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My knee hurts...

Old 04-26-05, 03:02 AM
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My knee hurts...

I don't recall doing anything at one instance that made it start hurting. Rather, it started hurting gradually as I was walking the day after going to the Tour de Georgia.

It was:
*Freezing cold. 39 degrees
*the Brasstown Bald leg. We hiked the 3+ miles to the top
*Long day. We stood around for hours and hours.

My symptoms:
*I'm okay for about 40 steps, then a pain begins to grow under my left kneecap
*The pain hurts most when my leg is at a slight bend--when I'm pulling the leg forward from behind
*I can't sit down and press on my knee ANYWHERE and find a sore spot
*No swelling or visible evidence of injury.

I have felt this same pain before, on a tour I took in Virginia. Around the 3rd and 4th days, I began to feel that 'tugging' under my kneecap. (Same leg, in fact.) But riding seemed to help it, as it went away within 20 miles each day.

Has anyone experienced anything like this? I have a ride coming up Wednesday, that I'm probably gonna take it pretty easy on to see if anything improves. If not, I suppose it's time to head to the doctor...
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Old 04-26-05, 04:22 AM
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Here's more than you probably need to know, but I hope it helps:

EDIT: Most of this is from Dorland's and Arnie Baker's excellent book, 'Bicycling Medicine,' and from Burke's 'Complete Book of Long-distance Cycling.' I don't want to come off like I'm some super-expert who discovered this stuff or anything. I'm just a medical nerd who transcribes ortho dictation all the time and loves reading about it. Anyway...

Usually, front knee problems are symptomatic of pushing too big a gear or overdoing it on climbs, but there are other factors, definitely, including positioning and possible chondromalacia (softening of cartillage in the knee), patellar/anserine/quadriceps tendonitis, pre-patellar bursitis, patellofemoral plica, ITB (iliotibial band) syndrome, or arthritis.

Chondromalacia Patellae:

The kneecap glides over the end of the femur. Sometimes the underside surface of the kneecap is roughened or softened, and instead of gliding smoothly it rubs over the end of the thigh bone. This is called patellofemoral dysfunction/syndrome. A grating sensation at the front of the knee, pain going down stairs, and a general ache are frequent features. Stiffness after prolonged seating (moviegoer's stiffness) is common.

The patella (kneecap) is not flat on its underside, but has a ridge. As the knee bends, this ridge follows a path along the surface of the femur. Excessive force pushing the kneecap onto the surface of the end of the femur creates excessive stress - called loading or shearing force - on the underside of the patella and may result in its surface becoming roughened. Some people are genetically predisposed to this.

A muscle or posture imbalance may cause the kneecap to stray from its ideal path over the surface of the femur. When not gliding over its ideal path, the patella is subject to increased forces and becomes roughened. A relative weakness of the inside or medial quadriceps muscles is often responsible. A wide pelvis and "knock-knees" may make the condition more likely. Some of the bicycling-related causes of excessive loading/shearing forces are hill climbing and big-gearing. Weight training, running, squatting, kneeling, and climbing also place increased pressure on the patellar-femoral surface. This tends to be an early season injury.

Bicycling done correctly often helps this problem, believe it or not. Many runners suffer from chondromalacia, and bicycle riding is often suggested for therapy. A rough patella can smooth out over time if offending activities are stopped.

A relatively high-in-the-saddle position helps - make sure your knee is not bent more than 25 degrees from horizontal when your foot is at the bottom of your stroke. Sit farther back in the saddle. Spin rather than use big gears - maintain a cadence of 85 r.p.m or more. Avoid hills, especially long climbs. Stand more when climbing. Avoid long cranks. If it's due to a tracking problem instead of a loading one, pedals allowing some free rotation may help. Off the bike, beware of exercise routines: Exercises that bend the knee more than 90 degrees place tremendously increased loads on those surfaces and may worsen your problem. Squats, leg presses, and leg extensions all place increased loads on the patellofemoral surface. Avoid squatting, kneeling, going walking, or running down stairs or hills. Avoid running. Above all, avoid running down hills.

Strengthening the medial quadriceps may help. You are looking for exercises that involve only the last part of straightening your leg. Remember, be cautious about strength training when you are injured. You might try placing a couple pillows under your knee while lying down. With weight around your ankle, lift and straighten your knee, hold for a couple seconds, then relax. Repeat up to 100 times. Athletes may use weights up to about 1/4 of body weight.

