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knee-cap pain

Old 07-29-09, 09:34 AM
  #1  
bay area biker
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knee-cap pain

I'm an older cyclist commuting ten miles per day round-trip. The route includes a couple of steep grades. I like to do the commute at a fairly brisk pace, for punctuality and the exercise benefits.

After cycling and sometimes on a non-cycling day, I have slight twinges right in the fronts of the kneecaps. Besides my age (not overweight, though), there are the following factors:

1. Short. 29-inch inseam. 165mm were the shortest cranks on a triple that I could afford. Top tube a bit long for me; have the brooks b17 saddle all the way forward to compensate. The knees are within a whisker of being fully over the pedals. Should I get a forward-offset seatpost? Does anyone think shorter riders do better farther forward in general?

2. Cycle commute most every workday. Should I be taking more days off? Would riding more strengthen the knee, or lead to more serious knee problems. Right now the pain is very moderate and bearable.

3. Cranks somewhat bowed, not extremely so, but I was disheartened when I returned to cycling to see that most affordable cranksets now have bowed-out cranks, forcing a wishbone leg configuration. Sometimes when I have to crank hard I notice the knee involuntarily swinging out to get itself over the pedal. I assume this must be bad for the knee, no?

Experience of others sought, and the input a physiologist or something like that would be especially welcome.

Thanks!
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Old 07-29-09, 10:09 AM
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have you tried taking a break from biking to see if that is truely the cause? I have knee pains also caused from biking.........well actually crashing, long story from J. high. I quit goin to docs about it cause either they dont seem to care or just give me a copied peice of paper with some knee exercise instructions on it.

one thing you could try is a knee brace. particularly one with the hole to keep the kneecap in place. I've tried one once, a type that is for exercising, but I only wore it a few times cause it kept rolling down.
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Old 07-29-09, 10:42 AM
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Are you riding in to high a gear? This will put a strain on your knees. Better a faster cadence in a lower gear than straining in a higher gear for more speed.
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Old 07-29-09, 10:57 AM
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This is your health and possibly your continued cycling happiness you're talking about.
I really think you should get a bikefit done by a pro, to make sure your position is correct.

I cannot ride now and am waiting to go under the knife. Partly due being loose with my position over the years, and partly for living a fun youth: lots of skiing, running marathons without proper training, death-marches with loaded packs, race pile-ups, surfing on big days, motorcycling... I wouldn't take back any of those fun experiences, but I wish I'd gotten the correct saddle height and riding position instead of going with what feels about right.

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Old 07-29-09, 11:33 AM
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1) The may be no solution to your mortality problem other than acceptance.

2) High pressure road tires?

3) Move saddle up or down? Better gearing, Shimano mega range freewheel? New handle bar / saddle?

4) Different bike? Recumbent. Giant Revive (I have met people that road this because of medical issues).

If there is a LBS or bicycle club talk to them. Try the 50+ board.
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Old 07-29-09, 11:50 AM
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Just as a general "old wisdom" thing; pain in the front of the knee or kneecap indicates your knees are flexing too much. Saddle too low, cranks too short, saddle too far forward... That sort of thing.

Pain behind the knee indicates overextension. Saddle too high, cranks too long, saddle too far back...

Yadda yadda...

A good (and I stress "good"; not some 17-year-old who's going to glance at your position and say "right on, man!") bike fit or assessment may be in order.
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Old 07-29-09, 12:00 PM
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Originally Posted by Bikewer View Post
Just as a general "old wisdom" thing; pain in the front of the knee or kneecap indicates your knees are flexing too much. Saddle too low, cranks too short, saddle too far forward... That sort of thing.

Pain behind the knee indicates overextension. Saddle too high, cranks too long, saddle too far back...

Yadda yadda...

A good (and I stress "good"; not some 17-year-old who's going to glance at your position and say "right on, man!") bike fit or assessment may be in order.
+1
Was having front of knee pain after fitting a new saddle. Moved the saddle back about 3/8" knee pain went away.
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Old 07-29-09, 12:56 PM
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My knees are completely shot and have been for years. Some of the things you are doing will correct knee problems like 165 cranks for short legs.

There is an "Inline" seat post that pushes the saddle a bit further forward. Top tube too long- get a shorter bar stem.

