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Recent sharp pain in left knee - what could be causing it?

Old 11-08-16, 03:49 PM
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Recent sharp pain in left knee - what could be causing it?

Hi everyone, I've recently - as in last 2 weeks or so - started getting a sharp pain in the front of my left knee, although more to the right side of the front of that knee rather than in the center. It feels like someone is pushing a sharp stick into that area - especially when I climb. It's more noticeable at the start of the ride, and seems to mellow out after about 20 mins of riding, though I can tell it's still there somewhat.

To give you some backround I'm 53, 5' 11", weigh around 145lbs and am pretty fit overall. I generally ride between 40-50 miles a day, on a fairly hilly route, and I've been doing this routine for quite a while. I do a lot of climbing (short but fairly steep hills) and ride at a decent pace on my rides - not Chris Froome decent but definitely moving along.
I should also mention I've been tweaking my saddle height and position here and there over the last couple months, so I'm wondering if this has something to do with it.

I realize I'm not giving a lot of helpful info here but was hoping some of you might know what is causing the pain. Thanks for reading.
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Old 11-08-16, 05:56 PM
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Originally Posted by exmechanic89
I should also mention I've been tweaking my saddle height and position here and there over the last couple months, so I'm wondering if this has something to do with it.
Of everything you have said... ...
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Old 11-08-16, 05:58 PM
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Originally Posted by Leisesturm
Of everything you have said... ...
Yeah I know.. The thing is I'm pretty sure the fit is correct. I'm leaning towards some type of overuse injury, or maybe too strong in some muscles, too weak in others.
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Old 11-08-16, 06:03 PM
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Originally Posted by exmechanic89
Yeah I know.. The thing is I'm pretty sure the fit is correct. I'm leaning towards some type of overuse injury, or maybe too strong in some muscles, too weak in others.
Was there a change in intensity, distance or some other parameter of your training in excess of 10%? I'd have knee pain if I tried to do even one of your rides, but you appear to have done them for "quite awhile", so... was there a recent change?
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Old 11-08-16, 06:05 PM
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Short term joint pain isn't rare and usually indicative of nothing except minor inflammation which makes the joint more sensitive to irritation in a self fulling cycle. Usually it clears with a bit of rest, or at least reduced use.

However, since it started with changes, I'd first change back to the prior position, and see if that changes things. If so, you know what you need to do. If changing back to the old position doesn't help, give it some rest, and try again, first in the old position, and if it's OK, you can try the new one again.
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Old 11-08-16, 06:09 PM
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Originally Posted by Leisesturm
Was there a change in intensity, distance or some other parameter of your training in excess of 10%? I'd have knee pain if I tried to do even one of your rides, but you appear to have done them for "quite awhile", so... was there a recent change?
I'm definitely riding faster than in the previous months. Probably not more than 10% -15% though. Quite a while is around the last year, btw. Although I've been riding that same ride every 3-4 days for a longer period of time. But yeah I'm thinking overuse or uneven muscle strength is most likely. I guess I was mostly curious if anyone else here has had this type sharp pain in the front of the knee?
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Old 11-09-16, 10:00 AM
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Chondromalacia. Google it. The most common cycling RSI. Your saddle is not too high. The usual recommendation is to raise your saddle another 5mm, back off on the hard leg efforts. The best thing is to ride rollers about 30 minutes/day until the pain goes away. I'd also recommend in your case pedaling with your feet pointing straight forward if you are pedaling toes out now. Also see: https://www.bikeforums.net/training-n...l#post16081392
although in your case, it's the VMO that's too strong. It's the other way for most folks.

Stretching might help, too. https://www.bikeforums.net/road-cycli...l#post15372967
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Old 11-09-16, 03:16 PM
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I appreciate everyone's replies and advice. I'll update this thread after I make a few changes.
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Old 11-09-16, 03:46 PM
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Ugh, ITB issues. I was just into get my yearly physical and diagnosed with an ITB issue in my left hip though. That sucker runs most of the way down your leg. I just ordered a foam roller and will be rolling it out. I have also been doing some stretches they suggested. it hurts like hell when I am stretching it. I am sure the roller won't feel good either. Good luck.
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Old 11-10-16, 11:04 AM
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Originally Posted by Yendor72
Ugh, ITB issues. I was just into get my yearly physical and diagnosed with an ITB issue in my left hip though. That sucker runs most of the way down your leg. I just ordered a foam roller and will be rolling it out. I have also been doing some stretches they suggested. it hurts like hell when I am stretching it. I am sure the roller won't feel good either. Good luck.
OP's pain is on the inside of the knee, nothing to do with ITB.
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Old 11-10-16, 11:27 AM
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I'll re-post what I wrote re: chrondomalacia patella a few years ago for another forum. I was diagnosed almost 40 years ago by an ortho who spelled out what I had, what I had to do and what I had to live with the rest of my life. I have since heard all of what he told me but never all of it on one place. (And every specialist I have talked to since has told me what that surgeon passed on to me in 1978 was right.)