Step-ups to a height of one step may be helpful. With only your body weight at first, face a 8- to 10-inch step, and place the foot of your affected leg on the step. Raise yourself up. Lower yourself. Repeat 15-20 times.

Surgical smoothing of the patella may be a last resort.

Patellar Tendonitis, quadriceps tendonitis, arthritis

The patellar tendon attaches the bottom of the patella to the tibial tubercule, a prominence on the front top of the shin bone. The quadriceps tendons attach to the upper pole of the patella or the shin bone. Irritation of these tendons causes tendonitis. (-'itis' always means "inflammation"). Low saddle, forward position, big gears, and long hills all contribute to this problem. Your own inherent anatomy too.

-same treatment as with chondromalacia, primarily - unless the medial (inside) quadriceps muscle is involved, in which case terminal extension exercises are to be avoided too. NSAIDs (non-steroidal anti-inflammatory drugs) are used with arthritis; otherwise, same treatment as with above.

Before any ride or activity, stretch, stretch, stretch! A lot! I've seen people just sort of cursorily reach down and touch their toes a few times, and that's not sufficient. You want to hold your stretches for about 45 seconds each (at least!) and feel the tension, and it should take a good 10 minutes to do a whole routine. You should stretch each day even if you don't ride. Although most of this information involves bones and cartilage, the skeletomuscular system is indeed one system involving also muscles, ligaments, and tendons, and improper stretching can lead to pedaling inefficiencies that might affect patellofemoral tracking or ankle problems.


Rider positioning

The basic position considerations are seat position and foot position.

I can't tell whether you mean that the pain is in front or inside of the knee when you say "under the kneecap," but it could be any of these things:

Front of the knee (anterior)
-Seat too low (raise seat)
-Seat too forward (move seat back)
-Climbing too much (reduce climbing)
Big gears; low r.p.m. (spin more)
Cranks too long (shorten cranks)

Inside of knee (medial)
-Cleats - toes point out (modify cleat position, consider floating pedals)
-Floating pedals (limit float to 5 degrees)
-Exiting clipless pedals (lower tension)
-Feet too far apart (modify cleat position - closer; or shorten BB axle; or use cranks with less offset.)

Outside of knee (lateral)
-Cleats - toes point in (modify cleat, toe out; consider floating pedals)
-Floating pedals (limit float to 5 degrees)
-Feet too close (Modify cleat position, longer BB axle, use cranks with more offset, shim pedal on crank 2 mm)

Last edited by Alekhine; 04-30-05 at 02:25 PM.
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Old 04-26-05, 05:04 AM
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Wow. Thanks =)
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Old 04-28-05, 08:12 AM
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Holy useful information batman!
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Old 04-28-05, 09:28 AM
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I have had knee problems for over twenty years. Incorrect bicycle set up and improper riding technique exacerbates the problem.

Last year I went to a kinesiologist who specializes in bike fitting. She changed the position of a cleat by a fraction of an inch, adjusted the seat height, and got me started on the long road to a more efficient pedaling technique.

The result: fewer knee problems.
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Old 04-29-05, 03:20 PM
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In the mean time, a simple treatment of the pain/inflammation is cold (ice the knee) followed by heat. I've use the bathtub spigot to run warm/hot water over the knee, right after icing. A heating pad is simply too inefficient to transfer heat well. Do this cold/heat several times a day.

Use some sort of knee wrap to _remind_ you to baby your knee. The wrap, by itself, won't do much. The reminder to take care to avoid things that can bring pain to your knee it the point.

This cold followed by heat helps the body flush out the by-products of the damage/inflammation. Knees are NOT well endowed with blood vessels. Icing the knee constricts the capillaries. The heat opens them up. Ibuprofen can also be useful to minimize the inflammation. If this helps your knee feel better, that's good. But, don't use the diminished pain as an excuse to do things that will hurt your knee further. It needs to HEAL. Reducing the inflammation will help healing.

There may be some muscles that need strengthening. I had issues with knee cap tracking. A very robust ligament on the outside of my knee was not balanced by sufficiently strong muscles pulling the kneecap back to the inside of the knee.

You may need to take greater care to keep your knees WARM while riding in the future. Tights. Knee warmers. Tights AND knee warmers. There is no insulation around your knees. Warm knees work better than cold knees, especially as one gets older. From your description of the onset of obvious symptoms, the cold maybe have been an aggravating factor. I use knee warmers or tights below 60F. Below 50F, I'll probably use both.

