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Persistent knee issues currently on tour.

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Persistent knee issues currently on tour.

Old 05-10-14, 04:00 AM
  #1  
Wowk
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Persistent knee issues currently on tour.

Ok, so this is going to be long winded but I hope someone out there can help me with my current knee issues.

I know such issues have been beaten to death on these forums, but I'm still at a loss.

I am 4 weeks into my 20 week cycle tour from London to Turkey. I have just passed the 1,000km mark. On about the fourth day of my tour I started experiencing pain in my left knee. Specifically, on the front of the knee, on the inside of the knee cap. So the interior of the front of the knee joint. I was told this is the meniscus joint as opposed to the patella, by a chemist, but I cannot be sure if she is correct. I had to take three days off to recoup, I then rode for a day and had to take another week off before I felt comfortable riding again.

Since then I have been conservative with my riding. Been spinning in a low gear, in many cases actually walking my bike up steep hills, and often taking rest days. At the moment I can ride for around 3 days before my knees (now my left and right) flare up and I feel it is best to stop. Needless to say this is more than frustrating, worrying about my knees on a tour is far from ideal.

If I can describe the pain as best I can: it is now in both knees. It starts as a dull pain on the inside of the front of the kneecap (not square alongside the kneecap but perhaps a bit lower than the middle of the kneecap). When I get off the bike I can often feel it more (i am resting at the moment and can actually feel creaking at the top of my kneecaps when I move them while sitting down). Sometimes when I feel I have pushed myself too hard and decide to take a rest I can feel clicking on the inside and/or the top of the knees. I have experienced clicking before whilst riding, but only on the inside of the knee, not above the kneecap. At present I am sitting on a bar stool, when I rock my right knee joint back and forth I have a click above the kneecap as well as a slightly sharp pain on the inside of the kneecap

Measures I have taken so far :

- I can hear everyone saying your saddle is too low! I hear ya. After the pain started I went to consult a bike store owner in Belgium. He told me my saddle was actually too high and adjusted accordingly, he also pushed my saddle back slightly. Alas, pain still there. I have since been fiddling with my saddle every which way. Still to no avail.

- I purchased a new Brooks b17 narrow before my tour started. I noticed a few weeks ago that looking at the saddle from the back, the left side has worn in considerably more than the right. In fact, it did not appear from the wear of the saddle as if my right sit bone was in fact riding ON the saddle, but rubbing against the side (it still shows this, I have attached a picture). This was when I had only experienced left knee pain. Thus I thought that perhaps I was dropping my right hip too much, missing the saddle, in turn making my left hip ride higher (evident in the wear) and leading my left knee to hyper extend (this still doesn't explain pain at the front of the knee,I would expect pain to be at the back of the knee in such a situation.

- I ride with toe straps. After the pain started I began tightening my straps more (previously I rode with them loose, practically so loose so they performed no function). I have since been tightening them in an effort to stabilise my foot and knee. Pain still there.*

I am at a loss. Each time the pain reoccurs I change the way I ride, thinking I have solved the issue only to be proven wrong by my body. My theory is constantly changing. At present, considering the wear of my saddle and my recent attempts to ride with my sit bones evenly positioned on the saddle, my theory is that the saddle is too narrow for my hips. Leading to one side or the other to drop/ride higher at any point in time, thus causing the pain to both my knees at present. But who knows.

Back home in Australia I never experienced knee pain. Only ever neck pain. I didn't ride exceptionally long distances back to back , admittedly. Could this be a conditioning issue?

I would go see a professional bike fitter if I could, but finding one, let alone an English speaking one in rural France is a task in and of itself.*

I hope you touring brethrens can help out a frustrated travelling cyclist!*

Sorry for the length of this post, but I figure the more information the better.

Thanks in advance everyone. *
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Old 05-10-14, 04:12 AM
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Is it Time to cancel the tour and return home?
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Old 05-10-14, 04:34 AM
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I once did my knee in on day one of a short 4 day tour crossing the UK from West to East. I finished the tour, but was pushing my bike up minor bridges by Day 4. I think it took a month before I was back on the bike (and have since swapped the 28 tooth granny for a 22 tooth one).

