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Keep training with knee pain?

Old 03-23-15, 08:47 AM
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jimutt
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Keep training with knee pain?

Hi there folks,
I'm going on a touring trip this summer and about two weeks ago I was out with my mountainbike (haven't got the touring bike I've ordered yet). Though I think I was pushing it a bit too hard because the day after I felt a quite strong pain around my knee cap. Though it wasn't very bad for mor than a day or so then the pain level has been pretty low. But now, 2 weeks after, it's still hurting sometimes. If I'm stationary I seldom notice anything but after being out walking our doing other activities I can feel it a bit. It's really not a very sharp or severe pain but it seems like it doesn't want to go away.

It's feeling like if there would be some sort of muscle inflammation and I really don't use to have any problem with my knees. I'm only 20 by the way and reasonably fit so there shouldn't be something wierd going on really.

I know there probably won't be any doctors around here but I'm looking for general opinions on whether you think it's still okay if I keep cycling even though the pain is not completely gone? Or will it probably make it much worse? I'm just tired of sitting at my computer waiting for my knee to turn good again . Well that's not really all I'm doing, but I've tried to avoid cycling and only been out walking the last two weeks to help it get better.
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Old 03-23-15, 09:32 AM
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Sounds like you need to give your knee some time to heal. If you keep pushing a damaged joint you risk turning an acute injury into a chronic one. Rest, ice, and elevation whenever possible for a few days and no hard use if you can avoid it. NSAIDS for pain if there are no contraindications and you feel you need them, but don't start pushing the knee into service just because the pain is blunted by OTC drugs. If the pain becomes sharp or the knee clicks, locks or feels unstable see an ortho doc. After a few days of rest and gentle use, you can start with some massage and stretching (ROM) while gradually increasing the loads you put on it. If the pain returns, see your doctor.
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Old 03-23-15, 11:23 AM
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Originally Posted by jimutt View Post
Hi there folks,
I'm going on a touring trip this summer and about two weeks ago I was out with my mountainbike (haven't got the touring bike I've ordered yet).
Just an educated guess: mtn bike seat too low?
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Old 03-23-15, 11:37 AM
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Originally Posted by GravelMN View Post
Sounds like you need to give your knee some time to heal. If you keep pushing a damaged joint you risk turning an acute injury into a chronic one. Rest, ice, and elevation whenever possible for a few days and no hard use if you can avoid it. NSAIDS for pain if there are no contraindications and you feel you need them, but don't start pushing the knee into service just because the pain is blunted by OTC drugs. If the pain becomes sharp or the knee clicks, locks or feels unstable see an ortho doc. After a few days of rest and gentle use, you can start with some massage and stretching (ROM) while gradually increasing the loads you put on it. If the pain returns, see your doctor.
Thanks for your advice Gravel! Guess you're right.. I will probaly get my touring bike tomorrow but I'll try to keep myself from it until the pain is as good as gone.


@tadawdy Well you could definitely be right about that
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Old 03-25-15, 09:57 AM
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I agree with Grave... There are several common and few uncommon causes or cycling knee pain. A very short, but to the point, definition of over training is “doing too much too soon”. As an athlete I can relate to that. You love your sport and if the world was coming to an end, many of us would just go out and train one more time, dead-set on putting up one more personal record. But you know what? The world isn't ending and only a chosen few are professional athletes, with first class medical staff on hand and money in the bank for putting their body on the line. My advice if you don’t let your body recover properly, you can suffer chronic pain & debilitating injuries. If you suffer cycling knee pain still, the first and most important step to kick off the healing process is to stop the activity that is causing the pain. Unless you're wanting a knee replacement no one wants that, so take a break from cycling
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Old 03-25-15, 10:40 AM
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Is it structural?
Or, is it tendonititis or other form of inflammation?
.
Only your doctor knows for sure and even he needs imaging to determine the cause. But, knowing what the problem is is the first step in figuring out what the cure is.
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Old 03-25-15, 10:51 AM
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This sounds a lot like chrondomalacia patella (CP), an issue I had show up in March of 1078 when I was coming back from my accident. I didn't see where you are located, but being March, it may not be warm where you are riding. Not building up conditioning gradually is also a risk factor, as is riding with tight hamstrings.