I wrote this 12 years ago. Replacement knees are now titanium and quite good, but my OEMs are going strong and have ridden 4 Cycle Oregons on fix gears since I wrote this. My logo is me climbing a 14% grade at CO two years ago on a 42-17.Those kneewarmers you can see are doubled 300 weight synthetic fleece kneewarmers hung by straps from my shorts under standard kneewarmers. I'd be happy to send you the patterns to make them if CP is indeed what you have to live with. They look goofy but are a Godsend. I wear them into the mid 80s.

Chrondomalacia patella. Yes, I can tell you a little about it. I was diagnosed in ’78 and given very good advice by the doctor (an orthopedic in sports medicine. He was also a novice bike racer, so he had more understanding of the cycling aspects of CP than most). I will do my best to pass on what he told me.

In CP, the kneecap is not aligned with the knee under it, hence there is chafing as the knee is moved. This causes wear, first to the cartilage, then to the bone under it. The wear accumulates with number of repetitions and pressure. At some point, the wear can cause permanent damage.

Some people are more prone to CP than others. It can be triggered by exercising in cold weather, exercising without adequate stretching of the hamstrings, i.e. touching your toes or less extreme stretches of the same tendons. It can be brought on by exercising without adequately strengthening the small quadriceps muscles just above the kneecap.

I brought on my CP by training to return my body to racing form after a very serious accident. (I was weak enough after my hospital stay that I was no match at 24 years old for any 7 yo. The accident was in November, and I returned to riding miles in March. I did nothing to keep my knees especially warm and did no stretching exercises (rationalizing that since my leg never extended to anywhere near straight, there was no chance of injury, hence no need to stretch). I was wearing just full tights and thermal underwear under them in Boston. The temperature was probably not much above 30. The ride that started it was 100+ miles on my racing bike, my first outdoor ride on that bike. It had 175 cranks. My trainer, with fixed gear and very low BB, had 168’s. After the ride I had a dull pain in my mid to upper knee in front. That Saturday was the first race of the season. I was forced to drop out, my knees hurt so much.

After that race, the race promoter introduced me to an orthopedic surgeon who diagnosed me in the back of a cold van. He laid out for me then and in later phone calls a plan that I will pass on here.

He first stressed that I had to stretch my hamstrings, touch toes or lean forward against a wall or post with one leg back and straight and stretch that hamstring or sit and touch toes. I now prefer the lean forward method. Very specific and hard to hurt yourself. (I am now a 48 yo, I damage if I am not careful.)

Second, he had me sit on the floor and do leg raises. He had me raise one leg at a time and hold it several inches off the floor for a while (I don’t remember the time, but 15 secs should work. Important – while the leg is raised, tense up your quads big time and tense up those little quads just above and beside the kneecap. Feel for them and get to know them. It is those little guys that keep you kneecap aligned. If you are in riding shape, you can do this with say 5 pounds on your ankles, but the tensing up is much more important than the resistance.

Third, KEEP YOUR KNEES WARM WHEN YOU RIDE!! For me, this is critical. I wear these dumb looking “knee warmers” for most of my rides, always below 70 degrees, often under tights. Since keeping the hamstrings loose is important, I had to stretch the elastic. To keep them from falling down, I sewed on garters that I clip onto my shorts.

Fourth, back off riding until you have been doing these two things long enough to make a difference. Keep up the exercises and especially the stretches after you resume riding. Build up your riding slowly. The doctor stressed this to me and it has been very true. My ability to come into real form and resilience on the bike is limited more by my knees than by my lungs/muscles.

After rides, take aspirin or Ibuprofen to speed recovery. I personally think aspirin is better, that my knees recover more with it. I disagree with the ice. I have always felt that moving my knees when they are cold is causing the damage I am trying to avoid. Perhaps ice speeds recovery, but I feel it also continues the damage (at least in my knees).

