vega2614

Yes, I know, another knee pain thread, but hopefully my situation will address issues that are unique and subsequent replies (hopefully) will help others in my similar predicament. I'll try to keep the setup and issue as short as possible.

I've had left knee pain during running for quite some time (I'm 30 now, pain since early 20s), which I now am sure is chondromalacia. So I began cycling regularly for exercise and loved it (~100 miles a week, usually high intensity). I started having left knee pain the next day after a long 200 miler weekend, about a year ago. This pain is different from running though. It's more localized to the inside (medial) edge of the patella (so anterior-medial), and is the worst when pushing down on the pedal. I rested, it went away, then biked again, and it came back. It doesn't seem to be going away after many attempts to fix it. I now have mild pain when walking as well, but usually only within a few days of running/cycling.

The following is what I've explored. Many of the tips are from Sheldon Brown's site, cptips, etc.; basically any website that talks about knee pain, I've been there and tried what they suggest.

-Adjusted seat height/distance from handlebars (had it so high one time that the back of my knees started to hurt!)
-Adjusted cleat position and rotation
-Tried quad strengthening (yes, VMO) and hamstring/calf stretching
-Went to PT for a few sessions (insurance ran out, plan to go back when it kicks back in)
-Foam rolled
-Vibram five finger running (heard it helps with knee issues by strengthening the muscles of the leg)
-Ice
-Drugs (ibuprofen, fish oil, glucosamine)
-McConnell taping (and opposite pull direction based on PT advice)
-Specialized BG in-shoe wedges (instead of cleat shims as I may consider getting new shoes soon)

Admittedly, some approaches I may not have tried for long enough, but I didn't notice any improvement.

I still have a feeling the pain is chondromalacia, but I'm not sure. Based on what I've read, medial plica syndrome is in a similar region. The PTs (I had 3 examine me at once because they were stumped) said my quads are strong and apparently balanced. One thing they have noticed is my left leg is more bowlegged and I have forefoot varus on my left foot, probably from repeated ankle sprains when younger. In general, my left leg is a lot looser, but they said that's more compared to my right leg, which is very stiff and unforgiving to tampering. They would play with my legs and I swore they were pushing a lot harder on my left, but apparently it's that much looser/weaker. I also had a functional leg length discrepancy that they removed by leg tugging. This might have been due to me adjusting because my knee was hurting.

So from this, it sounds like general strengthening of the muscles around the knee would help, but what is really frustrating is that when I do half-wall squats (as opposed to 90 degree) and laying-down straight leg lifts, I seem to aggravate it (pain delayed til the next day), even though it feels fine during the exercise. Lunges and more aggressive exercises definitely aggravate it during the exercise. The worst part? My knee even starts hurting after swimming freestyle! Seriously!? The one thing that people with knee pain are supposed to be able to do and I can't. Even with a pull-buoy, it feels a little aggravated.

So, here's my plan:
1) Go to see orthopedist
2) Probably go back to PT
Hopefully these 2 will take care of any biomechanical issues
3) Get fitted

Now I know many of you were thinking (3) when you first started reading, but since I get the pain on ANY bike I ride (I have more recently been regularly riding 3 different bikes with slightly different setups due to commuting requirements), I don't think its ONLY that.

Anybody else have a similar issue, and even better, what fixed the problem for them? I know resting will help, but I'd like to fix the cause as well.

Thanks in advance for any wisdom offered, and sorry about the long post.

freedomrider1

Did you have a MRI yet?

vega2614

Not yet. I'm guessing the orthopedist will do at least an X-ray, and an MRI would be great. Last time I went straight from general physician to PT, thinking PT would take care of it. One of the PTs suggested I go to an orthopedist since they couldn't figure out what was really giving me pain. They were just trying to eliminate the cause.

Bacciagalupe

I would start with the fit.

It doesn't matter if you're using 3 bikes with different setups. It's entirely possible that one, two or all three are off, and causing strain. It's possible your pedaling technique is wrong, and causing the issues. Or, if the one you ride the most is off, then you've already caused the injury, and even if the others are set up fine the act of pedaling is still aggravating it.

