Bottom front of knee caps are sore/numb... and the back has swelling
 

So I've been in denial the last few weeks. I've recently started riding on my bike at least 6 times a week whether it be outside or on a trainer. I've started to notice that my left knee feels numb/uncomfortable while riding and for at least a few hours after riding around the front lower cap area. Also, in last 2 weeks I'll often get sharp pains directly behind my knee itself on the back with some mild swelling. I realize that's not the best description, but it's incredibly difficult to describe. Thoughts?

I'm also noticing that the sides around my knees are hurting (think that's softball related, quick bursts of speed), along with agitation in the hamstring area on occasion. I'm going to schedule a doc appointment this week to discuss, but I've been trying to power through it since I've actually lost 6 lbs over a 6 week period, so I'm quite motivated and don't want to get off track.

Any thoughts? I had my bike professionally fitted when I purchased it, but maybe I'm doing something fundamentally wrong if possible?


***Update as of 04/18/2012***

Small update everyone.

Had x-rays done, and the doc said he doesn't see anything wrong, just that my kneecaps are slightly slanted outward. He offered foot orthos to keep my feet and knees at bay. He couldn't explain the tension I was having on the side and back of my knee.

Go back a few weeks later with the same pain, and we do an MRI. That comes back negative, with just a small bakers cyst. No tears though. At that point he says he still wants to go in and scope it, even though he doesn't see any damage. I was hesitant to do that with him spotting nothing other than a very small cyst, so I now have started physical therapy. The lady laughed at the tightness of my hamstrings and calfs. She said my left kneecap will barely move even when pressure is applied (something the doc never even attempted), and said I need to work on that. So we're going to try building some additional muscle for support, and manually stretching the kneecap.

However, my left knee is even worse than it was 6 weeks ago. Lots of popping, lots of inflammation in the knee. Anytime I go from bent to locked, I can get it to pop 75% of the time. Discomfort in the back of the knee and deff feels tight. I'm bummed the MRI came back negative in the sense that no one can really tell me whats wrong.

The kicker is, I'll sometimes get popping in my right knee as well as of 6 weeks ago... I don't get inflammation in that knee, but can get a small amount of discomfort and popping. So I'm not sure if I'm hyper extending them when I sit or stand, or if it's my shoes or what. I feel lost at this point.

I am seriously considering yoga to work on flexibility if PT doesn't work out. If anyone has thoughts or ideas, I'm more than willing to try. I am going to get a second opinion in 1-2 months if I don't feel improvement, and opt for the surgery as a last resort. Doc said there could be a tear they can't see, but he wasn't even interested in surgery when he had just x-rays, and MRI's came back completely negative.

I'd do anything to get back on my bike, my weight loss program was going so well. 11-12 lbs in almost 3 months! Haven't sat on the thing for the last 2...

Possibly Chondromalacia or any number of other things, google it, fix it and dont ignore.

Bike fits are good to a point but will struggle to get things right first go, have you been back to the fitter? Its likely your basic position is ok but you may benefit from fine tuning things such as better shoe insoles with arch support, get assessed for cleat wedging - a little varus wedge can go a long way. You may also need some adjustment to Q.

Yopur basic position is likely ok since you say you had a fit but the fine detials take longer to get right. The aim is to have your knees tracking virtically without any sideways wobble. Flat feet, varus forefoot and ankle issues can result in knee pain. Left foot issues are common for some reason and the knee becomes the victim

Bike fit, and www.mobilitywod.com has helped me in a number of other knee and back related issues.

Are you stretching? What you are describing are typically a result of tight overused muscles. If your quads are tight from using them more than usual(like biking 6x/week) they will cause undue pressure on the patella as they cross the patella and attach below.They basically grind the patella into the cartilage below,eventually damaging it. So stretch out those quads. Back of the knee pain and swelling can be from bursitis, again from the hamstring tightness, again from all the new activity. These press on the bursa behind the knee, so do the hamstring stretches. Next with be the IT band. This will cause lateral(outer) knee pain. Do stretches for those.( Laying on side put the top leg off the edge of couch or bed and bring it up towards your head while letting it drop towards floor , keep knee straight) Oh yeah, and stretch....Any new and vigorous use of muscle will make them tight, and cause FRICTION. Friction is bad, for you and your bike.

pain at the bottom of the kneecap is often a sign of the saddle being too low. HOWEVER, you said you've been fitted and you're also having other issues, so it's probably a good idea to go talk to your fitter and/or go see a sports medicine doc.

Sometimes if you ramp up volume too quickly, you might get pains like you describe. You may need to ramp up volume gradually to allow your body time to adapt.