I am going to paste on a post to the long defunct VeloNews forum I wrote over 10 years ago on my experience with CP. Maybe this will help.



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 168s. 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 dont 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) Im 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 03-25-15, 01:27 PM
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Great post, Ben, aka @79pmooney. I've had off and on trouble with my left knee that is partially relieved by stretching the hamstring. Careful attention to gearing and saddle position help keep it at bay, but like you, I've come to realize that CP will always be with me, ready to flare up if I don't take care of myself.

I'm curious, though -- why did your doctor recommend avoiding chondroitin? Have you ever played around with MSM? I've got most of those things in the cupboard, but have never taken any of them regularly enough to notice a difference.

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Old 03-26-15, 08:41 AM
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Thank you everyone for your advice! And a special thanks to @79pmooney for taking your time writing about chrondomalacia patella. Even though I'm not 100% sure that might be the case it doesn't sound very unlikely. The symptom you're describing applies very well to my knee and also what you wrote about the temperature. I'm living in Sweden and the day I got the pain it was about 0 degrees celsius (32 F) and on the way home I faced a quite strong headwind. So there's no doubt that my legs was rather cold.

I will try to follow your advice and begin with the stretching exercises you mentioned. The combination of the cold wheather and the fact that I've been very stationary and haven't exercised much this winter probably wasn't very good for my knee...
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Old 03-26-15, 05:57 PM
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My understanding is that kneecap pain is never good. Don't do anything that causes it. Do something to treat it.

I have had patellar tendinitis which I ignored too long. My orthopedist did a minor surgery to correct muscle imbalances that had caused alignment problems.
That tendinitis and the surgery started a chain of events ending a few years later with a catastrophic total knee dislocation.
It could all have been avoided if I had managed the tendinitis with conservative treatment. Rest, heat/ice, anti-inflammatories, gentle stretching, physical therapy-type exercises.
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Old 05-06-15, 05:18 AM
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I just thought that I would give you a brief update of my issues. My knee isn't good yet. But I've been cycling very short distances at a slow tempo and it usually goes pretty well. I've also invested in a pair of knee warmers.

And I have also visited a physiotherapist who looked at my knee and told me that she did not think there was anything severe. Though she said that one of the thigh muscles (the one on the inner side I believe) was a bit weak compared to the others so that the kneecap would twist when applying too much strength. So she gave me some exercises for me to do every day and then I'll go meet her in two weeks again to plan how I should continue exercise. She also said that I can keep cycling as long as I don't go to far or push the knee too hard.
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Old 05-06-15, 05:41 AM
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Originally Posted by jimutt View Post
I just thought that I would give you a brief update of my issues. My knee isn't good yet. But I've been cycling very short distances at a slow tempo and it usually goes pretty well. I've also invested in a pair of knee warmers.

And I have also visited a physiotherapist who looked at my knee and told me that she did not think there was anything severe. Though she said that one of the thigh muscles (the one on the inner side I believe) was a bit weak compared to the others so that the kneecap would twist when applying too much strength. So she gave me some exercises for me to do every day and then I'll go meet her in two weeks again to plan how I should continue exercise. She also said that I can keep cycling as long as I don't go to far or push the knee too hard.
Thanks for the update...

After 6 weeks and still having the problem suggests that there is a true injury to the leg/knee. Most likely the cure will involve much of the things that your PT suggested. But, without imaging, there is simply no way to know for sure just what that injury is (and even imaging may not tell you -- but it can rule out certain things). In short, you and your PT are guessing as just what the injury is and just what exactly the cure should be. Admittedly, those are educated guesses, but still guesses. Imaging (probably an MRI) will reduce the amount of guessing.

My suggestion: continue with the PT's advice. Give it a chance. But be cautious and apply critical thinking. If what she is doing is not working, if it is not getting better or if your instincts tell you something is amiss, seek further help -- mostly with a physician who can order the imaging that may tell you just what is injured inside your leg.

Until you know what the problem is, you probably won't know what the correct solution is... But treat it seriously because improper management can not only make the existing injury worse but also create entirely new problems as your body (without your knowledge or consent) compensates by over-using healthy muscles and tendons to compensate for the weak ones...
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