Last year I started getting a pain in my right knee while riding. A bit of history, I've suffered from obvious iliotibial band syndrome in my left knee for a few years while hiking or running, but not while riding. Last summer I did the Copper Triangle (80 miles, 6,000 feet gain) and felt great. I also hiked a 14er around then. A few weeks later on a short ride I started getting a significant pain in my right knee. I continued training and I think it kind of came and went, I don't remember being particularly concerned about it. Well, being in Denver I didn't train properly for El Tour de Tucson but did it anyway. My lungs felt fine but about 3/4 of the way through the pain became very significant on my right knee. The next few days were hard walking, especially down stairs. I went on a few rides the following week, had to cut the first one short and the second one just hurt.
I pretty much rested over winter, I rode an exercise bike about once a week and started getting some pain after 20 or 30 minutes but stopped after that and didn't think of it much. Well, the first ride of this season was quite painful. Now I can't really ride more than a few miles before it hurts. It's an odd pain though, it's not exactly like the ITBS in the left side. It seems to hurt in a few places, alternating between them. The side of the knee hurts, around the fibula head. The back of the knee hurts around the popliteal muscle. It also hurts some down the biceps femoris and maybe the peroneal nerver. Then eventually I get IT band pain too, right where it attaches at the femoral epicondyle and running up the IT band a little bit. I have pain around the fibula head doing other exercising on my feet. I also get pain when I straighten my knee, my PT noticed it tends to go more towards hyperextension than the left side. When I swam kicking with straight legs it hurt to straighten my knee after that. The pain on the bike comes when I'm most extended under power (no my saddle is not too high). If I REALLY lower my saddle it doesn't seem to hurt but I'm scared to ride significant portions of time like that because I imagine I could mess things up.
What the PT and bike fitter (Todd Carver with Retul) have noticed:
- PT - She thinks it has to do with a tibia that won't rotate fully (my right foot sticks out...but it's always done that) and maybe a frozen fibula. Lately she's been mobilizing that and having me strengthen the popliteal muscle. I can't rotate my foot inward without keeping my arch high and dropping the outside of the foot. But, as I said, I've always had that and so far no relief. She's also tried taping the fibula forward and backward and taping the tibia back at the foot. But none of that seem to work. Whole host of other things I won't mention.
- Retul Fit - Todd noticed my right knee wobbles a lot. He put in green superfeet and angled my forefoot out quite a bit. That fixed the wobble but, to be honest it still hurts, maybe more. He also noted my saddle was really low and raised it some. The more he raised it the more it hurt, he noticed I pointed my toes more to "protect" the injury. I had a low saddle to help with the pain, raising it just makes it worse.
Other than above here is what I've tried : I've been to multiple doctors and physical therapists (recently about half a dozen physical therapy sessions). I've tried foam rolling, extremely deep tissue massage (said he's never seen anyone take an IT band massage pain like me...I really want to get better), anti-inflammatory gel and pills, stretching, IT band straps, tennis ball massage, lengthening contractions on the hamstring, lowering my saddle, raising my saddle, cortisone shot (although he did it in the joint, not the tissue on the side of the knee), pedal extenders, rotating the cleats so my shoes point out, and an MRI in both knees (negative).
I hate to give up cycling. The left side I'm considering surgery for the ITBS. I don't even know for sure what's wrong with the right side though so I don't know that going in and scoping is a good idea.