Macca662

After a 25 minute session gradually increasing speed on a hill climb, I felt my left knee start to feel weaker, not sore.
I finished the ride and thought nothing of it, but after 8 months my knee still feels weaker with a constant dull ache.
I have tried resting my knee as much as possible, and am unable to ride or even walk for long periods now due to this constant ache / fatigue. Doctors tell me there is nothing wrong with my knee, tendons or ligaments.
Any thoughts.
Thank you.
Frank

JohnJ80

Have you seen a sports medicine doctor or a physical therapist? Both are usually excellent resources for subtle problems like this. Bike forums, not so much.

LottoAdecco02

I agree w/ JohnJ80 - if it were both knees you would adjust equipment or riding technique. Since it's only one I think a sports medicine specialist is the way to go, or a doctor that is a cyclist (not trying to be funny, mine is and he "gets it").

kc0bbq

I had to see a sports medicine PT to figure out one of my knees. No matter how "correct" I forced my pedal stroke to be, things just got worse and worse. Never would have figured it out without help.


My doctor isn't a cyclist, but a runner, but still knew the right person to send me to. If your doctor doesn't know, one of their colleagues will, you just have to ask.

seypat

Back In April I thought I had damaged one of my knees. I made an appointment, but it was scheduled at least a week out. By the time the appointment date arrived it was feeling better, but still a little iffy. I go in and the xrays, etc. are taken. Then, I had to set in the room for close to an hour because the doctor was behind. He finally comes in and apologizes for the delay. He does some poking around then we look at the xrays, etc. He says there doesn't appear to be any damage. I said ok. Then he apologizes more for wasting my time. I told him it wasn't a waste of time, that we could both get back on schedule, shook his hand, then left. From start to finish, maybe 10 minutes at the most. I got my assessment and that is what was important. When it is a health issue, go see a professional instead of asking on a bike message board.

Carbonfiberboy 

Except that an xray doesn't tell anyone anything about knee issues except that there is or is not bone damage, which is almost never the issue with knee pain. It's almost always a meniscus or soft tissue problem, both of which require a MRI and good luck with getting one unless you pay cash.

Which means that you need a sports medicine doctor, who can refer and order imaging, to examine the knee for problems. When something hurts like that, there's obviously NOT "nothing wrong with it." If that were the case, it wouldn't hurt. So . . . the possibilities would include a meniscus tear, a strained tendon attachment, bursitis, an irritated tendon sheath, chondromalacia, and a multitude of other things, none of which would be picked up by an xray - or possibly by a doctor who's not an orthopedist.

But speaking in the moment, where does it hurt, exactly? When does it hurt the most, walking down stairs for instance? At what angles of knee bend?

seypat

That's who I saw a sports Ortho specialist. My wife's doctor that has scoped both of her knees. I was just going with the condensed version instead of a long drawn out response.

Now for the longer story, I was out mowing my lawn Saturday midday when I noticed a woodpecker hole under a second story window. Heavy rain forecast for Sunday night. No time to call a pro, I was going to have to do a temp repair myself. Out comes the ladder...... then the story goes downhill from there!

kc0bbq

At least the response to your knee issue wasn't confused laughter. That's unsettling.

McBTC

How does a knee feel weaker? Do you mean, your knee feels less stable, like it may give way under your weight? Or, are you saying that something hurts...?

PaulRivers

Have you continued riding? Suggestions if you have:
- Switch away from clipless and to flat pedals with like five ten bike shoes. There's no substantial speed difference, but clipless keeps your foot locked into exactly the same place all the time, flats let your body move your knee/foot around a little. Sometimes it will fix itself.
- I actually fixed a decade of right knee pain while using clipless by doing barbell squats. I got the form down and one day my knee just stopped hurting. (However I later hurt my leg and hip doing barbell squats, so...not sure about that).
- I'd say see a doctor, but your post says you already did.

While barbell squats fixed my knee issues, I feel a bit absurd that I didn't just switch back to flats when I noticed I was having issues with clipless but no issues with flats. I bought into the whole "bikers wear clipless" mentality, and in retrospect it was pretty dumb to keep doing it when I realized clipless was causing a specific issue for me.