Last edited by sakarias; 04-29-05 at 03:30 PM.
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Old 04-29-05, 04:27 PM
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I was having similar problems with my knee both when running and biking. I began using a patella support when exercising. I found it helped quite a bit. A patella support is just an elastic band with a bit of foam to support the kneecap. It worked for me.
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Old 04-29-05, 06:30 PM
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I was at the orthopedist today for some shoulder tendonitis and I noticed a really cool diagram of how the kneecap works, and he explained it to me - it basically acts like a pulley out in front of the knee joint that increases the leverage of the thigh muscle over the tibia, or lower leg, by about 30%. Except, um, it isn't a pulley, it slides up and down... when you see what it does, and the amount of force acting on it, it is enough to make one think twice about the abuse we put them through. Any mis-tracking, or roughening up of the surface, or sudden overuse can damage it.

I also get a little pain there when I do hillwork, or change saddle position by too much. I used to get it when running hills and it is often referred to as "runner's knee". My point is simply to give it some rest, and make sure your fit is correct before going to hard on it, or it could become chronic.

Last edited by mtnroads; 04-29-05 at 06:32 PM. Reason: typo
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Old 04-30-05, 07:49 AM
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Originally Posted by Tom808
I was having similar problems with my knee both when running and biking. I began using a patella support when exercising. I found it helped quite a bit. A patella support is just an elastic band with a bit of foam to support the kneecap. It worked for me.
I was having knee problems a few years back. After going to a physical therapist he gave me this exspensive and cumbersome knee brace. That really didn't help. I ended up seeing one of those bands that you describe and thought what the heck. It ended up working and looks kinda cool too.

MBD
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Old 05-02-05, 02:48 AM
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What's odd about my particular knee "injury" is:

It doesn't hurt me or bother me one bit while I'm biking (as I've found). When I posted, I was really afraid that it WAS... But my knee started hurting after walking around at the Tour de Georgia all day in the cold.

Walking is what kills me now... and it only gradually builds over the first 35-50 steps... by 100 consecutive steps I have to stop as it's almost unbearable... But after stopping for a minute or two, it kinda "resets" its self and I can go 35-50 more steps with only gradually building pain.

When I ride, my leg stays bent at more of an angle than when I walk. When I ride, my leg never completely straightens, and never enters that threshold between "slightly bent" and "perfectly straight" that it enters when I walk...

That is where I'm hurting... when my leg goes from "slightly bent" to "perfectly straight." I can go from a straight leg to a bent leg and it doesn't hurt... ONLY when I'm going from bent to straight and over multiple consecutive times.

I can climb stairs just fine (as long as my left leg doesn't straighten all the way up).. I can sit down and press on my knee and I feel no pain... no swelling.

But it IS the area where my kneecap slides forward toward my shin. The area under my kneecap. I'm kinda leaning toward tendonitis at this point, minus the swelling.... I'm taking it easy, but I haven't seen improvement since I posted, and I rested well for 3 days... now I'm back at work walking around and it's hurting again. I think it's time to see the doctor.

What's funny is I can ride my bike with no pain... I've started saying that I'm going to bring my bike to work and ride it around the casino floor like the old ladies on their Rascals...

Oh boy... hang on, this one looks like she wants to race...
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Old 05-02-05, 06:54 PM
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Uh, may be time to see an orthopedist. Walking should not cause pain. That is what humans are designed for.

My wife and I were touring in the Canadian Rockies. While walking in a grocery store, one of her knees locked up. She had been having zero trouble riding. After it unlocked, she had zero trouble finishing the tour.

When she got home, the orthopedist checked her out and scheduled her for surgery and found damaged cartilage on the bone end. No amount of training, exercises or the like would have healed that.

Now, twenty years, we are still touring.
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Old 05-02-05, 08:13 PM
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Thanks a lot for that bittersweet input =) I'm going to make an appointment tomorrow.
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Old 05-03-05, 10:30 PM
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It does sound like you may have some cartilage damage, but it may be minor and not require surgery. It could also be some roughness under the kneecap, or slight mis-tracking. I used to get some of that also - pain and a feeling that the kneecap wants to pop, but won't. Since I have had both knees scoped in the past, I didn't want to have more taken out, so I quit running (sadly), started biking more, and started taking a Glucosamine - Chondroitin supplement every day. I also use Superfeet orthotics in all my shoes, including biking shoes, which helps foot and knee alignment.

Now a year later I can bike all I want - no more knee problems, except occasionally a mild soreness if I do lot of standing hillwork. Other than that, the knees feel really good, and fortunately I can still hike. You might also try ice and NSAID's to take down the immediate inflammation.
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Old 05-08-05, 05:02 PM
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I hope you're right. I have a doctor's appointment Thursday. From what I've read up on, and the posts in here, it's probably cartilage. Hopefully, I'll get it quick enough before it gets serious.