Obviously, only the OP can judge this, but from what he's saying, I'd seriously consider throwing the towel. I his injury is anything like mine, he'll need some serious time off the bike to recover, and he's not going to get that on tour.
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Old 05-10-14, 04:35 AM
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Originally Posted by 10 Wheels View Post
Is it Time to cancel the tour and return home?
No, at the moment the issue is just manageable. I am at least sticking out the trip until I reach Barcelona, Spain. Honestly, giving up on the trip is not something I want to consider. Call me stubborn..
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Old 05-10-14, 04:35 AM
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Wowk, I have a wrecked left knee and one bit of advice is to not carry on with your original plans by using the rail way when needed as there is a possibility of long term damage. Joint pain isn't treated the same as muscle pain that alleviates with use.

I don't know of anyone personally, but have read of cyclists that have their saddles a couple of degrees from the bike's center line to suit their sit bones. You also may just naturally weight your left side more than the right.

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Old 05-10-14, 04:37 AM
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Originally Posted by fairymuff View Post
I once did my knee in on day one of a short 4 day tour crossing the UK from West to East. I finished the tour, but was pushing my bike up minor bridges by Day 4. I think it took a month before I was back on the bike (and have since swapped the 28 tooth granny for a 22 tooth one).

Obviously, only the OP can judge this, but from what he's saying, I'd seriously consider throwing the towel. I his injury is anything like mine, he'll need some serious time off the bike to recover, and he's not going to get that on tour.
My knees appear to be recovering a little easier each time they flare up. If there was to be any long long term injury I would think it would have occurred by now?
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Old 05-10-14, 04:42 AM
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Originally Posted by Wowk View Post
My knees appear to be recovering a little easier each time they flare up. If there was to be any long long term injury I would think it would have occurred by now?
What I mean to say is that as recovery time is gradually improving I can't imagine this would indicate an inherent issue of joint degradation, but a bicycle fit/posture issue.
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Old 05-10-14, 05:37 AM
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I usually find any knee pain to be an issue with cleat angle and adjust it accordingly, but on one long tour I did injure a knee. I wound up walking a lot of the climbs to ease the strain on the knee. After several days of that I gradually recovered. It was a pain to walk the climbs, some of them quite long, but it allowed my knee a chance to recover and prevented the need to end the tour.
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Old 05-10-14, 07:27 AM
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A few loose thoughts:

--I know the injury happened with loose toe straps but could it be that the tightened straps are causing your knee to track incorrectly and delaying your healing? My understanding is that we unconsciously and reflexively make small adjustments while we pedal so that our knees track correctly and that with not enough "float" the knee can track incorrectly.

--There is a thread in BF in which a few people report apparent knee tracking problems from compression pants.

--The depressions on my seat are also greater on one side. I haven't had any knee pain but I remember years ago when I went to a chiropractor that she checked my uneven leg lengths and then did an adjustment to correct this. Lying on my back with my bent knee pulled across my body toward the floor she pushed down sharply resulting in the "cracking" noise and the subsequent evening out of my leg lengths. I could actually feel the difference when I walked. It also seemed like I could adjust myself by simply doing the same thing she did but as a stretch. So I am wondering if this stretch could even you out a little bit.

--Could you take a long rest and then complete a shorter tour?

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Old 05-10-14, 07:46 AM
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ursle
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The only thing you can do is listen to your body, masking pain with drugs isn't going to feed the bulldog, your knee says "stop" so stop, spend a month or two out of the saddle, then slowly start again and build up over the course of a year, tendinitis needs to heel, I'd advise a roller for the rest of your body to take the pressure off the tendons and ligaments that are under stress.
Amazon.com : GoFit 24 X 6-Inch Professional Dense Foam Roll (Black ) : Exercise Foam Rollers : Sports & Outdoors
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Old 05-10-14, 08:38 AM
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Originally Posted by mm718 View Post
and that with not enough "float" the knee can track incorrectly.
This may not work for everyone, but I have found that for me at least, a lot of float is not needed or even desirable. The lack of it does mean that you must take great care to get foot angle correct if using clip-less. I use the minimal float in my pedals to help figure out where the adjustment needs to be. If I feel any slight twinge in the knee, I check if it feels better two degrees in or out and then adjust one or two degrees in that direction. It takes some tweaking untill dialed in, but then is likely to be good indefinitely.