Big gears are the enemy of CP knees. I love to climb hills standing. I love to ride hilly country on fix-gears. It is a fact of my life that I can only ride certain not-so-steep hills on my commuter and that I have to have and use a granny ring on my custom. It is a fact that there are days, weeks and months when I have to let whippersnappers blow by me on hills where I know I can humble them.

Lastly, what you did not want to hear, but again what the doctor told me. Get used to the idea of CP. If you are at all like me, it will be a fact of your cycling life for a long time. 23 years later for me and I am feeling my knees now because of a very easy ride I did in street clothes without knee warmers at noon today.

Sorry to be the bearer of bad news, but you can still do a lot of riding. I raced that season (I already knew it was my last) and have done 60,000 (?) miles since. I still commute, but only on alternate days. (But for the first 7 years with CP, I did not own a car and rode everywhere.)

I took the time to spell all this out because in the 23 years I have had CP, I have never seen all of this in one place. In fact, I have only heard about the importance of keeping the knees warm from that one doctor. That is the single most important aspect of the program for me. Thank you Dr. Kish, wherever you are. I will probably ultimately need those carbon fiber knees, but by following the regime, I figure I can wait until a) the product improves, b) the price comes down and c) I’m old enough that my cycling level will be within the abilities of those knees. I hope to delay another 10 years.

Since I wrote this a year plus ago, my physician has recommended that I take glucosamine. He was very specific, that I should take 3000 mg/day in the form of glucosamine sulfate or glucosamine hydroxide, but to avoid chrondroitin. This I did faithfully for 9 months. Between riding steadily starting two years ago and the glucosamine, my knees never felt better than they did last summer. I was passing whippersnappers uphill. Then my riding tapered off, I tapered down on the glucosamine and got sick so my riding and conditioning dropped. Thanksgiving I rode 50 miles with 2500’ of climbing on a cool day. My knees hurt. How many of those rules outlined above did I break?

Ben
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Old 11-18-16, 04:06 PM
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I have the same issues. I can deal with it, but my knees are prone to getting sore. Things that cause it to flare up:

bigger gears
sudden increase in mileage
sudden increase in intensity
low saddle height

I had it so bad on a ride from Chicago to Madison, WI it felt like I had broken glass under my kneecap the last 15 miles. That was rough....

I make VERY certain to get my seat height dialed in, and don't do anything drastic in terms of riding .
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Old 11-18-16, 11:10 PM
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I had this same thing a couple years ago, just came out of nowhere...turned out to be an IT Band issue that was caused by tight muscles from the winter temperatures. As it gradually warmed up, it gradually went away and hasn't been back. Actual ITB stretches didn't do anything for me, but I discovered the focal point for mine was in the muscles in my lower back that connect in some fashion to your ITB. It took doing some really odd stretches and prodding with a tennis ball on that area to realize how sensitive/tight those muscles were, but it still took warmer temperatures and thus relaxing of the muscles to get it to go away.
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Old 12-03-16, 06:01 AM
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Originally Posted by Carbonfiberboy
Chondromalacia. Google it. The most common cycling RSI. Your saddle is not too high. The usual recommendation is to raise your saddle another 5mm, back off on the hard leg efforts. The best thing is to ride rollers about 30 minutes/day until the pain goes away. I'd also recommend in your case pedaling with your feet pointing straight forward if you are pedaling toes out now. Also see: https://www.bikeforums.net/training-n...l#post16081392
although in your case, it's the VMO that's too strong. It's the other way for most folks.
.......
I solved my "sore right knee" issue by finally raising my seat. When I raised it by an inch (or so) the pain disappeared. So I raised it another inch. Bingo! I had no more knee issues for the rest of my bicycle trip (about 2000 km)...

When I started the tour, I did not raise the seat to it's (past tour) original comfortable height because the mark on the seat post had rubbed off... hence the trial and error when my knee started to ache...
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Old 01-16-17, 11:08 AM
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Originally Posted by tmac100
I solved my "sore right knee" issue by finally raising my seat. When I raised it by an inch (or so) the pain disappeared. So I raised it another inch. Bingo! I had no more knee issues for the rest of my bicycle trip (about 2000 km)...

When I started the tour, I did not raise the seat to it's (past tour) original comfortable height because the mark on the seat post had rubbed off... hence the trial and error when my knee started to ache...
I haven't been around on the forums for a while, but I would have suggested raising the seat as a quick solution to see if that was the problem. Whenever someone comes to me and tells me they have knee pain, I always start with the easy solution and work my way to the harder ones. I'll raise the seat and we'll see if that solves the problem. If it still persists, then time to move on to the next solution.

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