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Old 03-25-13, 08:36 AM   #1
Hubble1229
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Knee pain. Advice would be greatly appreciated!!!

I was off of my bike all last season with knee issues. It started with IT band syndrome, which was tenable, but I then started to expeience an entirely different type of pain in the same knee. After 20 miles or so of training paced cycling on varying gradients I would start to have pain in my left knee. Below, I have attached a picture of a left knee, with a red circe indicating where I experience this pain



I saw a doctor who suggesed I get an MRI to rule our a meniscus tear. My insurance is not great, and the MRI would have cost me $2000. I did not get the MRI, instead opting to take the season off and hopefully heal on my own. After a year, I am IT band syndrome free and have been out a total of 4 times this year with ride of 6.5 miles, 12 miles, 22 miles, and most recently 30 miles (my regular average distance is 35-40 miles) all with a week in between (due to weather in WI, and work). During my last ride of 30 miles I started to experience that same knee pain right around the 20-22 mile mark.

Here are some descriptions of the pain...

-Always happens around 20 miles into a ride
-once the pain begins it is most noticable on the downstroke and the pain increases with the intensity of the stoke, making climbing out of the saddle and sprinting painful.
-The pain can be described as a "tightening pain" and almost feels like a bubble or knot in my knee
-when stretching my quad post-ride, I can really feel it, as if my quad is directly connected to the culprit
-I am entirley pain free when I am off the bike, accept when walking down stairs immediately after a ride. Its seems to only flair up afer 20 miles of riding.

Has anyone experienced this before? Any tips as to what it could be? I have flat feet, and have been told by a personal trainer that one of my legs is slightly longer than the other. I think it would be weird if these were the causes seeing as those physical characteristics have always been the same since I started cycling, and have never caused problems in previous years. Could this be a meniscus tear? Would the MRI be worth it?

Any information you could provide would be much appreciated, I just want to be healthy and enjoying cycling again....

Thanks in adance!
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Old 03-25-13, 09:30 AM   #2
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Flat feet and one leg shorter than the other. That sounds like me. I had exactly the same problem as you. Both of those things were the cause. Best thing I can suggest. Go get a proper bike fit. They'll sort your flat feet out and get you tracking correctly on the bike. My leg length was due to my pelvis being out of line. Some stretches sorted that out. I went to see a physio about those.

Trust me, get those sorted and you should see a huge difference. My story is exactly the same as yours.

Good luck.
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Old 03-25-13, 12:05 PM   #3
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Originally Posted by Hubble1229 View Post
Any information you could provide would be much appreciated, I just want to be healthy and enjoying cycling again....
I'll be watching the thread; I've been having similar knee pain for months and it seemed to come out of nowhere so so I don't think it is a leg length discrepancy for me.

My pain comes up after 60-90min of spirited riding (~0.90 IF). No pain off the bike. The other day it came on more suddenly than before, with a dull pain (so I let off on the effort) followed within minutes by a sharp, I probably shouldn't pedal anymore, pain.

I did notice that if I pressed firmly on the inside quad, just above the knee, the pain decreased. Also I've noticed that when I've had the pain, that same muscle post-ride feels like it has a tight knot in it near the knee (I can make the knot flip side to side under my thumb). Last night I foam rollered it for the first time and it was tremendously painful, but the knot/ability to make it flip/flop went away.

I have insurance, but have been neglectful in making an appt. I do plan to do so real soon now.
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Old 03-25-13, 01:50 PM   #4
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I had some pain in that area on my left knee off the bike that I believe was caused by a wide q-factor of a triple. More of an ache than a pain. When I converted to a compact double it finally went away. If my shoe slid out on the cleat I could start to feel it coming back again. Here's a thread over RBR I started with a lot of good advice from other posters. You certainly want to start with making sure your bike fit, cleat wedging, fore/aft and all that is in the right ballpark.
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Old 03-25-13, 01:52 PM   #5
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I've had a meniscus tear, MRIed and scoped and fixed. My experience is that there's more pain off the bike than on with a tear. The OP is indicating pain below the kneecap on the outside of the kneecap, right? I get that from time to time. That's just an inflamed tendon sheath. Try 600 mg ibuprofen. If the pain goes away, that's almost diagnostic. I also get pain that's completely on the outside of the knee, where one can feel a bump. That's pes anserine bursitis, which can be fixed by stretching, especially ham stretches.

With stuff like this, I don't try to be too scientific. Throw the kitchen sink at it. So:

Raise your saddle until the heel of your bike shoe doesn't quite touch the pedal, knee locked out.

Do high kicks: 15 reps each leg kicking as high as you can with the knee locked. Every day or twice a day.

Stretch: see this post: http://www.bikeforums.net/showthread...1#post15372967
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Old 03-25-13, 02:00 PM   #6
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The OP is indicating pain below the kneecap on the outside of the kneecap, right?
Looks like the inside to me but after looking at it again, now I'm not sure.
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Old 03-26-13, 09:21 AM   #7
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Looks like the inside to me but after looking at it again, now I'm not sure.
the picture is of a left knee, so the pain is on the outside of the kneecap. Sorry for the confusion...