I think that if a rider is floating the angle much during every pedal stroke either they are probably doing something wrong or they have some strange bio-mechanical issues.

I am not sure any of that applies to the OP and his clips and straps, since his feet can probably float a good bit.
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Old 05-10-14, 08:46 AM
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Thanks for everyones' replies so far. Mm718, thanks for the thoughts. I only recently started tightening my straps, but yes will take on board that the feet do need room to adjust. Also, I dont wear compression pants.

To the queries about throwing in the towel. It is a constant thought in my head. I have set Barcelona as my next goal, a far cry from Turkey but at least a destination that would mean I had a significant tour. This tour is the reason I left Australia, quit my job etc etc. So ending in such a short time would be rather disastrous. I can snake a really really slow trail to Barcelona, or I could just rest in cities and do nothing. This is not only very expensive in France but mind numbingly boring and frustrating. The alternative, catching trains everywhere is just as frustrating.Not only is travelling on trains with a fully laden bike a huge hassle, but you miss out on the real experience of a cycle tour. Alternatively, canning the touring aspect of the trip and continuing as a backpacker of sorts has its own logistical problems (shipping the bike to where? I have no home in London as of yet, where I will be settling at the end of the Trip.)
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Old 05-10-14, 09:08 AM
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Bare in mind that it's a 28km climb across the Pyrenees. It's 'only' 1000 meters up, but you may want to consider an alternative to riding for that leg if you decide to try for Barcelona.

I can see your predicament. If the issue is manageable, then perhaps you need to just make do. Forget about Turkey, take your rest days when needed, and just see how far you can make it. I'd be wary if it gets worse though.
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Old 05-10-14, 09:26 AM
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the picture may simply show the pelvis is not symmetrical and sit bones.. one part of your hips, due to asymmetry
is pushing more firmly on one side of the saddle , and/or perhaps that leg is a wee bit shorter.
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Old 05-10-14, 09:29 AM
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Originally Posted by staehpj1 View Post
This may not work for everyone, but I have found that for me at least, a lot of float is not needed or even desirable.
I agree with this. I used to use clipless pedals that allowed a large amount of float. I bought them thinking they might help with my constant knee pain. They didn't help much at all and if anything made the pain worse. I now use clipless pedals that offer very little float (Shimano SPD). As you suggest, they've helped me (finally) get my cleat position correct and my knee pain has disappeared... My assumption is that having too much float exacerbated any knee tracking problems I might have had. Less float and correct cleat position probably tend to keep my knee on the "correct" path through the entire pedal stroke.
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Old 05-10-14, 09:39 AM
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1. how much stuff are you carrying? tent+cooking gear?
notebook? 200mm camera lens? get rid of as much weight as possible.

2. how hilly is your projected route? take a day or two off and re-route.
holland is flat. so is northern germany. spend a couple weeks in the
flats. if you feel better, take a train to a new starting point.

3. what are you riding? what's the gearing?
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Old 05-10-14, 10:33 AM
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I just looked at your photo. That really is a pronounced difference between the left and right sit bones depressions. What about a new non-leather saddle that doesn't stretch? That way you would be sitting more level and it might make a favorable change in your biomechanics. Just a thought.

Also saddlesores comments about weight and gearing seem like they could really help if applicable. Maybe a few tweaks (rest, saddle change, weight/gearing changes) will cumulatively make a difference.
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Old 05-10-14, 10:51 AM
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Originally Posted by mm718 View Post
I just looked at your photo. That really is a pronounced difference between the left and right sit bones depressions. What about a new non-leather saddle that doesn't stretch? That way you would be sitting more level and it might make a favorable change in your biomechanics. Just a thought.

