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Knee pain - feels like someone hit my kneecap with a hammer

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Knee pain - feels like someone hit my kneecap with a hammer

Old 10-28-13, 10:50 AM
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Knee pain - feels like someone hit my kneecap with a hammer

"Not another knee pain thread"... Yes, here I am asking about it.

I've read almost every thread here on BF and online that I could find, and I'm hoping someone has at least some insight as to what part of the knee physiology may be causing the pain, so I can focus my adjustments and training/stretching efforts accordingly. In summary, "kneecap" pain, focused on the left side, and almost feels like it's over the top of the left side of the kneecap.

I've been through PT, bike fitting, and a chiropractor that does a lot of work with cyclists, and honestly after the bike fitting my own research and trial-and-error changes have been more productive, supplemented by the stretching that the 3 experts worked with me. I've been road cycling for a year, and worked my way up to do a charity ride a month ago, 135 miles over two days (82mi / 53mi). The month before that I was doing back to back 40-50 mile rides each weekend, and had eliminated almost all knee pain (entirely IT band issues) through a combination of pedal spacing, cleat adjustments, and overall proper bike adjustments.

I took it easy a week after the charity ride, doing a short flat ride, and then a week after went out for a reasonable 40 mile ride...not too hard on the hills, and late into the ride knee pain developed "on" the knee cap and lasts for 2-3 days. This is my right knee.The pain is focused on the left side of the knee cap. When I flex the leg it hurts on the kneecap, especially when bending it back towards a right angle, and lesser so when I extend out my leg. I've had this on every ride now for the past few weeks...usually riding 40-50 miles once on a weekend, but some light training 1x/week in between. The pain comes on fairly quickly, though lightly at first, now on my rides. Raised the seat about 6mm (3mm at a time) as it seemed to be riding a little lower than I remember.
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Old 10-28-13, 11:00 AM
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1) Sounds like you have not yet seen a sports doc / orthopedist. That'd be my next step.

2) Sounds like you should ice it. Don't overdo the ice. https://www.webmd.com/pain-management...-a-knee-injury

3) Doubling your weekly cycling in 4 weeks or less could easily result in an overuse injury, especially if you are already prone to it. Ideally, you should increase your weekly mileage by no more than 10% per week.

4) Don't take (specific) medical advice over the Internets. Seriously. No one here can diagnose a knee injury based on a few lines in a forum post.
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Old 10-28-13, 11:18 AM
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Can't say what your issue is over the internets, but I can say that rest fixes a lot of things. The saddle position is probably a causative factor, as well as straight up conditioning. It's not just your muscles which get conditioned! It's your tendons and ligaments as well.

Take it easy for a couple weeks minimum or until the pain goes away. Don't ride through that kind of pain. Then reevaluate.

Also, you talk about working with three professionals and then implying you discard their advice on bike fitting and do your own thing. I would suggest getting a bike fitting through a bicycling specific physical therapist (a single person with both skills) and ditching the chiropractor. Then work with the PT to get to something that works. I don't know you, after all this is the internets, but if you have only been cycling a year, with much of that year spent making (probably large) changes to both your fit and fitness, a ride of 135 miles over two days is too much. Especially if you are older.

You should not have any knee pain ever when you ride, and it is my belief that knee pain, unless you are anatomically "not normal" is a characteristic of muscle imbalances more than the millimeters revolving around pedal spacing and cleat adjustment. I've been working in the weight room a lot this year (track cyclist, tool of the trade), and have been learning a lot about how muscles stabilize the knee. When you extend your leg, both your hamstrings and your quads contract. The hamstring crosses both the knee and the hip on the back of the leg. It has more leverage on the hip, so it acts to extend the hip joint. The quad crosses both the hip and the knee on the front of the leg, but it has more leverage on the knee, so when it contracts, it acts to extend the knee. If you have weak hamstrings and back (your back needs to be stiff to transmit power through the hip joint) and pedal mostly with your quads, then the quad is pulling with huge force on the front of your knee and pulling the joint out of position. If you develop the hamstrings and the hip extension, then the hamstring pulls equally with the quad, and the knee, being pulled from two opposite sides, remains stable.

What I am saying is, absent any particular knowledge of you, your constant knee pain (you said you eliminated almost all your knee pain) might be the result of overdeveloped quads (the huge increase in cycling miles in just a year's time would explain this) and underdeveloped hamstring and lower back. The solution might be as simple as resting until the pain goes away and then backing off on the intensity and miles and increase these only gradually and without joint pain. The body, in general, knows how to work it's muscles. It's only when you push your capabilities, repeatedly and without remorse, that muscle imbalances don't fix themselves.
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Last edited by Brian Ratliff; 10-28-13 at 11:23 AM.
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Old 10-28-13, 11:56 AM
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Brian...thanks for the thoughts. My bike fitter is a highly regarded PT/bike fitter here in the Bay Area...had some extra healthcare money to use up and that was the only way I could afford their services. It may be time to fork over some money to them for another appointment because that was 8 months ago and all the pain was IT band issues related to some physiology issues in my right hip. Basically, 2 months - right IT band issues. Bike adjustments and stretching cleared that, then 2 months - left IT band issues...basically "rebalancing"...then 3 months with no pain (woohoo!).

I do appreciate what you have said about 1 year being a short time. I've been mountain biking inconsistently for 20+ years, but road cycling, especially with long 4+ hour rides, has brought out completely different physiological issues. Unfortunately knee pain, not muscle strength of fatigue, has been my limiting factor. BTW: I'm only 35 y/o.