The doctor will probably tell you to stop cycling and running for a few weeks, while you ice the knee and/or work over your IT band. That might help; and the second you get back onto the improperly fit bike, you're going to irritate it all over again.

So, I'd start with the fitter. Use only the bike he set up for you, for two weeks. If that doesn't work, go back to the fitter and get him/her to adjust it. If that doesn't work, then go see the doc.

vega2614

Thanks for the reply. I agree that pedaling in general is probably aggravating the previous injury. I've gone weeks without biking, felt great, and then it will come back randomly a few weeks after riding again. I probably am pedaling funky. I've always noticed my left foot doesn't seem to be as supported on the pedal. When I ride without clipless (both commuter bikes), I ride with my foot further forward on the pedal and seems to cause less pain.

I'd love to be able to only use the bike they fit for me for a while, but based on my commuting requirements I have to ride 3 bikes throughout the week.

I will still go to the orthopedist as I'd like to be able to run without pain as well (which has been a problem since well before I even cycled), but based on your advice I know I don't necessarily have to wait to see a bike fitter.

Is there anything in particular I should look for in choosing a fitter? I'm afraid I'll go to a bike shop and spend a lot, only to get subpar assessment. I just can't wrap my head around how a PT needs like 6-12 sessions, but a bike fitter can fix issues in one 2-3 h appointment.

Also, is it possible to apply what you've learned during the fitting of one bike to another? This is mainly my hesitation in doing so, as I'd like to learn what I'm doing wrong and what setup works right, rather than the fitter just doing some magic and sending me off on my way.

Bacciagalupe

Sorry, I'm not really computing that. It's unclear why you can't just stick to your commuter bike for a week or two.

Next best solution is to make clear to your fitter that you need to know how to adjust those other bikes.


Unfortunately, finding one is hard; you may need to ask around, including checking with local bike clubs.

PT and fit are very different things. PT is a rehabilitation process which requires repeated sessions and supervision of your progress. The goal of a fit is to get your body in the best position to handle the unnatural act of cycling.


Sort of. The better approach is to tell the fitter how the other bikes are set up. There's a limit to how much they can do without actually seeing you on the bike.

However, if they notice an issue with your pedal stroke or cleat position, that will carry over to your other bikes.

rangerdavid

If you're not using clipless, then your foot position is going to be different not only on each bike, but since it's not locked in, it is going to change on the bike you get fit on.

vega2614

OK, here's the breakdown if you're interested. I have two commuter bikes; I have a bike-train-bike sandwich commute, with a 4 mile ride each way. I cannot take a bike on the train. Both bikes are locked up for extended periods of time (one is locked up every night at the stop near my work). The bike I put the most miles on, by far, is my recreational bike, which I would never lock up as it would get stolen in probably 1 h. The commuter bikes are complete junkers that I fixed up and made ridable. One I actually found in the garbage. You'd have to be insane to steal one, along with the fact that I use 3 locks on each. What's funny is I'm actually concerned people will see all the locks and think of it either as a challenge or that the bike is more than meets the eye. Both commuter bikes are traditional platform pedals, while the rec bike is SPD mountain clipless.

So, long story short, it would be silly to spend a ton of money to get fitted on a junk commuter bike that probably isn't causing the issue (just aggravating it) and doesn't get nearly the mileage my rec bike does.

Anyways, I see what you're saying about PT. But here's the issue: I know I have some biomechanical problems as running has always hurt, the PTs told me so, and I've had various biking issues over the years that resolved from strengthening/stretching; the knee injury described in this post as the exception. There's no question in my mind that I need to fix the biomechanical issue, but I wonder if fixing it will change my specific bike fit.

I have actually explored the internet and found a bunch of recommendations for a fitter. The session runs about $325, which seems really steep to me, but maybe I'll just bite the bullet. Does that seem reasonable?