Kneecap maltracking...
 

Hi. I was cycling a lot two years ago but I was having knee pain after every ride. I couldn't figure out what was wrong and I had no choice to stop long distance rides. I am still doing commute rides almost every day but for very short distance like 4-5 miles max. And my knees going worse every day. Now I am only using my bike for commuting but still having knee pain even after walking a couple of miles. I have inflammation around my knees all day while sitting on my office chair. Life has been a nightmare for me for the last few years. Anyway... I was out with bike to do some shopping yesterday and I realised my kneecap was maltracking badly while going uphill (%2-3 inclination maybe). My right kneecap was going in and out of its groove while I was pedalling. All the orthopedist I visitied having MRI's and x-ray's of my knee while it is in straight position and they say they don't see a major problem but it looks like I have problem when I bend my knees. It could be weak tendons or muscle imbalance, I don't know the cause and I also don't know how to cure it. Anyone else have the same problem and found a way to fix it?

Time to talk to an orthopedist with a sports/exercise background. Might be something that can be improved with physical therapy. Kinesio tape does wonders in the short term but you'll want to have a physical therapist work with you to make sure you are taping it properly for your specific condition. There are lots of videos on YouTube about kinesio tape but they are too generalized (or just plain wrong some of the time) to be considered a good resource for someone who has specific needs.

I've struggled a bit with this too. I've tried strengthing this or that, and stretching this or that, without really knowing what if anything was too tight or too loose. :) (this or that = various leg muscles). So... I don't have specific advice, but there's a lot on the internet about it if you search on knee problems like runners knee and bike related knee problems.

This might be chrondomalacia patella. I have had it for decades. If it is, you may be able resume riding as before but you will have to make changes to accommodate it. I have a long post I wrote years ago on my experience that may be helpful:

Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo. The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben

The straighter your leg is while pedaling, the less strain on your knee. Are you sure your seat height is correct? Is your gearing low enough for hills? Standing up while hill climbing is easier on the knees but takes a lot of effort. It becomes easier with practice.

I just found this link but I haven't really studied it yet. Seems like it's worth a read, though.

https://www.stevehoggbikefitting.com/bikefit/2011/11/knee-pain/

As per the steve Hogg link above, cleat position and wedging are very important in dealing with/preventing knee pain. I suggest you read all the stuff on his site about these things. A premium membership, which is, I think, $20 is a very worthwhile investment.

Thanks for your advices, especially Ben.

Yes, most of the orthopedists I've seen diagnosed me with CP. When they press down on the area right above my kneecap I have big, sharp pain there. I think it tells you about you have some wearing not only on the cartilage also on the underlying bone. My MRI's also show a bit of bruising there but I think it shouldn't hurt if my kneecap was tracking normally.

Ben, I was riding on cold weathers at times but most of the time I was riding under warm weather. I don't think cold has been the number one reason that I got this. I had no idea about the cadence when I first started cycling and doing too much riding uphill with poor cadence. That should be the main reason. Anyway I will keep them warm if I ever ride again (I don't classify commuting as riding).

I have no problem touching my toes without bending my knees, I never had tight hamstrings problem.

I have been prescribed glucosamine many many times but I didn't use it for a long period. And the ones I used had chondroitin. I don't know why chondroitin should be excluded though.

Sometimes, for a week or two I am having pain free periods but as soon as I try to do a short ride I have my pain back again. I don't want to live a sedentary life but it looks like I have no choice.

A former chiropractor here. There's lots of good info at this thread. Sounds like chondromalacia patella where the kneecap isn't correctly tracking in the groove of the femur and this can lead to not only pain but also boney degeneration. You need to at least get some xrays of the afflicted (and non afflicted) knee joint to help with a diagnosis. A very competent chiropractor who's into bikes and sports injuries could provide not only an accurate diagnosis but also aid in (hopefully) fixing the problem provided that the joint isn't too degenerated.

(EDIT) Perhaps a simple modification of your biking posture would alleviate the problem, like altering the tilt or horizontal placement of the seat (forward or rearward) or perhaps the seat's height (distance from the spindle).

Both chemicals are integral in cartilage production at the "end" of the bone where it articulates with another bone. Your body no longer makes those two chemicals and requires an exogenous source to aid in joint healing. And it can take at least three months of ingesting those chemicals for any positive effect to take place. In other words, they need to be taken over the L O N G term and make no doubt about it. How much is it worth to you to maintain your knee joint properly? :):commute::giver:

Why should my body no longer produce those chemicals? I have only kneecap maltracking, no? Btw, I can post my x-rays or send it to you via e-mail.

That's just the way the body works, it no longer produces certain chemicals and you'll know it when you advance into your twilight years; think hormones!!!!!!!!!!!!!!!!!!!!!!!!!

While both sides of the body resemble one another, there's some asymmetry going on. You know, you favor one side more than the other: handedness, left handed versus right handed yada yada yada. What do you do with your right hand that you don't do with your left hand********** HUH?!?!?!?!?

As to your xrays, please find someone local as I've been out of practice for almost twenty years.

I am 35 years old if it is considered as twilight years.

Perhaps you were born/conceived with a focal weak spot. In this case it might be your knee. It happens all of the time with the body.

Everyone who rides a bicycle long enough injures their knees and feet at one point. The OP has been in pain for years and is finally thinking about a solution. The bad news, there isn't a surgical or drug solution to this problem that is inexpensive and will fix it for good. Here are my answers.

1. Clipless --- If you are using them, it time to go back to platforms. It's very possible the pedals are causing the problem and don't think it's going to be easy finding a solution. No one really knows whether a change to a certain position will make your pain better or worse. It's all guess work.