Also saddlesores comments about weight and gearing seem like they could really help if applicable. Maybe a few tweaks (rest, saddle change, weight/gearing changes) will cumulatively make a difference.
This might be something to explore. You stated that you bought a Brooks b17 just prior to you tour. You also stated that you had never experienced knee pain before this tour. I would try one of the inexpensive wider thick-gelled seats.
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Old 05-10-14, 10:51 AM
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I would dump the straps, cleats, clips whatever. This isn't a race. Get some thick soled tennis shoes and platform pedals, like V Sixty's.
I have always ridden with my arch over the pedal shaft. The few times I got a temp ache I turned that side to the back a bit.
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Old 05-10-14, 10:57 AM
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Your knee issues are almost exactly what I put up with for about a decade when I was young (and chasing dinosaurs). Start taking some anti-inflammatory drugs like aspirin or naprocin; the swelling causes more than pain, it is part of the damage process.

I would recommend that you take about a week off. After doing nothing for two days, start stretching. Focus on your quads and hamstrings (hurdlers' stretch and reverse) as well as your hips and calves. Buy a yoga book if you don't know any stretches. Stretch slowly, hold without bouncing and release with care. What counts is the time you hold each position and how many times per day you do it, not how far you can go. Aim for discomfort, not pain.

I spend at least an hour per day stretching when I'm on tour, which does take a commitment since I tend to ride 200-300 km per day, but it's the price I pay to not be in your situation.
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Old 05-10-14, 10:59 AM
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Originally Posted by mm718 View Post
What about a new non-leather saddle that doesn't stretch? That way you would be sitting more level and it might make a favorable change in your biomechanics. Just a thought.
On the other hand the uneven wear may be because his sit bone is more prominent on that side and the depression may actually allow him to sit with his whole pelvis more level. Could go either way though, I guess.
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Old 05-10-14, 11:14 AM
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Is it possible to visit a doctor ? I had knee pain for three months hoping it would disappear , it didn't. I had an X-ray, then later an MRI followed by surgery. I have no solution or advice other than it may pay to visit a Doctor, MRI's outside of the USA are often times not so expensive. Mine cost $ 300 in Bangkok, and it provided a great image my Doctor in the States was very pleased to see, but it did show a problem, and was corrected.
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Old 05-10-14, 01:31 PM
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Originally Posted by saddlesores View Post
1. how much stuff are you carrying? tent+cooking gear?
notebook? 200mm camera lens? get rid of as much weight as possible.

2. how hilly is your projected route? take a day or two off and re-route.
holland is flat. so is northern germany. spend a couple weeks in the
flats. if you feel better, take a train to a new starting point.

3. what are you riding? what's the gearing?
Good questions.

1) I am riding light but everything is at the rear of the bike. Images attached. Cooking and camping gear included. I have been wild camping. If this answers your question : it is very difficult to lift the rear of my bike.

2) route from now is hilly. Holland and Belgium are done. Plus I have agendas to keep, people to meet etc. It's funny actually. Cycling out of Holland my left knee was in agony. I actually got out of my saddle and the pain all but disappeared. Cycling out of the saddle (if feasible all of the time) actually feels better.

3) I am riding a Fuji 2014 touring with 48/36/26 chainring and 11-34 9 speed cassette.
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Old 05-10-14, 01:34 PM
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Originally Posted by Wowk View Post
Good questions.

1) I am riding light but everything is at the rear of the bike. Images attached. Cooking and camping gear included. I have been wild camping. If this answers your question : it is very difficult to lift the rear of my bike.

2) route from now is hilly. Holland and Belgium are done. Plus I have agendas to keep, people to meet etc. It's funny actually. Cycling out of Holland my left knee was in agony. I actually got out of my saddle and the pain all but disappeared. Cycling out of the saddle (if feasible all of the time) actually feels better.

3) I am riding a Fuji 2014 touring with 48/36/26 chainring and 11-34 9 speed cassette.
Here ya go
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Old 05-10-14, 01:42 PM
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Thanks for the many replies. Good to have some consultancy while away. I have considered both the options of a fat gel saddle and losing the toe straps. These are things I have to implement before I can report on them. Something seems wrong about throwing away ny Brooks, however.

B.carfree, anti inflammatory drugs and stretching have been a large part of my attempts at recovery. They help in the short, but not the long term

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