Wow, it makes me realize that maybe I'm starting to have this. My knees are "always" cracking (I know, no one here talks about cracking...). It's insane. And I sometimes get some pain near the kneecaps, mostly on the right cap. However, it doesn't seem to be painful during exercises. I probably should do some stretching which I never do. Can't be bad...

fify - seriously OP - don't try to diagnose this over the net. It could be any one of a number of problems, and why risk further damage by not knowing?

Hi everyone, thanks for the help. I'm not trying to diagnose as I will see a doctor, I just wanted to hear your ideas in case it could have been fitting etc etc. I don't stretch, but probably because I don't know exactly how to stretch certain areas other than my quads. Probably best to see a sports medicine doc.

I was getting Knee pain in the same spot on my MTB, on my left leg, I moved the cleat back on my shoe and it resolved the issue.

Baker's cyst?

http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002202/

My knees crack a lot too. Don't think it's a bad thing, unless YOu have pain

This sounds like a classic case of too much too soon; take some time off the bike and see a doc for diagnosis and then you may need some PT. I injured my knee in my first year of riding due to a fit issue; I needed additional wedges in my right shoe to better align my knee. Thing is, despite getting that fixed, I had an injury that needed proper rehab before I could get back to riding hard again. Even if you fix your fit (if that's your issue), you'll need to heal up again, or risk exacerbating the problem.

Have a pro check your fit both up and down and forward back. It could also be that you are trying to improve too fast and or riding too hard, ( been there done that), your muscles are probably overpowering your tendons and ligaments, (they don't "build" as fast), and if your aren't stretching immediatly after riding, DO SO! If you have good insurance, see a sport doc. oh almost forgot, if aren't doing "core" and hamstring strengthening do that too. That'll help-the back; cycling w/o core and hamstring exericses, cases strength imbalance in your back and outer thighs

The answer is "it depends"...by that I mean if you were riding a bike that was not set up and this setup on your new bike (you could also have been riding the wrong size previously for all I know) is dramatically different that could be a contributing factor. I am guessing (since I did not see this in your comments) that you are riding clipless and your shoes/cleats were part of the fitting process (it needs to all be done at once to get the maximum benefit).

Personally, I'd start with the doctor and go from there....you don't say if you had any pre-existing knee issues (we cull this out in an interview we do at the beginning of the fitting to see what we are working with) that might have been exascerbated by a new setup.

In other words, while I do fittings there's a lot of info that's missing from your comments (not a criticism) that I would have, so the best suggestion is to see the doc or to go back to the fitter and talk to that person. If you had zero knee issues before this, there's something going onwith your setup, but that does not mean the setup's wrong, it just may be a lot different than what you had before.

Also...I don't know what pedal system you have and whether there is any float which can help if you are riding pedals and cleats with no float...

Small update everyone.

Had x-rays done, and the doc said he doesn't see anything wrong, just that my kneecaps are slightly slanted outward. He offered foot orthos to keep my feet and knees at bay. He couldn't explain the tension I was having on the side and back of my knee.

Go back a few weeks later with the same pain, and we do an MRI. That comes back negative, with just a small bakers cyst. No tears though. At that point he says he still wants to go in and scope it, even though he doesn't see any damage. I was hesitant to do that with him spotting nothing other than a very small cyst, so I now have started physical therapy. The lady laughed at the tightness of my hamstrings and calfs. She said my left kneecap will barely move even when pressure is applied (something the doc never even attempted), and said I need to work on that. So we're going to try building some additional muscle for support, and manually stretching the kneecap.

However, my left knee is even worse than it was 6 weeks ago. Lots of popping, lots of inflammation in the knee. Anytime I go from bent to locked, I can get it to pop 75% of the time. Discomfort in the back of the knee and deff feels tight. I'm bummed the MRI came back negative in the sense that no one can really tell me whats wrong.

The kicker is, I'll sometimes get popping in my right knee as well as of 6 weeks ago... I don't get inflammation in that knee, but can get a small amount of discomfort and popping. So I'm not sure if I'm hyper extending them when I sit or stand, or if it's my shoes or what. I feel lost at this point.

I am seriously considering yoga to work on flexibility if PT doesn't work out. If anyone has thoughts or ideas, I'm more than willing to try. I am going to get a second opinion in 1-2 months if I don't feel improvement, and opt for the surgery as a last resort. Doc said there could be a tear they can't see, but he wasn't even interested in surgery when he had just x-rays, and MRI's came back completely negative.

how often per week are you riding, and what distances and intensity?

age? prior injuries or conditions?

pic of you on bike?

diet/nutrition on average day?

are you in good shape (less than 20% body fat)?

I strongly suggest using a foam roller for your IT bands.

i get a feeling that you dont allow enough recovery time.

remember, fit is dynamic.

also, if its still cold where you are at, then that could also explain the pain.

need more details.