Next thing is to spin faster. This will mean a lower gear for the same speed and will take strain off the knee .

Position of foot on the pedal. I always ride with the toes pointing in (Toe In) That works for me but a few say that they have to have toe out to stop knee pain.

And next is the Quad muscles. These are above and below the Knee and I keep these strong. Extra exercises and the easy way is to lie on the floor and keep a straight leg and raise the leg and lower it. 20 of these at a time and when that gets easy- put a 1 lb weight on the foot. The quads have a lot to do with knee strength so get them strong and the knee is stronger.
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Old 07-29-09, 02:05 PM
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Very interesting, thanks.
2 people have suggested that front-knee pain indicates moving the saddle BACK, which surprises me, but I'll try it. There is a tendency to sit too much in the middle of the saddle when I do this, but I'll try it anyway. I suspect in view of all this that the best thing would be to have bars a little farther back, and cranks a little shorter still (perhaps 162mm).

I don't have the long history of taxing my knees in various ways, as that one poster has done, so I doubt the little fellows are in imminent danger if I'm reasonably careful with them.

Thanks again,
Chas.
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Old 07-29-09, 03:15 PM
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Bay area as Bikewer said generally speaking front knee pain can be caused by not enough leg extension you could get a little more extension by sliding the seat back but you mentioned the toptube is a little long for you so raising the seat is probably a better option. At some point you should probably get a fitting, it is well worth the money if they can get you comfortable on the bike and it may save you a few doctors bills in the future.
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Old 05-22-10, 12:42 AM
  #11  
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In early Autumn 1976 we started doing a lot of off road "rough stuff" riding in the mountains of New Mexico and Southern Colorado. We we riding road and later cyclocross bikes using cyclocross sewups when the terrain permitted - soft dirt versus sharp rocks. Otherwise we rode on the largest 700c clinchers we could find which were cheap Wolber 700x35c town bike tires.

Eventually I switched to alloy upright bars for better control coming down long steep mountain trails. I was running a TA double with a 26T small front with a 34T large rear. It allowed me to pop a wheelie to get over logs and rocks. I also ended up with my seat much higher than on my road bikes and all the way back for better traction. My knees were hyper extended much of the time. Off road we played cyclocross a lot and ran up or down hills we could ride so we were always on and off the bikes and I wasn't in the saddle that much.

One morning in 1978 I started out on a century ride. I set my road bike up like my off-roader with the saddle high and back. At 25 miles I had to stop and lower my seat and move it forward because my knees were hurting. At 50 miles I had to abandon the ride because my knees were killing me. For the next 14-15 years I had recurrent knee problems. I had to give up cycling, cross country and telemark skiing for most of those years because of my knees.

In the early 90s I was showing a new bike to a friend who had been a top northern California racer and had trained under "Eddie B" the Polish coach who helped transform US cycling. He watched me ride around a parking lot and stopped me. He said that my toes were pointing inward and that was probably the cause of my knee problems.

I switched to long toe clips on wide pedals which I re-drilled to move the clips all the way outboard. This really helped with my knee problems. I later had MRIs taken of my knees and was told that I had bone spurs under my knee caps and they had worn "grooves" into the cartilage.

It became even more important to let my knees freely track. I stopped using cleats and that helped more. I know, clip-less pedals, but since then I had a full hip replacement and my doc said no cleats, no clip-less (no running, jumping, tennis or skiing either unless I wanted to come back in for another replacement!).

So, check the angle of your toes versus your standing and walking orientation.

Chas. Verktyg
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Old 05-22-10, 03:22 AM
  #12  
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Have a read through this article:
http://www.cptips.com/knee.htm
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Old 05-25-10, 06:18 PM
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Machka, that is very thoughful and interesting. Shame you had to stop cycling for so long. The last sentence of your post is much to the point. Personally I am naturally pigeon-toed, with a narrow tread while walking, and must be careful not to point toes out. The still-unresolved problem is the tread or q-factor, which I can do only so much to resolve, with modern cranks too bowed-out. Wide chainstays are also a limiting factor.
I have largely gotten past my knee pain though, having made the following changes:

