at least do that. Try not to move your upper body at all. Hold it perfectly still. The act of pedaling circles will prevent upper body movement all by itself. You won't need to pry on the bars at all.
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Old 11-19-09, 11:54 PM   #13
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Did anything about your bike or riding regimen change about seven weeks ago?

If you haven't already, I would strongly recommend that you get a bike fitting; otherwise it's likely that you're only treating the symptoms.

And like others have posted, spinning is definitely easier on the knees than mashing.
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Old 11-20-09, 03:36 AM   #14
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Judging by those legs, I assume you are pretty new to the sport. I had similar issues when I first started out, and especially when I switched to using clipless pedals. A proper bike fit aleviated most of the issues. The other niggles just took time. I think years of doing no sport led to the muscles around my knees being pretty weak. I concentrated on good diet, weight bearing exercise, walking/jogging and miles on the bike which eventually strengthened things up.
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Old 11-20-09, 02:25 PM   #15
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Did anything about your bike or riding regimen change about seven weeks ago?
Yes, in the month leading up to the injury I increased my mileage. I was definately overtraining. I felt a burning pain in my quads in the first mile of several rides. It was the feeling you get before a cramp. I wasn't stretching properly either. I was mashing up big hills in cold conditions wearing just shorts. And I wasn't clipped in. It's not that I couldn't be bothered.. I just didn't know what was optional and what was necassary.

In future, wearing knee warmers for atleast 6 months of the year will be necassary, so will stretching every day, and strengthening every other day. and of course going clipless.

Quote:
If you haven't already, I would strongly recommend that you get a bike fitting; otherwise it's likely that you're only treating the symptoms.
There's actually nowhere around here that does them. I live in rural UK, about 30 miles away from Manchester, so I've been looking at the shops there. I've done many Google searches.. 'bike fitting manchester' etc etc. no luck.

..except for one shop, which may do them, but they have very poor customer service and reviews. I'd rather wait and find a decent shop further afield.

If anyone knows of any in Derbyshire/Cheshire/Manchester.. even Merseyside, Yorkshire or Leicestershire.. please let me know. I could take a day out to get it done

Quote:
enfilade, my partner in pfps crime - no itb stretches? shame on you.
Shush it JC I tried one yesterday, the one in Metzinger's video. Couldn't do many though, they seem to put pressure on the knees.. started aching after a minute or two so I stopped. I've been focusing on straight-kneed stretches and exercises as much as I can. I'll take up the ITB stretch soon if my knees are up for it. Foam roller in the meantime. Isn't that just as good as stretching? Kind of like a massage.

Quote:
Judging by those legs, I assume you are pretty new to the sport
Not really, but I'm new to training. The muscles are more developed than they look in that picture, they're fully relaxed there. Still, very narrow legs and weak VMO's though. The physio said I need to build the muscles near the knee to help the patella track better.

It's difficult. I eat 4, sometimes 5 meals a day, always have done. Still only 125lbs :|


I've got bad clicky, popping knees at the moment. Anyone get rid of it? And how? Hoping it will clear up when my muscles are more balanced.
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Old 11-20-09, 05:27 PM   #16
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I have the same crooked knee shape, and I've also had some knee problems.
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Old 11-22-09, 08:46 AM   #17
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Best to get a pro bike fit.

Second best is to get a number of good pics of how you sit on the bike and post them here. We'd need
a side shot with leg all the way down.

A video of you from the back pedalling would be ideal.

However, I use pedal spacers, and they may help you.
http://www.bikefit.com/products.php

Do you wear out your shoes on one side more than the other? If you do, you may also need ITS Wedges.
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Old 11-22-09, 09:22 PM   #18
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To me, it almost looks as though one leg is a little shorter than the other one... just a tiny bit. It could be the cause of any knee pain. If that's the case, the Wedges will help quite a bit.

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Old 11-23-09, 04:38 AM   #19
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fyi, both my giant defy and cervelo p2c have been setup to my body
does not mean you wont pick up injuries however.
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Old 11-23-09, 05:30 PM   #20
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Best thing to do is to check your cleat fitting. This takes a while to do - usually done by feel (trial and error).
The other thing you can do is to strengthen your joints and take glucosamine supplements so you have plenty of cartilage.
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Old 11-23-09, 06:10 PM   #21
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I don't use clipless yet. That's probably the cause of the problem actually.. or one of the many causes.

I've been taking Glucosamine for the past few months now. I haven't seen any improvement.. but there's no evidence it was a cartilage issue in the first place. I think it's the tendons because of the fact I had pain come on in both knees in the same day.. and I'm only 21. I must've had pretty weak cartilage if it's all worn out already
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Old 11-23-09, 06:21 PM   #22
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i have the same crooked knee shape, and i've also had some knee problems.
+2
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Old 11-23-09, 10:08 PM   #23
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I don't use clipless yet. That's probably the cause of the problem actually.. or one of the many causes.

I've been taking Glucosamine for the past few months now. I haven't seen any improvement.. but there's no evidence it was a cartilage issue in the first place. I think it's the tendons because of the fact I had pain come on in both knees in the same day.. and I'm only 21. I must've had pretty weak cartilage if it's all worn out already
So how about trying clipless? You may need the cleat float. Not having that will definitely work against your knee or any connecting tendons.
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Old 11-24-09, 02:47 PM   #24
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Not a proper fix - but its a quick fix if you want to go for a ride.
McConnell Taping - youtube it. It works. It works well.
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Old 11-24-09, 02:59 PM   #25
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Not a proper fix - but its a quick fix if you want to go for a ride.
McConnell Taping - youtube it. It works. It works well.
I did not know about that, interesting, thanks. The problem of course is having someone handy to do it if indeed you can't do it by yourself as the clip I saw suggests.
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