If the MRI's are negative it has to be biomechanical and maybe fit. All the clicking in the knee is because the knee is tracking wrong due to some kind of response to over-use. You got some muscles over-developed, some tendons under-developed, a lot of tightness and it's causing the kneecap to be pulled out of position. I'm guessing all this cos I have the same issue. Had to stop cycling last year because of it and was hobbling for a few months the knee was so bad. Rest and lots of stretching from the hips down and strengthening of the muscles around the knee is all that's helped me. When you get back on the bike limit distance and stay away from hills. Build up slowly and always rest the day after a ride.

I have bad knees - patellar tendonitis (and other similar stuff I'm sure) and have had orthos recommend nothing but physical therapy, which was similarly frustrating. I used to wear a brace on my right knee, and sometimes on my left knee, about 50% of the time just to walk around in comfortably. Since I started riding regularly (5+ times a week - mostly commuting) I almost never wear one.

I would say (given that this is just BF advice) - for a few days try keeping your cadence up higher than normal and try putting your seat up and/or back just a tad, ride easier, and don't climb out of the saddle too much. I actually had severe pain in my left knee (on the front outside tendon both above and below the kneecap) a couple weeks ago after doing some extra climbing miles and took a few days off. It all felt better until I started riding harder again. Then I remembered about a month ago I'd changed out my saddle and I never made too many other adjustments since changing it. It's flatter than my old one so I decided I needed to move it up a bit, and back. My left knee has been much better since, although my right knee has had some discomfort - I suspect now my right leg is probably shorter or has less flexibility than my left. But I digress...

Don't worry about the popping when going from bent to straight. My knees do this all the time and the problems I had are solved. (I had that popping before and after thoses problems)

-I'll add +1 to the foam roller recommandation, it helped me a lot.

I would look for and consult a Sport Medicine Physician - bonus if the physician has experience with Cyclists - perhaps contact local Cycling Clubs/ Teams to see if they know anyone.

Foam roller seemed to help me too - either that or the pain just went away as I adjusted around the same time I started using the roller. Maybe it was a bit of both.

I haven't watched all of this, but a quick search found it and it looks like the exercise I have done.

Depending on your age, and knowing what I now do about your lack of stretching, and the number of days you pedal, I would expect all kinds of joint problems.
The lady is right about the stretching, you need a lot. There may be all kinds of other problems, no one on the internet can diagnose them.

BUT, stretching correctly would be one thing to do unless some doctor says don't. You need to do what I do. Buy the Cycling book written By former Olympic cycling coach Eddie B. Google the book using those words. There are a few pages just dedicated to stretching for bike racers. It is incredibly good. Do it every day, and don't ride so many days in one week. Try riding every other day, or even three days off in a row once in a while. Of course take the book to the right doctor and get approval first.
It has helped me more than I thought. I don't think there is anything better for some one who rides a lot. I only do the first few pages, before you get to aerobic stuff and stretching with a partner. You may be able to find it in a library, and just photo copy the stretching pages.

Thanks for all the responses everyone. I think I was doing a little too much so fast, but I was determined to lose weight and it's something I finally started to enjoy. With that being said, I probably only rode about 6 hours a week, so not a ton. But I'd often try and get an hour ride in 6 days a week. I'm 28, slightly out of shape, but not large by any means. I stay active by doing hikes, softball, volleyball etc.

I'm going to continue PT for a little and continue to stretch every day. again, I wasn't stretching before or after my rides, so that wasn't helping. But, i haven't been on my bike in 2 1/2 months because my knee is just that bad. Pops all the time. It's never pain, but lots of inflammation.

I will try that roller and see if that helps at all. I know this is going to take some time, but the PT says my kneecap is definitely not aligned correctly. We were doing some leg presses today and every time i extended 90% they'd pop. She then started to hold and push my kneecap inward and some of the clicking would stop.

Anyway, I really do appreciate all the responses. Feels good to have suggestions and not know I'm alone. Thanks again.

I started cycling about 6 months ago and I had all sorts of knee issues/problems at first when I switched to clipless. I have a pretty good handle on it now I believe and I can attribute the pain to too much too soon, the pedals I was using, and saddle position (lowering it a little and moving it forward). I also try to stretch more often.

Even though I feel I am moving along well I have to give myself resting time to not be sore, and I find I actually do much better if I give myself 2-4 days rest sometimes.

I started out using SPD cleats with no float, and then switched to Look with 8 degrees of float and was still having knee issues. I then switched to speedplay zeros with 15 deg of non-centering float which cleared up a lot of issues. They allow my foot to move a little during the stroke which I found I needed to keep the pain at bay.

Also since I am not too flexible right now (getting better w/ stretching and riding more) I found that I needed to lower the seat a little bit (maybe 1cm) also and have my seat a little further forward than KOPS asks for to keep pain away.

So don't give up. I was ready to call it quits for a while but I tried some different equipment, resting more, and stretching and it is so much more fun to ride now.