1. Careful about foot position as you suggest.
2. Built up supporting muscle, I think, with time and judicious riding.
3. Raised saddle, which also moved it back a little. For me it has to avoid full extension, but too-low saddle was causing trouble. I know enough's been said about the Brooks saddles, but the intentional sliding while riding you do is just invaluable for best position overall in different circumstances. My B17 is the best bike component I've ever owned.
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Old 05-26-10, 08:22 AM
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I've been had that kind of knee pain off and on for 35 years, and physical therapy for it has improved a lot in that time.
One thing that happens is that your body responds to some painful inflammation by turning off the muscle causing the inflammation, and transferring the work to some different combination of muscles. When that happens around your knee, the vastus or quads become weak, and your kneecap misaligns and no longer tracks correctly in the groove at the end of your femur. That just causes more inflammation. The solution is to build strength, but you need to wait until all the inflammation is gone before you do it. Physical therapy can help with that.
In my experience, a saddle position that allowed more leg extension helped, shorter cranks helped a little, but pedal and cleat position had nothing to do with it. Maybe if your knees are not tracking straight over the pedal you can correct that, but that was never my problem, and I've seen plenty of healthy riders whose knees are all over the place.
Using low gears all the time made my problems worse, because I needed to build strength and all the spinning caused inflammation. When it got really bad, I spent 2 days a week doing hill intervals to build strength (after the inflammation was gone). That ended up being the solution for me.
Hope this helps, good luck.

em
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Old 05-26-10, 10:52 AM
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Originally Posted by Machka View Post
Have a read through this article:
http://www.cptips.com/knee.htm
Machka,

Thanks for the link. If nothing else, it explained the mechanics of the diagnosis of my knee injuries.

Article had minimum of "thou shalts/thou shalt nots" and one size fits all attitude.

In my situation, I have very wide feet, 10 1/2 EEE (45.5 XW) compounded with a wide stance so I found a wider than normal Q-Factor works well for me. Clipless pedals were out of the question back then because I couldn't find wide enough shoes for clipless cleats.

Standard Campy style quill pedals were always too narrow for my feet. Back in the 90s I switched to the wide MTB pedals that were available then. That coupled with moving my toeclips out to the ends of the pedals so that my toes can point outward helped MY knee problems.

I'm built like a running back with wide shoulders, short legs, a short neck and a very long torso. I used to ride on the drops with the seat back. Over the years I've found that moving my seat all the way forward, using a short stem and short top tube allows me to ride in a more upright position. It's more comfortable all around especially for my neck. Also I found that frames with a 74° -75° seat tube work better for me because they push my pelvis more forward.

Riding some of my early 70s bikes with classic 72° parallel angles becomes uncomfortable on my knees after about 10-15 miles because I'm sitting too far back.

In 1998 I was hit sideways in my car and received a "double sideways whiplash" - my neck went one way and my lower back the other. My lower back kept going out causing my pelvis to rotate making my right leg 3/4" shorter resulting in AVN (avascular necrosis) after several years and eventually requiring a total hip replacement.

Now my right leg is permanently 3/4" shorter and my right foot is angled out about 10 degrees. An 18mm 3/4" pedal extender on the right side fixes those problems.

Everyone's physique is different. One size does not fit all.

Chas. verktyg

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Old 05-26-10, 11:36 AM
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Agreed, move seat back, pedal in easier gear, that should resolve it. Also, stretching helps - before and after especially the quads/hamstrings, I had a someone tell me that pain below and in front of the knee could actually be caused by quads that a too developed/tight pulling up on the kneecap. Going to the ortho next week to see if I actually did anything beyond a strain to my knees, I hope not. Good news, OK maybe not, I did it running not cycling, although the tips above are allowing me to continue to cycle pain free. Running however is temporarily suspended.
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Old 05-26-10, 12:25 PM
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Originally Posted by eddy m View Post
...One thing that happens is that your body responds to some painful inflammation by turning off the muscle causing the inflammation, and transferring the work to some different combination of muscles. When that happens around your knee, the vastus or quads become weak, and your kneecap misaligns and no longer tracks correctly in the groove at the end of your femur. That just causes more inflammation. em
Good points. When I was going through my knee/hip problems several orthopedic MDs suggested that knee pain can really be caused by hip problems and the pain is referred to the knee!

Chas. verktyg

Last edited by verktyg; 05-26-10 at 12:30 PM.
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