When I injured my feet, I spent thousands trying to find a solution. I got rid of the clipless pedals and several months later, the feet were able to recover.

2. Lower gears --- The days of going fast are over. It's part of the aging process and there is nothing wrong going slow. I have every symptom the OP described but they went away after 2 years and I'm pain free. I cut down my riding and now go slow. Your body can recover but it's going to take time. A lot of time.

++++++1^^^^ Excellent point. But it could also be a postural thing.

1. Clipless --- If you are using them, it time to go back to platforms. It isn't always this simple. I was diagnosed when I was a bike rider in the days of slotted cleats. Float didn't yet exist. The doctor looked at me on the bike, asked if there had been any changes form the previous year and when I said no, he said don't change anything. I forget how I came on tho this, but my cleat position eveolved to more toe-in than my feet naturally took and that forced toe-in was a blessing for my knees, clearly allowing them to track "cleanly" and right. Any time I went away from the forced toe-in, my knees suffered. Shimano clipless itht the cleats set to toe my feet in with gentle pressure work bat are not as good as cleats with a very positive toe-in. Free floating and platform are just plain bad (unless you happen to be the orthopedic surgeon ready to bill me for the knee replacement).

OP, learn what you have to do to get your knees to track right. And when you find that solution, hold on to it. Don't let voices of "wisdom" sway you when you have found that answer. The ortho who diagnosed me (a fellow bike racer) said that I had to listen to my knees; that the alternative was 3rd party joints. But you might look at your hamstrings. You say you do not have the very short hamstrings I was given. But the hamstrings are instrumental in positioning the patellae. (I have no idea what the mechanism is.) It may be that your hamstrings are not as stretched as they should be; that maybe yours are supposed to be so loose that you can reach another half foot lower.

2. Lower gears --- The days of going fast are over. Yes, you have to back off big time now and build slowly. You will always have to accept a build time perhaps far longer than the muscles and cardio take. Learn to listen to your knees. But there is a good chance that if you take this slowly that you may well be able to build back up to impressive levels of strength and speed. I was diagnosed in early March. I won the field sprint at the State Championships in June (not a big deal; the places all went to the break). Rode Mt Washington in September after racing 113miles the day before.

Be patient. I have done about 160,000 miles on these OEMs since I was diagnosed including 3 Cycle Oregons riding fix gears. Your cycling life may have years or decades still.

Ben

You're giving me advices to fix my riding settings but even after walking 1 mile I am having pain here and there around my knee joint. I don't give a damn about riding bicycle now. I will see physiotherapist. She says she can sort knee problems with manual therapy. What do you think?

Give it a shot - I don't think there's a whole lot of risk in trying. Good luck.

I am dealing with this problem for 3 years. I don't think it will be healed by massaging.

It appears that glucosamine+chondroitin is most effective on knees when it hurts a lot, not just a little.

Efficacy of Glucosamine and Chondroitin Sulfate May Depend on Level of Osteoarthritis Pain | National Institutes of Health (NIH)

I was told to take it for a mildly arthritic thumb and haven't really felt any improvement. I guess I didn't believe in it enough.

1) Stop consulting the internet for medical needs.

2) Get a real medical opinion from a sports medicine doc.

Hillcrawler, the three things I have to do to live with my knees are 1) keep them warm, 2) keep my hamstrings loose and 3) keep the quads and especially the little inner quads tight and strong. The ortho specified those three out to me in 1978. Serious stretching was the first thing I has to do. Those three things are still true for me 37 years later. If I don't don't do them, I can feel my knees grinding going up stairs.

To keep my knees happy, I have to keep them far warmer than standard knee warmers will get them. They like to be at body temperature, ie in the 90s. Below mid eighties, I wear custom knee warmers on the bike that look like basketball knee pads. Properly dressed, my knees sweat before the rest of me. Since tight straps around hamstrings is a no-no, I have just loose ones and use a velcro "garter" running around a "D" loop I sew to the front of my shorts. Below mid 70s I wear standard warmers over my customs. These get warn under whatever tights I wear in the fall and winter. I've been known to wear those riding knee warmers under my street clothes. (Well that's not really true. I know it and now you do but the general public doesn't.)

Doing anything at all without keeping my knees warm is exactly like running a car engine without oil. (My body can do "rebuilds" to small levels of damage but the wear is obvious; both as I am doing it and after.)

If you are CP, get used to the idea. It is and will be just as real as diabetes. Managed religiously, we can have great lives. No and the best part is that we can get knee replacements much more easily than the diabetics can get body replacements. Go to the specialist. But don't expect to be freed from this by her. If she is good, she will help you get on track to a life with those knees that works. It is then up to you to live that life and get to know and love your knees. (And get used to the concept that, like women, they run our lives, not us or they can make our lives hell.)

If you like, I can send you the pattern for those knee warmers. Hang on to jeffriesatspiretechdotcom.

Ben

<guess> Lose the Clipless pedals* forcing the Knees in an angle that is contrary to their needs .

* Speedplay Frog has a Lot of float angle .. But you may want pedal extenders of the angle needed

is a Lot of deviation from their available angle as the heel can hit the crank arm ,

I don't know what the OP will need for his knees, but that advice (Speedplays, completely free float and pedal extenders would have me in for knee replacements rather fast. My knees have to have the forced toe-in from my cleats to track properly and are happiest with the smallest Q-factor possible. (I have worn out many cranks form my shoes brushing them. With wear, my feet can sit closer in and my knees are happier. They love riding the fix gear with its track standard, very narrow crankset. The only pedals worse for me than speedplays are platforms where not only is there no forced toe-in but I cannot even pull up, the portion of the pedal stroke that is "free" relative to knee damage.

Ben