Thanks all!
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Old 05-15-05, 01:21 PM
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Originally Posted by ImaGoTourNow
What's odd about my particular knee "injury" is:

It doesn't hurt me or bother me one bit while I'm biking (as I've found). When I posted, I was really afraid that it WAS... But my knee started hurting after walking around at the Tour de Georgia all day in the cold.

Walking is what kills me now... and it only gradually builds over the first 35-50 steps... by 100 consecutive steps I have to stop as it's almost unbearable... But after stopping for a minute or two, it kinda "resets" its self and I can go 35-50 more steps with only gradually building pain.

Rub your knee liberally with Vicks, do it again after it dries and before you go to bed. Do both knees and walk arourd with shorts. You should be ok in the morning, avoid long walks in cold weather. Let me know if it works.
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Old 05-16-05, 01:21 AM
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Nothing noticeably wrong with the X-Rays, so they're referring me to a specialist...

Funny thought, tho... I hadn't been on my bike in a couple of weeks when my knee started hurting me walking around.

Lately, I've been on my bike almost every day and tonight was the first night that it hasn't pained me at all... and I've done a considerable amount of walking..
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Old 05-16-05, 12:18 PM
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Hey
Ken Cox has some great posts over in the S.S / fixed gear forum on this subject..his advice has worked wonders for my knee pain (Patella and Iliotibial Band)
https://www.bikeforums.net/singlespeed-fixed-gear/102272-prevention-knee-injury-pain.html
https://www.bikeforums.net/singlespeed-fixed-gear/106450-pedaling-technique-2-s-1-a.html
i would like to hear what the specialist has to say
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Old 05-17-05, 10:31 PM
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Originally Posted by ImaGoTourNow
Nothing noticeably wrong with the X-Rays, so they're referring me to a specialist...

Funny thought, tho... I hadn't been on my bike in a couple of weeks when my knee started hurting me walking around.

Lately, I've been on my bike almost every day and tonight was the first night that it hasn't pained me at all... and I've done a considerable amount of walking..
FWIW, I had two issues with my knees, Chrondomalacia and a patella that was being pulled to the outside of the knee. This later problem was due to a very sturdy ligament on the outside of both knees that was not balanced by strong enough muscles on the inside of the knee. The two recommendations were a patellar strap to help the patella track better (a Cho-Pat strap or a similar one made by Pro-Tec, which is what I use), though it is not clear this is actually doing me any good. The second recommendation was to strengthen the muscles around my knee: hiking and biking. Whenever my muscles have been out of shape, I get twinges in the knee at random times in my right knee, only. When my legs are strong (as now and usually during the summer) I don't have problems. These are 57 year old knees with a lot of miles (biking and hiking) on them.

Basically, I can not let myself get out of shape, anymore. I rode rollers daily 45-90 minutes all winter, as well as snowshoeing and similar. These days, I am biking 200+ miles a week.
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Old 05-20-05, 08:50 PM
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Today, the specialist said:

My patella was tracking perfectly, X-rays looked great, and if I had torn a ligament, tendon or ruptured cartilage, I'd still be feeling it... (as I haven't hurt in about a week, noting that these past 2 weeks I've been on my bike nearly every day)

They showed me some exercises to do to keep the local knee area strong, and suggested that I probably strained my knee, but helped it along by strengthening it while cycling. Most likely, I overexerted it while climbing around Brasstown Bald all day at the Tour De Georgia.

It hurt me for a solid month... sometimes unbearably, but only when I walked... never hurt on the bike, so I went from easy to moderate to very strenuous rides, then the pain went away...

Thanks to everyone for their input, and here's to another good riding season!

=)
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Old 05-21-05, 06:19 AM
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I also went to see physiotherapist this week... According to him, my knee look fine but he thinks I am not flexible enough and that certain muscle groups are not strong enough (i.e. I don't use them enough)... this probably cause great pressure on certain part of my knee which in turn cause the pain over a long period of activity. I got some stretching (all thigh muscles) to do as well as some strenghtening of certain muscle group (mostly , ass, hips and lower back).
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Old 05-21-05, 12:10 PM
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Originally Posted by ImaGoTourNow
Today, the specialist said:

...

Thanks to everyone for their input, and here's to another good riding season!

=)
Good to hear. Now your mind can relax.
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