Thanks a lot everybody for all of the advice and ideas. I think the first thing I'm going to do is have my legs measured and then put the appropiate shim in my cleat to offset the discrepency. Hopefully that works


Thanks again!!!
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Old 03-26-13, 02:54 PM   #8
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Originally Posted by anotherbrian View Post
I'll be watching the thread; I've been having similar knee pain for months and it seemed to come out of nowhere so so I don't think it is a leg length discrepancy for me.

My pain comes up after 60-90min of spirited riding (~0.90 IF). No pain off the bike. The other day it came on more suddenly than before, with a dull pain (so I let off on the effort) followed within minutes by a sharp, I probably shouldn't pedal anymore, pain.

I did notice that if I pressed firmly on the inside quad, just above the knee, the pain decreased. Also I've noticed that when I've had the pain, that same muscle post-ride feels like it has a tight knot in it near the knee (I can make the knot flip side to side under my thumb). Last night I foam rollered it for the first time and it was tremendously painful, but the knot/ability to make it flip/flop went away.

I have insurance, but have been neglectful in making an appt. I do plan to do so real soon now.

This seems very similar to the issue I am having....
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Old 05-14-13, 12:38 PM   #9
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all meniscus tears are not the same. time does not heal them. stick to short low intensity rides or get better insurance, even for a little while. then get it "scoped". by this time next year you'll be back in action
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Old 05-15-13, 06:47 PM   #10
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Originally Posted by MeOwd View Post
Best thing I can suggest. Go get a proper bike fit.
I never had knee pain while cycling until I bought a new bike. I was "semi-fitted" at the LBS when I took possession of the bike. I had done a 8-10 mile quick test-ride before taking the bike and followed it later that day with another quick 8-10 mile ride. It was after that second ride that my left knee started hurting in a way it had never hurt before. I waited a couple of days, took it out for a longer ride but turned around earlier than I wanted due to the knee pain. Took it back to the LBS and had a complete fitting ... pain gone. I also hike and backpack pretty regularly. Several years ago I began getting severe stabbing pains in my left knee while walking downhill ... never a problem going uphill or on the flats. My doc suggested glucosamine-chondroitin but the cost of that combination was more than I was willing to pay at the time. So I started taking just glucosamine sulfate. After several weeks ... pain gone. It doesn't work for everyone but it's pretty inexpensive and might be worth a try.
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Old 06-01-13, 03:38 PM   #11
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I had pain on the right side of my right knee. It only occurred while riding about 20 miles into the trip. My pain disappeared after replacing my cheap pedals that lacked "float" with pedals that had significant float (Time Xpresso 4).
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Old 06-05-13, 12:05 PM   #12
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So many variables with knee injuries so start with the cheap and easy fixes (not the MRI).

Raise your saddle a little, check your fore-aft. Stretching is good. Check your cross training program - are you working on core, glutes and hamstrings? Quad overdevelopment paired with glute and abdominal underrecruitment can lead to a horrible cascade of knee pain, that I'm just getting over.

Work on hip mobility and take a whole-body approach. Knee pain sometimes has nothing to do with your knee itself, other than the fact that some postural misalignment is causing inflamation there. Yoga is great for virtually all kinds of injury prevention. Also look for a groupon deal for chiropractors - usually $30 gets you an initial visit and adjustment. Any decent chiro can diagnose leg-length discrepancy and recommend an orthotic.

If the pain gets worse, see a doctor again or try to get a referral for physical therapy. One PT visit will get you targeted exercises to do on your own and is sometimes all you need. If it persists get an xray, which can show alignment issues and many tendon problems. Most doctors can diagnose things like ligament and meniscal tears in an office visit with a fair degree of certainty using strength and stability tests. I'm suprised that yours recommended an MRI without symptoms suggesting a tear of some kind.

Best of luck!
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Old 06-07-13, 08:18 PM   #13
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That is exactly the pain I have and exactly 20 miles. It is most likely IT band. It starts as a little sticking sensation then exponentially gets worse and worse till you want to scream? Mine is on the outside of my knee and I too have one leg slightly longer than the other. I have had a professional bike and cleat fit but unfortunately I think I push too hard coming out of the gates sometimes and get the IT band all P/O'ed again. I'm at the icing, elevating and Advil'ing stage right now. Next is strengthening the hip muscles to help not get the problem as easily. IT band issues really suck.
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Old 06-07-13, 09:35 PM   #14
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That is exactly the pain I have and exactly 20 miles. It is most likely IT band. It starts as a little sticking sensation then exponentially gets worse and worse till you want to scream? Mine is on the outside of my knee and I too have one leg slightly longer than the other. I have had a professional bike and cleat fit but unfortunately I think I push too hard coming out of the gates sometimes and get the IT band all P/O'ed again. I'm at the icing, elevating and Advil'ing stage right now. Next is strengthening the hip muscles to help not get the problem as easily. IT band issues really suck.
I had severe ITB issues - so bad I had a hard time walking. In addition to hip stretches, I use a foam roller and roll on the roller every day, putting my full weight as I roll my upper leg (knee to hip) back and forth - both legs. It really,really hurt at the start a couple of years ago, but now there is no pain as I am rolling. Your IT band needs to only be stretched out about 1/4 inch or so to make a big difference.


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Old 06-08-13, 05:04 PM   #15
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I got a roller today and did my first roll, OUCH! I am pretty sure I have some scar tissue in there because there seemed to be hard spots in the one side that's giving me fits. OMG that hurt so effing bad.

Thanks Dnvr that's the rolling method I used and you are right it was painful.
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