In regards to the jump in mileage, I didn't jump from 40 miles/week to 135 for the charity ride...I've been riding 40-60 miles rides for 6+ months now. About 2 months before the charity ride I was doing 40-50 mile endurance rides on Saturday followed by 20 mile training rides on Sundays. 1 month before I was doing back to back endurance rides on Saturday and Sunday totaling about 90 miles. Still, I know that's more than the 10% jump recommended, and I clearly need to work on the "training" component of the muscles more than the endurance part to build up the right muscles.
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Old 10-28-13, 12:26 PM
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Speaking from experience, and being roughly the same age as you, there is a lot of difference between your training you described and the "event". In any event, the best thing you can do right now is rest. You have injured yourself. There is no magic stretch, no magic therapy you can perform to heal damaged tissue. You have to let your body repair itself. And until you do, there is absolutely no point in messing with your bike fit. It's okay to keep in "contact" with your bike; in other words, go out two or three times a week on very easy, short, flat rides, as long as you have absolutely no pain. You shouldn't even need to shower after these rides, they should be that easy. When your brain thinks it's time to increase the mileage, hold back for at least another week. Your body will tell you when it is raring to go; your brain doesn't know sh*t about it. Your brain is obsessed with your "plan" and your "fitness". F**k your brain. Let your body tell you when it's time to train again.

Again, you should not have knee pain at any point when you ride, especially at 35 years old. If you do, you are, by definition, overtraining; some part of your body is weak and needs rest before you can resume training. Lay off.

My story:

When I was starting out with road cycling, or rather, when I made the decision to start becoming fast at road cycling, I started pushing bigger gears. This was 10 years ago when I was in my early 20's. I started having some intriguing and unsettling knee pain from this. I did just what I recommended to you, didn't see any therapist or anything, and futzed with my position. I found my saddle was too low and the pain eventually went away and I could increase my time and intensity again.

Fast forward a few years; I win a race and get a really superb picture out of it. Head on shot from the finish line of the final sprint with me in front of a huge, spread out field of 100+ riders behind me all charging to the finish line. First thought from my brother when he sees the photo: "your knees are HUGE!" Yes. Looking at the photo, and down at my legs, I have huge knees. My knees weren't always this big, what happened is, in the course of training, the connecting tissues in my knees have become more and more developed with my leg strength to support the muscles and forces from cycling. This doesn't happen in a year. At 35 years old, you have an extreme disadvantage when it comes to athletics in that you didn't use the growing years of your life, your preteen and teen years, to develop your body to absorb the forces of the athletic motions. You look back to the pro cyclists, they all start in their early teens, and none of them were doing 40-60 mile rides in their first year. Guys and gals who take up athletics later in life think they can just jump in because they are adults and all growed up, but those several years it takes to acclimate the body to athletic stresses don't shorten just because the person is older. It actually might lengthen.

So, be patient, rest, let your body heal, and reintroduce the cycling gradually and in a way that gives you absolutely no pain. Your body will adapt without the help of physical therapists or chiropractors just fine if you give it time.
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Old 10-28-13, 12:55 PM
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Thanks again Brian! Message received and I'm going to follow through on the advice.

You're completely right on... It's like my snowboarding. I started as a teenager, finally got good enough to start hitting big jumps in my mid-20s, but quickly realized that by that age for amateur snowboarding you're already on the tail end of the body's ability to bomb 30-50 feet gap jumps and need to stick with more natural terrain instead. I'm intrigued to see how my legs and knees are going to react to this year's snowboarding season after a year or cycling.
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Old 10-28-13, 01:58 PM
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One last word: you'll know when your body is telling you it's okay to start training again. You'll feel powerful. You won't feel fragile anymore. And you'll stop thinking about your knees when you ride.

If you are resuming training because you "should" or because you "think you can", this is your brain talking, and it doesn't know anything. It's obsessed with schedules and those thoughts are there because your mind is getting obsessed with the notion that you'll get "out of shape" or you'll "lose fitness". Your body is ready when the thought is not that you "should do such and such" or that you "can do such and such", but when you know that doing your training will be of no consequence.

Performance is stress, like the challenge ride you just did. It takes time to recover from that. Training is routine. You do something, and you do it again and again until you are bored and then you do it harder or faster or longer. Rinse and repeat. You rest when you feel weak and fragile, and you push when you feel powerful and strong.

This is probably contrary advice to a lot of fitness books aimed at adult athletes or athlete wannabes. The advice there is: get a measuring stick (heartrate monitor, powermeter, etc.), do the stuff printed on the worksheet in the back of the book and ...???... get fit. This is the way to injury. No athlete does this without lots of experience with and knowledge of their own body. These books are written by people who train people who were already athletes for half their lives. And it will work for them. For the person just starting out in their first years in a sport, the best training advice is to learn your body. In fact, one of the best books about training for cycling, Friel's "The Cyclist's Training Bible", actually states up front that his specific training program recommendations are only for established athletes. It is good to read the book if you are a beginner (and you are, being in your first year), but you don't follow the specifics in the book until you have some knowledge of your own body.
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Old 10-28-13, 05:33 PM
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What is this "absolutely no pain" bidness?! Good lord man, there's HTFU'ing to be done!
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Old 10-28-13, 06:33 PM
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Originally Posted by Long Tom
What is this "absolutely no pain" bidness?! Good lord man, there's HTFU'ing to be done!
Joint pain, my man. Muscle pain is all you can eat. But, gotta heal the joint first.
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