When I hurt my hip (not my knee) as I mentioned, this warmup/flexiblity routine fixed my "pain inside my hip" problem. No idea if it would help with knee pain:
https://www.bodybuilding.com/fun/lim...ever-need.html

One other suggestion...I also took up swimming. It takes the weight off your joints while also using the muscles. Has improved how I feel. Might be worth a shot.

JohnJ80

Not true. There are many, if not all, clipless pedals that allow float and movement. Survey the available choices and you can find pretty much whatever amount of float you want. That said, proper set up can be important.

J.

PaulRivers

It is true, being able to twist side to side still keeps your foot locked into the same position on the pedal. Was a problem for me, and I tried both time atac's and speedplays with plenty of float. Not commenting on "everyone everywhere", but it happens to some people including myself.

Boondocksaints

Just wear a knee brace or wraps.

Macca662

First of all thank you for all the replies.
I have seen my doctor and have had a number of x-rays which have not shown any damage.
I have tried resting the knee, no cycling for nearly two weeks at a time, but it doesn`t seem to make any difference.
I have asked my doctor to arrange a scan, and I am waiting for that appointment.
The only way I can describe the pain is like a nagging constant dull ache, the knee feels much worse if I walk backwards while pulling something heavy. An example would be a heavy pallet truck.
It feels as if something has pushed my knee backwards, I used to do mixed martial arts, and a kick to the front of the knee would cause this type of pain.
But that was many years ago.

I have tried a knee wrap, but this only helps a little, when I take it off my knee feels as if there is something loose within and directly behind the knee cap.
I`m at a complete loss at the moment, the doctor I`ve seen at the hospital has even suggested it might in my mind rather than a physical problem.
I can only hope a scan will bring a solution, thank you once again for your help.

Phugoid 

Best to follow the advice of your doctor and it sounds like MRI is a good next step. But since you're also asking non-professionals for anecdotes...

Have you considered trigger points? I had a nagging back-of-the-knee dull ache after ramping up my training and went through the proper channels (PCP, Ortho doc, MRI, no findings, two rounds of PT, retul bike fit) before giving up when I had no improvement. Then I came across trigger point theory and gave the massages a shot...and got significant improvement quickly. Might be worth a try if you haven't already eliminated this. Trigger points in your quad or calf can cause referred pain in and around your knee.

https://www.amazon.com/Trigger-Point...dp/1608824942/
Hip, Thigh & Knee | The Trigger Point & Referred Pain Guide

Standard disclaimer- not a doctor, ymmv, and all that.

Wheever

I'm no doctor, obv, but my first thought is it sounds like some sort of tendinitis, perhpas in your hamstring or top of calf, possibly because of a fit or leg length issue, or maybe equipment wear, say a saddle drooping to one side, or having crept back on the rails, or a cleat that has shifted position.

You don't state whether you've ever had a fit done, but if you haven't it might be a good idea to have a pro look at your position. If you have, try giving your saddle and shoe a good look-over, and see if anything is amiss, and consult the numbers the fitter gave you to make sure nothing has shifted around. Then maybe try lowering your seat a few mm and see what happens. (Usually back of the knee pain is because your either your saddle is too high or too far back.)

My thinking is, if something subtle changed in your setup, every time you rode, you'd strain the same part of your knee. (or, as Phugoid suggests, above, causing the same trigger points to be inflamed.)

Just ideas. Good luck and let us know how it goes.

sunburst

I see you rested up to two weeks at a time. Someone else mentioned tendonitis. I've been plagued with tendonitis for about 10 years in elbows (see my avatar!), hips (cycling and especially hiking) and now knees. Two weeks rest is nothing for me. It took many years, 5+, to recover from hip inflammation, and that was after seeing multiple docs and PTs. The elbow inflammation I have not been able to recover from completely and had to switch guitar styles.

Anyway, two years ago, for the knees, I saw a different PT and she started me doing squats, lunges, side leg lifts, etc, which I now do religiously twice a week, yoga the other 5 days. This helped the knees and hips and I'm finally on my bike again (and enjoying the hell out of it!).

Turns out I had a PT that was a bike racer, and bike fit tech, and yoga instructor. She started me on the yoga, and other stuff, but it was the more recent PT with the squats that helped the most.

But I'm firmly convinced that it was laying off bicycling (bought a moto instead) for a few years that was an essential ingredient. My doc had told me to lay off but that can be the hardest thing of all.

McBTC

...try starting up with just a 15 minute daily workout with the bike on a stationary trainer, breaking up the time into 3 intervals beginning with a warmup and ending with a cool down. Step up the watts on a middle ~6 minute interval by --e.g., a factor of ~6, then 5 then 4, etc. Overall all that would probably translate to ~4 miles. Maybe follow the training with some stretches and see how it goes from there...

knitguy

I have a handful of knee issues in both knees that are likely very different than yours but I would also really urge you to ask for a referral to a physical therapist who specializes in sports medicine. You could wait until your next appointment but if I were you I would call/send a message before then just so you can get the ball rolling.

As someone else suggested, likely the vast majority of knee problems aren't going to be visible on an x-ray so good on you for asking for the MRI. As someone who is headed towards their 4th knee surgery, one of my issues is flat out impossible to diagnose on an x ray (a torn MPFL) and the other diagnosis is inconclusive via an x-ray but somewhat easily diagnosed on an MRI (patella alta).
Lastly don't be afraid of getting a second opinion no matter how good or experienced you think the doctor is. My old ortho who did my first surgeries specializes in sports medicine and is the team doctor for a professional sports team. That said he had no real idea what to do with my knees when I came back 3 or 4 years after my first surgeries saying that my knees unstable again and I had a fair amount of knee pain while cycling (among other things). He wanted to go with rather conservative treatments and after those didn't work he more or less threw his hands up - I'm fine with conservative treatments being offered first but if those don't work then really it's time for something else. I got a second opinion and it turns out a second round surgery really was the logical option. My current ortho also just knows more than the old one did in general (it's helpful that she works at a teaching hospital) and it is very clear that she keeps herself informed of new new research globally.

Drew Eckhardt 

Fit can still impact just one side - only my right knee hurt after my saddle sank, although given the change following one ride which hasn't resolved I'd see a sports medicine clinic about a potential injury.

79pmooney

Go to a good orthopedic specializing in sports medicine. I started having real knee pan after my first long ride o the season. First race 3 days later. Had to drop out because of my knees. Race promoter knew I wasn't a quitter and asked why. Told me there was an orthopedic surgeon riding the race and he would introduce me after he finished.

Doc first watched me on the bike, then took me into a van (it was a cold NH March morning). Didn't have me undress, saying it was too cold, but started poking around my knees, obviously knowing what he was looking for. Diagnosed me on the spot with Chrondomalicia Patellae, gave me exercises and told me to call him. Life changing.

Ben

JohnJ80

Yes. I think the lesson here is that this is very difficult to resolve by yourself. It's important to have someone observe and it's important to have someone who understands the biomechanics. It's even better if they are the same person.

I have knee issues - on one side I'm without an ACL. On the other side, I've had some meniscus issues after a small tear. If my seat height is off by less than 1/4", I have irritation that starts up and I have to adjust. I had to fool around with pedals and a pedal fit by an expert with feet problems. 4mm solved that one. Small difference matter.

In the ski boot world, just a single millimeter can make a difference. I don't think cycling is a lot different especially since there is a high degree of repetition and we are pretty much locked into a given position on the bike. So something that is off by a little bit gets aggravated quickly after a thousand repetition. Pretty easy to do if you're pedaling at 80rpm - all you have to do is ride for two hours and you've hit a thousand repetitions.

I suppose you can solve it by yourself, but it's going to go a lot faster if you get pro help (doctor, pt, etc...). The faster you get it solved, the better chance you have from creating a long term problem.

J.

Dark Night

had a right knee problem myself, emanated from a hiking fall years earlier. I solved my problem knee with lunges. started out very slow, deliberate and 2 or 3 to start, cpl times a week. built up and up over several years. Now can do 25 lunges (each side, back and forth) while (for lack of a better term) jumping. PS I started this program at age 60!

Greatestalltime

Ok. Been following this thread for a week or so. 20 years back I had microfracture on my left knee. Been riding again for the last 6 years. I never had any major problems until recently and it was the "fatigue" you describe. It was like it was worn out as your legs may feel after a very hard pull or ride.

About 3 months ago I switched to 2 degree float cleats. Maybe a few more aches, but nothing major. Then about 2 weeks ago starting noticing the fatigue in that knee. I put the yellow 6 degree back on and two days later no fatigue. I guess my knee needs some float.